About VA Form 10-10d
- Related to: Family member benefits, Health care
- Form last updated: July 17, 2014
When to use this form
If you’re the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).
Downloadable PDFDownload VA Form 10-10d (PDF)
Related forms and instructions
VA Form 10-7959C
Form name: CHAMPVA—Other Health Insurance (OHI) Certification
Use VA Form 10-7959C or Formulario VA 10-7959c (español) when:
- You’re applying for CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and have other health insurance to declare as part of your VA Form 10-10d application.
- Or you need to report changes in your other non-VA health insurance, such as new beneficiaries or coverage changes.