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VA Form 10-493b

Form name:CHAMPVA Benefits Election Affirmation
Form revision date: January 2016
Related to: Family member and caregiver benefits, Health care

Downloadable PDF

Related forms and instructions

VA Form 10-10d

Form name: Application for CHAMPVA Benefits

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).

VA Form 10-493

Form name: TRICARE Affirmation

VA Form 10-493a

Form name: TRICARE For Life Affirmation-Spanish

Helpful links related to VA Form 10-493b

  • Learn how eligible spouses and children of Veterans can get health insurance through CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs).

  • Find out about VA benefits for spouses, dependents, survivors, and family caregivers.

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