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VA Form 10-7959A

Form name:CHAMPVA Claim Form
Form revision date: March 2025
Related to: Family member and caregiver benefits, Health care

When to use this form

If you’re currently enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), use form 10-7959A to file a claim for reimbursement.

Only use VA Form 10-7959A if you’ve already received your CHAMPVA enrollment packet in the mail.

Downloadable PDF

Online tool

You can file a claim online instead of filling out and sending us the paper form.

Helpful links related to VA Form 10-7959A

  • Learn how eligible spouses and children of Veterans can get health insurance through CHAMPVA (the 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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