Form to submit other health insurance (OHI) information for CHAMPVA
- Form name:CHAMPVA Other Health Insurance (OHI) Certification (VA Form 10-7959c)
- Form revision date: March 2025
- Related to: Family member and caregiver benefits, Health care
When to use this form
Only use VA Form 10-7959c or Formulario VA 10-7959c (español, PDF) if any of these descriptions are true for you:
- You recently applied for healthcare benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and we asked for your other non-VA health insurance information, or
- You’re currently enrolled in CHAMPVA and need to report updates to your other non-VA health insurance information, like Medicare
If you applied for CHAMPVA benefits by mail, download the PDF version of this form and send it to us by mail.
If you applied for CHAMPVA benefits online, use our tool to submit this form online.
If you haven’t applied for CHAMPVA benefits yet, you’ll need to submit your application for CHAMPVA benefits (VA Form 10-10d) first. You’ll be able to submit your other health insurance information when you apply for CHAMPVA online.
Downloadable PDF
Online tool
You can submit your form online instead of filling out and sending us the paper form.
Related forms and instructions
VA Form 10-10d
Form name: Application for CHAMPVA Benefits (VA Form 10-10d)
If you’re the spouse, dependent, or survivor of a Veteran who meets certain requirements, use VA Form 10-10d to apply for healthcare benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).