VA Form 10-7959c: CHAMPVA Other Health Insurance (OHI) Certification
VA Form 10-7959c tells CHAMPVA about any other health insurance a beneficiary has, including Medicare and employer plans. CHAMPVA needs it to coordinate benefits and pay claims correctly.
This is the genuine VA PDF, unmodified. Source: VA official page.
What is VA Form 10-7959c?
CHAMPVA is almost always the secondary payer when a beneficiary has other health insurance (OHI). The 10-7959c certifies what coverage exists: the insurer, policy details, effective dates, and Medicare information. Without a current OHI certification on file, claims can be delayed or denied.
The form is filed both with a new CHAMPVA application when the applicant has other coverage, and any time coverage changes later, such as gaining employer insurance, enrolling in Medicare, or losing a plan. Each beneficiary's coverage is certified so CHAMPVA knows which payer is primary.
Who files VA Form 10-7959c?
- CHAMPVA applicants who have other health insurance to declare with their VA Form 10-10d application
- Current CHAMPVA beneficiaries whose other insurance started, changed, or ended
- Beneficiaries enrolling in Medicare Part A, Part B, or a Medicare Advantage or Part D plan
- Sponsors or caregivers reporting coverage changes on behalf of a beneficiary
How to fill out VA Form 10-7959c
- Gather insurance cards and policy information for every plan covering the beneficiary, including Medicare.
- Complete the beneficiary information section, then the sections describing each insurance plan and its effective or termination dates.
- Attach copies of the insurance and Medicare cards, front and back, as the instructions require.
- Sign and date the certification.
- Mail it to the CHAMPVA address in the form instructions, or submit it with your online CHAMPVA application if you are applying online. New enrollees should wait for their enrollment packet before sending updates.
Quick fill VA Form 10-7959c on this page
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Frequently asked questions
What happens if I do not report other insurance to CHAMPVA?
CHAMPVA pays as secondary to most other coverage, so claims may be denied or paid incorrectly if your OHI information is missing or outdated. Reporting changes promptly keeps claims moving and avoids repayment demands later.
Do I need to file this form if I lose my other insurance?
Yes. Losing coverage is exactly the kind of change CHAMPVA needs certified, and you may be asked for a letter from the insurer showing the termination date. Once processed, CHAMPVA can pay as primary where appropriate.