VA Form 10-10d is the application that qualifying spouses, surviving spouses, and children submit to enroll in CHAMPVA health insurance. At Rank and Pay, we keep our CHAMPVA guide current, and this application is how eligible family members secure medical cost-sharing coverage through the Department of Veterans Affairs (VA). The official title of the document is Application for CHAMPVA Benefits, and VA last updated it in April 2025.
What VA Form 10-10d Does
VA Form 10-10d establishes health insurance enrollment under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) for eligible dependents. CHAMPVA is a cost-sharing program where VA shares the cost of certain healthcare services and supplies with you. You can review covered services in the official CHAMPVA Guidebook published by VA.
Applying requires submitting the completed form alongside required supporting documentation to verify eligibility. You can submit the form online, send a paper copy by mail, or transmit it by fax. Once VA processes and approves the application, enrolled family members gain access to CHAMPVA cost-sharing coverage.
Who Qualifies for CHAMPVA
You qualify to file VA Form 10-10d if you are the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died. VA defines a permanent and total disability as a disability VA has rated 100% disabling and that is not expected to improve.
Certain restrictions apply depending on other military health benefits and caregiver status:
- TRICARE enrollment. If you are eligible for or enrolled in TRICARE, you cannot get CHAMPVA.
- Primary family caregivers. Primary family caregivers in the Program of Comprehensive Assistance for Family Caregivers with no other health insurance may qualify for CHAMPVA and are enrolled automatically if VA finds they qualify. In that case, you do not need to file VA Form 10-10d. Our caregiver program guide covers those rules in detail.
For broader family entitlements, our dependent benefits guide outlines additional support available to military families.
Ways to Submit VA Form 10-10d
You can submit VA Form 10-10d through the official online application portal, by postal mail, or by fax.
- Online submission. You can apply online through the VA online application portal. The online system allows you to complete the questions digitally and upload electronic copies of your supporting documents during the process.
- Mail submission. You can download the paper form from the VA Form 10-10d page and mail the form and supporting documents to: VHA Office of Community Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475.
- Fax submission. You can fax your completed form and all supporting records to VA. The fax number is not reproduced here, so check VA.gov to obtain the current number before sending your packet.
VA lists online, mail and fax as the three ways to file.
Required and Optional Supporting Documents
Submitting the correct supporting documents alongside VA Form 10-10d verifies your eligibility and relationship to the Veteran sponsor. Providing these records with your initial packet helps prevent processing delays.
Health insurance cards and Medicare documents must accompany the application in specific circumstances:
- Other health insurance. If you have other health insurance, including Medicare, submit a copy of the front and back of your health insurance card or Medicare card.
- Medicare Part D. If you have Medicare Part D prescription coverage, also submit a copy of the front and back of your Part D card.
- Medicare ineligibility. If you are 65 or older and not eligible for Medicare, submit a notice of disallowance from the Social Security Administration (SSA) confirming that you do not qualify for Medicare under anyone's Social Security number.
How you submit insurance information depends on your application method. Online applicants upload digital copies of their cards directly in the portal. Mail applicants download VA Form 10-7959c, complete and sign it, and send it with photocopies of the front and back of their cards to the address on the form.
VA identifies several relationship records as optional items that speed processing:
- Spouses and surviving spouses. Submitting a copy of your marriage certificate, certificate of civil union, or common-law marriage affidavit is optional but speeds processing. For a surviving spouse who remarried before age 55 and whose remarriage ended, submitting a divorce decree, annulment decree, or death certificate speeds processing.
- Dependent children. Submitting a copy of the child's birth certificate is optional but speeds processing.
Other documents are required in specific family situations:
- Adopted children. Adoption papers are required in that case.
- Stepchildren. Proof of the marriage between the Veteran sponsor and the child's other parent is required in that case.
- Students age 18 to 23. A school certification letter as proof of enrollment is required in that case, and enrollment must be recertified once a year.
Special Eligibility Rules and Family Changes
Certain family milestones, age thresholds, and health insurance changes directly affect CHAMPVA coverage.
Medicare rules require coordination for older beneficiaries or individuals eligible through disability. If you are 65 or older, or Medicare-eligible at any age, you must have Medicare Part A and Part B to get or keep CHAMPVA. A Medicare Advantage plan (Part C) also meets this requirement.
Newborns require prompt administrative steps before coverage takes effect. VA cannot pay medical claims for a qualifying newborn until the child is enrolled in CHAMPVA, so apply as soon as possible after birth. Before applying, obtain a Social Security number for the child at an SSA office, then add the child as a dependent of the Veteran sponsor by contacting the nearest VA regional office.
Age and marriage changes also alter child eligibility:
- Children reaching age 18. Dependent children who are not enrolled in school or disabled lose CHAMPVA eligibility at age 18.
- Children in school. Children enrolled in school keep CHAMPVA between ages 18 and 23. Coverage ends when they are no longer enrolled, reach age 23, or marry before age 23, whichever occurs first.
- Disability before age 18. Children permanently unable to support themselves due to a disability that began before age 18 keep coverage past age 18.
- Stepchild household status. Stepchildren who leave the Veteran's household because of divorce or remarriage no longer qualify.
Surviving spouse remarriage carries specific timing rules. A surviving spouse who remarries on or after their 55th birthday keeps CHAMPVA. Remarrying before age 55 ends CHAMPVA benefits on the remarriage date. If that remarriage ends, the surviving spouse may qualify again starting from the first day of the month after it ends.
A related VA form is used to report changes to non-VA health insurance or personal information for CHAMPVA benefits.
Next Steps After Submitting Your Application
Keep a copy of everything you send in your household files.
While waiting for VA to process your packet, review our CHAMPVA explained guide for details on program cost-sharing rules, and consult our VA healthcare guide for system-wide options. If you need other official paperwork, browse our VA forms directory.
To begin your application, download the paperwork from the official VA Form 10-10d page or submit your packet online to establish your CHAMPVA coverage.
This guide provides general information about VA Form 10-10d and CHAMPVA benefits. It is not legal or financial advice. Eligibility standards and administrative rules change, so verify all details directly with the Department of Veterans Affairs or your local regional office.