Application for CHAMPVA Benefits
You are the spouse or dependent child of a veteran rated 100% P&T due to service-connected disability, OR the spouse or child of a veteran who died from a service-connected condition. CHAMPVA is VA's health coverage for dependents who do not qualify for TRICARE.
Gather before you start
Attach with the form
Section I - Applicant Identification
Blocks 1-6Your name, SSN, DOB, relationship to veteran, addressPII
Your information as the person applying for CHAMPVA coverage. File one application per eligible dependent. The veteran does NOT apply - CHAMPVA is for dependents only.
(your legal name, SSN, DOB, relationship)
- Veteran filing for themselves - veterans are not CHAMPVA eligible; they receive VA health care directly.
- Multiple dependents on one form - file a separate application for each eligible dependent.
Section II - Veteran Sponsor Identification
Blocks 7-12Veteran's name, SSN, VA File Number, disability ratingPII
Identify the veteran who is your CHAMPVA "sponsor." Include their VA File Number and the nature of their qualifying status: 100% P&T rating for SC disability, death from SC condition, or Line of Duty death. VA will verify the qualifying status against the veteran's existing records.
(veteran's name, VA file number, qualifying condition)
- Applying based on a 100% temporary rating - temporary 100% ratings (e.g., post-surgery) do NOT qualify; it must be a PERMANENT and TOTAL rating.
- Not knowing the 10-year P&T rule (38 USC 1318) - if the veteran was 100% P&T for 10+ years before death (even from a non-SC cause), survivors may qualify for both DIC and CHAMPVA.
- Not knowing that TDIU (100% Individual Unemployability) also qualifies as a "permanent and total" rating for CHAMPVA purposes.
Section III - Proof of Relationship
Blocks 13-16Documents proving your relationship to the veteran
Spouse: marriage certificate (certified copy). Former spouse: NOT eligible unless remarriage to the veteran occurred. Stepchild: marriage certificate showing your parent married the veteran. Adopted child: adoption decree. Child 18-23: enrollment verification letter from school. Helpless child (any age): medical documentation of permanent incapacity before age 18.
(describe attached relationship documentation)
- Former spouses applying - CHAMPVA ends upon divorce from the veteran; former spouses are NOT eligible.
- Surviving spouse who remarries after the veteran's death - remarriage generally terminates CHAMPVA; there is a narrow exception for remarriage after age 55.
- School-age children not providing enrollment verification - CHAMPVA ends at 18 without proof of full-time school enrollment.
Section IV - Medicare Status
Blocks 17-18Medicare Part A and B enrollment status
If you are 65 or older, OR if you have been on Social Security disability for 24+ months, you must be enrolled in BOTH Medicare Part A and Part B to receive CHAMPVA. CHAMPVA acts as secondary to Medicare. If you are eligible for Medicare but refuse Part B, CHAMPVA will not cover costs that Medicare Part B would have covered.
e.g., Medicare Part A and Part B enrolled since 01/2020.
- Having only Medicare Part A (hospital) and not Part B (medical) - CHAMPVA requires BOTH for those who are Medicare-eligible.
- Paying for CHAMPVA cost-shares that Medicare should have paid first - always bill Medicare before CHAMPVA.
Section V - Certification
Blocks 19-20Applicant signature and datePII
Sign and date. CHAMPVA applications are processed by the VA Health Administration Center in Denver. Processing typically takes 6-8 weeks. Do NOT contact the local VAMC - CHAMPVA is managed separately.
(your signature/date)
- Sending application to the local VAMC instead of the CHAMPVA Center - mail to: VA HAC, P.O. Box 469028, Denver CO 80246.
- Not filing VA Form 10-7959c (Other Health Insurance) separately - required at application and with any changes in coverage.