Health Benefits Update Form
You are already enrolled in VA health care and need to update your address, report a change in insurance, report a change in income (for copay recalculation), or add/remove dependents.
Gather before you start
Attach with the form
Section I - Veteran Identification
Blocks 1-5Name, SSN, DOB, VA patient IDPII
Your VA enrollment record identifiers. Include your VA patient ID from any VA medical center letter or MyHealtheVet account if known.
(legal name, SSN, VA patient ID)
- Filing 10-10EZR when you are not yet enrolled - if you have never enrolled, file 10-10EZ instead.
Section II - Information Being Updated
Block 6What information are you updating?
Check all that apply: (1) Address/phone/email; (2) Health insurance (add, remove, change); (3) Income (may reduce copays); (4) Dependent changes. For each checked item, complete the corresponding section.
Check all sections that have changed
- Updating address only through the post office without telling VA - mail forwarding is not reliable for VA appointment notices.
Section III - Income Update (if applicable)
Blocks 7-18Prior year income if requesting copay recalculation
If your income decreased from last year, reporting the lower income can reduce your VA health care copays or move you to a higher priority group. Report gross income for yourself, your spouse, and any dependents. Also report unreimbursed medical expenses which further reduce countable income.
(last year gross income for you and household)
- Not knowing income updates are retroactive to January 1 of the current year - filing early in the year maximizes the copay reduction.
- Forgetting that unreimbursed medical expenses reduce countable income further.
Section IV - Signature
Blocks 19-20Veteran signature and datePII
Sign and date. Updates typically process within 1-2 weeks.
(signature/date)
- Not updating income even when it decreased significantly - this can mean paying unnecessary copays.