Quick answer
Use VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification, when CHAMPVA needs information about Medicare or other non-VA health coverage.
The current VA form page identifies two main situations:
- You are applying for CHAMPVA and have other health insurance to declare as part of your application.
- You are already enrolled and need to report a change in other non-VA health insurance.
VA also uses the form when it asks for OHI information after you have applied. The paper form says new beneficiaries must provide OHI information back to the date CHAMPVA eligibility became effective, and enrolled beneficiaries should update the information every time their OHI coverage changes.
This information directly affects claims. Under 38 CFR § 17.276, CHAMPVA is generally the last payer to other health insurance and generally will not pay until the other insurer has made a final payment determination or issued an explanation of benefits (EOB). The form itself warns that missing OHI information can delay or prevent reimbursement until VA receives the information.
When should you submit VA Form 10-7959c?
| Situation | What to do |
|---|---|
| You are applying for CHAMPVA and have OHI | Report the other coverage as part of the application process. For a paper application, use Form 10-7959c with the required insurance-card copies. |
| VA asks for OHI after you applied | Submit Form 10-7959c separately. VA's current post-application guidance specifically directs applicants to this form when VA requests OHI information. |
| You are enrolled and your OHI starts, changes, or ends | Submit an updated Form 10-7959c. The form instructions say to recertify whenever OHI coverage changes. |
| Medicare starts or changes | Report the Medicare information and attach the required Medicare card copy. Medicare is OHI for CHAMPVA purposes. |
| You have more policies than the form has room for | Add an attachment with the additional policy information requested by the form. |
For a post-enrollment OHI update, VA's current form page says to wait until you have received your CHAMPVA enrollment packet before submitting the update.
If you are applying for the first time, see the CHAMPVA application checklist and the VA Form 10-10d guide for the rest of the enrollment paperwork.
What counts as other health insurance?
38 CFR § 17.270 defines OHI broadly as health insurance plans or programs, including Medicare, or third-party coverage that covers a CHAMPVA beneficiary's medical services and supplies.
The current Form 10-7959c asks about:
- Medicare Parts A, B, C, and D;
- non-Medicare health insurance;
- whether a policy is through employment;
- whether it includes prescription coverage;
- HMO or PPO coverage;
- Medicaid or state assistance;
- Medigap coverage and the Medigap plan letter; and
- specialty, limited-coverage, or CHAMPVA supplemental policies.
The online VA OHI workflow may also ask for supporting cards or documents for coverage such as vision, dental, accidental insurance, Medicare, and current co-payment or schedule-of-benefits information.
How to complete the current form
1. Use a separate form for each family member
The March 2025 version of Form 10-7959c says to use a separate certification for each beneficiary. Do not put several family members' OHI histories on one form.
2. Complete the beneficiary information
Enter the beneficiary's identifying and contact information. The form also allows you to indicate that the address is new.
3. Report Medicare accurately
If the beneficiary has Medicare, complete the applicable Part A, B, C, and D fields and effective dates. The form asks for the Medicare Beneficiary Identifier (MBI) and, when applicable, Medicare Advantage carrier information.
Attach a copy of the Medicare card. Do not send the original.
4. Report all applicable non-Medicare coverage periods
The form instructs new beneficiaries to provide OHI history from the date CHAMPVA eligibility became effective. For each policy, provide the insurer and coverage dates and answer the questions about employment-based coverage, prescription coverage, and plan type.
Only enter a termination date when a policy is actually inactive. The form specifically warns that the end date printed on a card that will simply be reissued is not necessarily the policy's termination date.
If you have more policies than fit on the form, attach a separate page with the additional policy information requested in the form instructions.
5. Attach current insurance cards
The form requires:
- a copy of the Medicare card, when applicable; and
- a copy of the front and back of the other health insurance member ID card.
VA's current CHAMPVA pages also say to include the front and back of a Medicare Part D card when the beneficiary has Part D.
6. Sign and date the certification
The beneficiary, sponsor, or legal guardian must certify that the information is correct to the best of their knowledge and agree to report later insurance-status changes.
Why outdated OHI information can disrupt a claim
OHI information is not just an enrollment record. It tells CHAMPVA who must adjudicate the claim first.
The usual sequence is:
- The provider or beneficiary submits the claim to the primary insurance plan.
- The primary plan processes the claim and produces a final payment determination or EOB.
- The provider or beneficiary submits the remaining claim to CHAMPVA with the required EOB information.
- CHAMPVA calculates any payment under its own coverage and allowable-amount rules.
If VA's record is missing a current primary plan, CHAMPVA may process a claim using incomplete payer-order information. VA's current CHAMPVA Care page says that if it learns about OHI only after a claim has already been processed, it will automatically reprocess the claim using the OHI information.
The reverse can also cause problems: if VA still has an old primary plan on file after that coverage ended, the record can point to an insurer or EOB that no longer matches the beneficiary's actual coverage. Correctly reporting the true termination date helps CHAMPVA apply the right payer sequence.
The current paper form is explicit that failure to provide requested OHI information can delay or deny reimbursement until the information is received.
When CHAMPVA pays first instead
VA's current CHAMPVA guidance lists four situations in which CHAMPVA pays before the other program or policy:
- Medicaid;
- State Victims of Crime Compensation programs;
- Indian Health Services; and
- insurance purchased specifically as a CHAMPVA supplemental policy.
For other OHI, CHAMPVA is generally secondary or the payer of last resort. If more than one other plan is responsible, those plans generally process the claim before CHAMPVA.
A Medicare supplement (Medigap) is different from a CHAMPVA supplemental policy. The Form 10-7959c instructions say Medicare supplemental coverage is primary to CHAMPVA, so the relevant payer determinations must accompany the CHAMPVA claim.
What EOB information does CHAMPVA need?
An EOB is the primary insurer's statement showing what it did with a claim. The Form 10-7959c instructions say that when OHI is primary to CHAMPVA, the EOB from each primary insurer must accompany the health care claim submitted to CHAMPVA.
If the primary plan does not issue EOBs, the form says to submit current co-payment information from the insurance card or another document showing the co-payments with each claim so CHAMPVA can calculate its benefit.
The VA guidebook notes that Medicare can transmit its adjudication information electronically to CHAMPVA, so a beneficiary may not need to send a Medicare EOB manually in the same way as another insurer.
How to submit the OHI update
Use the current VA Form 10-7959c page rather than relying on an old saved copy.
VA currently provides two main routes:
- Online: complete the VA OHI submission workflow and upload the requested supporting documents.
- By mail: download the current PDF, complete and sign it, attach the required card copies, and send it to the address printed on the current form.
Using the address on the current VA form is safer than relying on an old saved address because operational mailing information can change.
A practical OHI-update checklist
Before submitting, confirm that you have:
- used the current version of Form 10-7959c;
- used a separate form for each beneficiary;
- listed Medicare and every applicable non-VA policy;
- provided coverage effective dates and true termination dates;
- correctly identified prescription coverage;
- attached the front and back of current insurance cards;
- attached Medicare and Part D card copies when applicable;
- added an attachment if you have more policies than fit on the form;
- signed and dated the certification; and
- kept a copy of what you submitted.
After the update, make sure your providers also know which plan is primary so they can bill in the correct order.
For other reportable changes, see CHAMPVA Life Changes: What to Report and How. For current VA forms and contact routes, see CHAMPVA Contacts, Mailing Addresses, and Official Forms.