About VA Form 10-7959A
- Form name: CHAMPVA Claim Form
- Form revision date: August 2013
- Related to: Family member benefits, Health care
When to use this form
If you’re currently enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), use form 10-7959A to file a claim for reimbursement.
Only use VA Form 10-7959A if you’ve already received your CHAMPVA enrollment packet in the mail.
Downloadable PDF
Online tool
You can file a claim online instead of filling out and sending us the paper form.
Helpful links related to VA Form 10-7959A
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Learn how eligible spouses and children of Veterans can get health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).
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Find out about VA benefits for spouses, dependents, survivors, and family caregivers.