Who needs VA Form 10-7959c?
This form is used by the veterans and beneficiaries who have Medicare or other type of insurance. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAM PVA) is a specific program for beneficiaries. This program can partially reimburse the medical costs spent for health care services.
What is the purpose of VA Form 10-7959c?
The main purpose of this form is to apply for CHAM PVA benefits and provide essential details about the current health insurance. It can be also used to update an information in the previous certification.
What other forms and documents should be attached to VA Form 10-7959c?
The certification form is usually accompanied by the Application for CHAM PVA Benefits, VA Form 10-10d. The applicant should also attach a copy of a Medicare card and copy of the current health insurance member ID card.
How long does it take to fill out VA Form 10-7959c?
The estimated time for searching all the required information and completing this form is ten minutes.
What information should be provided in VA Form 10-7959c?
The certification form has four sections for completion. Let’s find out what the applicant has to add to each of them.
Section I has the information about the beneficiary: name, address, phone number, Social Security Number, sex
Section II is for Medicare information: effective date, carrier name.
In Section III the applicant has to provide all periods of other health insurance coverage: effective date and other details.
Section IV is a certification. It must be signed by the beneficiary, sponsor or legal guardian.
The applicant must also add a date to this section.
What should I do with the form after its completion?
The completed and dated form is forwarded to VA Health Administration, PO BOX 469063, Denver.
