Who needs a VA Form 10-10EZR?
Veterans or service members receiving their medical benefits should file this Health Benefits Renewal Form with the Department of Veterans Affairs in order to update their personal, insurance, or financial information after having been initially enrolled.
What is the VA Form 10-10EZR for?
The information provided on this form is used by the Department of Veterans Affairs to determine whether a submitter is eligible for medical benefits or not.
Is the VA Form 10-10EZR accompanied by other forms?
An applicant must provide all necessary financial documentation to prove their eligibility and copay responsibilities in order to obtain the medical benefits. The list of documentation can be found in the first pages of the form.
The Power of Attorney, if any, must be attached to the Health Benefits Renewal Form as well.
How do I fill out the VA Form 10-10EZR?
The following information must be provided in order to complete the 2010 VA form:
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Section 1 — General applicant’s information;
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Section 2 — Insurance information on all health insurance providers that cover the applicant;
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Section 3 — Employment information;
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Section 4 — Financial disclosure;
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Section 5 — Dependent information;
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Section 6 — Previous calendar year gross annual income of the veteran's spouse and dependent children;
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Section 7 — Previous calendar year deductible expenses;
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Section 8 — Previous Calendar year net worth;
The instructions should be read before filling out the form. They can be found on the first and the second pages of this Health Benefits Renewal Form. The continuation sheet can be used if necessary.
Where do I send the VA Form 10-10EZR?
Once completed and signed, the original application and supporting materials should be directed to the applicant’s local VA health care facility. The addresses can be found on the www.va.gov
