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Apply for CHAMPVA benefits

Application for CHAMPVA benefits (VA Form 10-10d)

If you’re the spouse, dependant, or survivor of a Veteran or service member who meets certain requirements, you may qualify for health insurance through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).

Follow the steps to apply for CHAMPVA benefits.

Check your eligibility

Make sure you meet our eligibility requirements before you apply.

Find out if you’re eligible for CHAMPVA benefits

Gather your information

Here’s what you’ll need to apply:

  • Personal information about you and anyone else you’re applying for
  • Personal information about your sponsor (the Veteran or service member you’re connected to)
This includes dates of birth, Social Security numbers, and contact information.

You may also need to submit supporting documents, like copies of your health insurance cards or proof of school enrollment.

Start your application

We’ll take you through each step of the process. It should take about 10 minutes.

After you apply

We’ll contact you if we have questions or need more information.


Need help?

If you have trouble using this online form, call us at (). We’re here 24/7.

If you need help gathering your information or filling out this form, contact a local Veterans Service Organization (VSO).