CHAMPVA Application

1. 1

   Do now · 01

   Before you start

   Estimated time

   30-45 minutes

   Use this form when: When VA’s current eligibility rules cover you as the spouse, child, or survivor of a qualifying Veteran and you are not eligible for TRICARE.

2. Gather · 02

   Gather your documents

   Helpful when available

   • +Documents supporting the qualifying relationship or status — The exact evidence depends on whether the applicant is a spouse, child, or survivor. Follow the current application checklist.
   • +Marriage certificate — May be needed for an eligible spouse.
   • +Birth certificates — May be needed for eligible children.
   • +Medicare card (if applicable) — CHAMPVA can be secondary to Medicare. Include your Medicare information if you have it.
   • +Other health insurance information — CHAMPVA is a secondary payer to most other insurance.
3. 3

   Waypoint · 03

   Complete the form

   • ✓Qualifying Veteran information
   • ✓Dependent information (spouse, children)
   • ✓Other health insurance information (Medicare, employer)
   • ✓Supporting documents (marriage/birth certificates)
4. 4

   Waypoint · 04

   Avoid common mistakes

   • ×Assuming every dependent of a disabled Veteran qualifies
   • ×Not reporting other health insurance (CHAMPVA is a secondary payer)
   • ×Assuming TRICARE covers dependents (it doesn't for most disabled veterans)
   • ×Not applying for all eligible dependents
5. Go next · 05

   Submit the form

   Available methods

   • Online
   • Mail
   • Fax

   Mail to

   VHA Office of Integrated Veteran Care, CHAMPVA Eligibility, PO Box 137, Spring City, PA 19475

   Fax to

   303-331-7809

   Submission note

   Submit online, mail the completed application and supporting documents, or fax them to the current CHAMPVA eligibility fax number.

   Start on VA.gov↗ (opens in a new tab)View or download official form↗ (opens in a new tab)

Continue the route

Forms are just one piece. Make sure your full claim is solid.