VA Form 10-7959C. CHAMPVA—Other Health Insurance (OHI) Certification

The VA Form 10-7959C CHAMPVA—Other Health Insurance (OHI) Certification is a form used by the Department of Veterans Affairs to certify that a veteran or their dependent has other health insurance coverage that may affect their eligibility for CHAMPVA benefits. The main purpose of the form is to ensure that CHAMPVA benefits are provided only after all other health insurance benefits have been exhausted.

The form consists of two parts: Part I, where the veteran or dependent provides personal information such as name, address, and Social Security Number; and Part II, where the veteran or dependent provides information about other health insurance coverage, including the name of the insurance company and policy number.

Important fields on the form include the name of the insurance company, policy number, and effective dates of coverage. It is important to provide accurate and complete information on the form to ensure that CHAMPVA benefits are provided only after all other health insurance benefits have been exhausted.

The parties involved in the form are the veteran or dependent and the Department of Veterans Affairs. It is important to consider the details of other health insurance coverage when filling out the form to ensure that CHAMPVA benefits are provided only after all other health insurance benefits have been exhausted.

When filling out the form, the veteran or dependent will need to provide personal information and information about other health insurance coverage. No additional documents are required to be attached to the form.

Application examples and use cases for the form include certifying that a veteran or their dependent has other health insurance coverage that may affect their eligibility for CHAMPVA benefits.

Strengths of the form include its simplicity and ease of use, while weaknesses include the potential for errors or inaccuracies in the information provided. Opportunities for the form include potential improvements in the verification process for determining eligibility for benefits. Threats related to the form include potential privacy and security concerns related to the release of personal health information.

Related form is the VA Form 10-7959a CHAMPVA Claim Form, which is used to submit claims for CHAMPVA benefits.

The form affects the future of the participants by ensuring that CHAMPVA benefits are provided only after all other health insurance benefits have been exhausted.

The form can be submitted online or by mail to the CHAMPVA Eligibility Center. Once submitted, the form is stored in the VA's electronic records system.