About VA Form 10-10d
- Form name: Application for CHAMPVA Benefits
- Form revision date: April 2025
- Related to: Family member benefits, Health care
When to use this form
If you’re the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).
Downloadable PDF
Online tool
You can apply online instead of filling out and sending us the paper form.
Helpful links related to VA Form 10-10d
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Learn how eligible spouses and children of Veterans can get health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).
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Find out about VA benefits for spouses, dependents, survivors, and family caregivers.
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Use this form to report changes to your non-VA health insurance or to update your personal information for CHAMPVA benefits.