CHAMPVA enrollment application
VHA Office of Community Care
CHAMPVA Eligibility
PO Box 137
Spring City, PA 19475
VA Form 10-10d — Apply for CHAMPVA coverage
Apply for CHAMPVA health coverage as an eligible family member or survivor. This does not enroll a Veteran in VA health care.
Use the current official form
Revision: April 2025.
These are reviewed, scoped methods. Read the current official program and PDF instructions for conditions, signatures, additional methods and exceptions.
Submission instructions
Fax
CHAMPVA application on 10-10d
303-331-7809