Health Benefits Update Form - VA Form 10-10EZR Instructions

To submit the completed VA Form 10-10EZR, mail it along with any supporting materials to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207. For email or fax submissions, contact your local VA health care office for specific instructions and contact details. My advice is to ensure all information is accurate and all required sections are completed before submission to avoid any delays in processing. Additionally, keep a copy of the form and any supporting documents for your records.

The current VA Form 10-10EZR expires on 06/30/2024. Ensure to complete and submit any updates before this expiration date.

The purpose of the VA Form 10-10EZR is to allow Veterans to update their personal, insurance, and financial information with the Department of Veterans Affairs. Accurate updates help maintain eligibility for various benefits and health care services provided by VA. By submitting this form, Veterans ensure that their records are current and reflect their most recent information.

• 1. 1A. VETERAN'S NAME: Enter your full legal name including last, first, and middle names.
• 2. 2. SOCIAL SECURITY NUMBER: Provide your Social Security Number.
• 3. 3A. BIRTH SEX: Select your birth sex from the given options.
• 4. 3B. SELF-IDENTIFIED GENDER IDENTITY: Select your self-identified gender identity from the options.
• 5. 4. DATE OF BIRTH: Enter your date of birth in mm/dd/yyyy format.
• 6. 5A. HOME TELEPHONE NUMBER: Provide your home telephone number including area code.
• 7. 5B. MOBILE TELEPHONE NUMBER: Provide your mobile telephone number including area code.
• 8. 6A. MAILING ADDRESS: Provide your full mailing address including street, city, state, zip code, and county.
• 9. 7. HOME ADDRESS: Provide your home address if different from the mailing address.
• 10. 8. E-MAIL ADDRESS: Enter your e-mail address (optional).
• 11. 9. CURRENT MARITAL STATUS: Select your current marital status from the options.
• 12. 10A. NEXT OF KIN NAME: Provide the full name of your next of kin.
• 13. 10B. NEXT OF KIN ADDRESS: Provide the address of your next of kin.
• 14. 10C. NEXT OF KIN RELATIONSHIP: Describe your relationship to the next of kin.
• 15. 10D. NEXT OF KIN TELEPHONE NUMBER: Provide the telephone number of your next of kin.
• 16. 11A. EMERGENCY CONTACT NAME: Provide the full name of your emergency contact.
• 17. 11B. EMERGENCY CONTACT TELEPHONE NUMBER: Provide the telephone number of your emergency contact.

Failing to submit this form may result in delays or denial of health care benefits. It is crucial to keep your information updated to maintain eligibility.

• Benefit Denial: Missing or incorrect information may lead to benefit denial.
• Delayed Processing: Delays in processing may occur due to incomplete submissions.
• Lapsed Coverage: Failure to update insurance information might affect your coverage.

• 1. Personal Information Update: When there are changes in your personal information such as name, address, or marital status.
• 2. Insurance Information Update: If your health insurance coverage changes or you obtain new insurance.
• 3. Financial Information Update: To provide updates on your financial situation for benefit assessment.
• 4. Dependent Information: When adding or updating dependent details for benefit purposes.
• 5. Annual Income: To report your previous calendar year's gross annual income.