VA Form 10-10EZR Heath Benefits Update Form

What Is Form 10-10EZR?

VA Form 10-10EZR, Health Benefits Update Form , is a form that should be filled in by veterans or service members, qualified for Veterans Affairs health care benefits, to renew their personal, health insurance, and dependent information, provided in the previous application. Form 10-10EZR is used to renew the financial information of an applicant as well, which allows them to obtain cost-free medical services.

This form was released by the Department of Veterans Affairs (VA) and the latest version was issued on January 1, 2020 . A fillable Health Benefits Update Form is available for download below.

The instructions for filling in Form 10-10EZR are the following:

1. Section I. The applicant should enter their personal information: name, social security number, and date of birth. Enter home and mobile phone number, permanent and residential address. The current marital status of the applicant must be indicated as well.
2. Section II. The applicant must provide their insurance information, including the health insurance company name and its address, name of the policyholder, policy number, and group code.
3. Section III. The applicant should indicate the name of their spouse, their Social security number, and date of birth. Provide the date of marriage, address, and phone number of the spouse. The applicant should indicate the name, date of birth, and Social Security number of their child. The child's relationship to the applicant and expenses paid for this child must be also be provided.
4. Section IV. The applicant must indicate their amount of the gross annual income from employment, net income from their farm or property, and other income amounts for the previous calendar year. Provide the same details regarding the spouse and child.
5. Section V. The applicant should enter their deductible expenses for the previous calendar year.
6. Section VI. This section contains the consent of a filer to copay and to receive communications.
7. Section VII. The applicant must sign the form and enter the date of completion.