Haris Ashley
Veterans Affairs (VA) offers a variety of benefits, including disability compensation and health care. To start your VA claim for medical insurance, you can apply online, by mail, in person, or with the help of a professional. The process involves submitting evidence, such as medical records and lay statements, to support your claim. You can also set a potential start date for your benefits by notifying the VA of your intent to file. This may even make you eligible for retroactive payments. It is recommended that you work with an accredited representative who can guide you through the claims process.
| Characteristics | Values |
|---|---|
| Ways to apply | Online, by mail, in person, or with the help of a professional |
| Documents required | VA Form 10-10EZ, VA Form 21-526EZ, VA Form 21-10210 |
| Other documents required | Medical records, medical opinions from healthcare providers, supporting statements from family members, friends, clergy members, etc. |
| Insurance information required | Insurance card information for all insurance companies that cover you, including any coverage provided through a spouse or significant other |
| Other information required | Gross household income from the previous calendar year, deductible expenses for the past year |
| Deadlines | Up to a year from the date the claim is received to turn in any evidence |
| Contact information | Department of Veterans Affairs Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444 |
| Phone number | 877-222-8387 |
| Phone line working hours | Monday to Friday, 8:00 a.m. to 8:00 p.m. ET |
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What You'll Learn
File a claim online, by mail, in person, or with the help of a professional
You can file a VA claim for medical insurance online, by mail, in person, or with the help of a professional. Here's how:
Online:
To file a claim online, go to the VA website and fill out the Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). You don't need to notify the VA of your intent to file online; your effective date gets set automatically when you start filling out the form. Once you've submitted your form, you don't need to do anything while waiting unless the VA sends a letter requesting more information or schedules an exam for you.
By Mail:
Download and print VA Form 21-526EZ, or get it by visiting a VA regional office near you. After filling out the form, send it to:
> Department of Veterans Affairs Claims Intake Center
> PO Box 4444
> Janesville, WI 53547-4444
If you plan to file using a paper form, you may want to submit an intent to file form first. This gives you time to gather evidence while avoiding a later potential start date.
In Person:
You can bring your application to a VA regional office near you.
With the Help of a Professional:
You can work with an accredited attorney, claims agent, or Veterans Service Organization (VSO) representative to get help filing a claim for disability compensation. These professionals can guide you through the process and ensure you have all the necessary documentation.
Regardless of the filing method, be sure to gather any supporting documents, such as medical records, hospital reports, and supporting statements from family or friends, that relate to your claimed illnesses or injuries. You have up to a year from the date your claim is received to turn in any evidence.
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Provide medical records and hospital reports
When filing a VA disability claim, you will need to provide medical records and hospital reports to support your claim. These records could relate to your claimed illnesses or injuries or show that your rated disability has worsened. You can submit VA medical records and hospital records, as well as private medical records and hospital reports.
VA medical records and hospital records are typically generated when active-duty members are hospitalized while in service. These records are usually retired to the National Personnel Records Center (NPRC) by the facility that created them, and they can be accessed through the VA. You can also set up your personal health record and download medical records, reports, and images to share with your VA and non-VA doctors.
Private medical records and hospital reports can be obtained from your healthcare providers and can show that your claimed condition has worsened. These records can include doctor's reports, X-rays, and medical test results. You can also submit supporting statements from family members, friends, clergy members, law enforcement personnel, or people you served with. These statements can provide additional information about your claimed condition and how it occurred or worsened.
It is important to note that you have up to a year from the date your claim is received to submit all the necessary evidence. You can file your claim online, by mail, or in person, and you have the option to work with an accredited attorney, claims agent, or Veterans Service Organization (VSO) representative to help you gather evidence and file your claim.
If you are filing a disability claim for a condition related to your active-duty service, you will need to provide medical or lay evidence of a current physical or mental disability, an event, injury, or disease during your service, and a link between your current condition and the event, injury, or disease that occurred during your service. Medical records and opinions from healthcare providers are typically required to support this link, but lay evidence, such as buddy statements, may also be accepted.
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Submit supporting statements from family members, friends, etc
When filing a VA disability claim, you may be asked to submit supporting statements from family members, friends, clergy members, law enforcement personnel, or people you served with. These statements can provide valuable information about your claimed condition, including how and when it occurred or how it worsened over time.
It is important to note that these supporting statements are considered lay evidence, which means they are written testimonies from individuals without specific medical training or education. Despite this, lay evidence is still given due consideration and can be submitted in addition to any medical records or opinions from healthcare providers that you provide.
Anyone can submit lay evidence, and it can be done in several ways. One way is to write and submit a statement on a blank piece of paper. This allows the writer to freely express their knowledge of your condition and any relevant events in their own words, without being confined to a structured form.
Another way to submit lay evidence is by completing and submitting a Lay or Witness Statement, also known as a "buddy statement," using VA Form 21-10210. This form can be downloaded and filled out, providing a more standardized format for the statement. Additionally, there is VA Form 21-4138, also known as the Statement in Support of Claim, which can be used for this purpose.
Remember, when submitting supporting statements from family members, friends, or other individuals, it is not necessary for them to have medical expertise. Their statements can still hold significant value in supporting your VA disability claim and providing a comprehensive understanding of your condition.
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Notify the VA of your intent to file
To start your VA claim for medical insurance, you must first notify the VA of your intent to file a claim. This can be done in several ways:
Online
You can submit an intent to file form online. Certain forms can be started online to automatically notify the VA of your intent to file. This sets a potential start date for your benefits. Sign in with an identity-verified account and start one of these forms online to reserve an earlier potential start date. However, do note that the automatic intent to file doesn't apply to DIC (Dependency and Indemnity Compensation) benefits or Supplemental Claims for non-disability benefits. For these, you must submit a separate intent to file form.
Phone
You can call the VA at 800-827-1000 (TTY: 711) to notify them of your intent to file. They are available Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.
In-person
You can also notify the VA in person.
By mail
Download and fill out an "Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC" (VA Form 21-0966). Then, mail the completed form to the address listed in the PDF. If you apply online for pension benefits, you still need to submit VA Form 21-0996 as your intent to file.
With the help of a professional
You can work with an accredited attorney, claims agent, or Veterans Service Organization (VSO) representative to get help with filing your intent to file.
Once you have notified the VA of your intent to file, you have one year to complete and file your claim.
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Provide evidence of current physical or mental conditions
When filing a VA disability claim, you will need to provide evidence of your current physical or mental condition. This evidence can be in the form of medical records or medical opinions from healthcare providers. You may also submit supporting documents such as medical test results, doctor's reports, and other records. If you have seen a non-VA healthcare provider, you will need to upload copies of all medical records related to your disability claim. Private medical treatment records are also acceptable.
In addition to medical evidence, you can also submit lay evidence, or written testimony, from yourself or someone who knows about your condition. This person does not need any specific training or education. A lay evidence statement can be written and submitted on a blank piece of paper or by completing and submitting a Lay or Witness Statement (VA Form 21-10210).
You can upload evidence to support your claim online using the claim status tool. You have up to a year from the date your claim is received to turn in any evidence. If you don't provide any evidence within 30 days, a decision on your claim may be made earlier.
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Frequently asked questions
You can apply for VA medical insurance online, by phone, fax, or mail. You can also go to your nearest VA medical center or clinic and bring a signed Application for Health Benefits (VA Form 10-10EZ).
You will need to provide insurance card information for all insurance companies that cover you, including any coverage provided through a spouse or significant other. You will also need to provide gross household income from the previous calendar year for you, your spouse, and your dependents.
You will need to submit or give permission to gather certain documents to support your claim, including any medical evidence related to your illness or injury (like doctors’ reports, X-rays, and medical test results). You can also submit lay evidence, which is written testimony by you or someone who knows about your condition.
You can submit an intent to file form online or call the VA at 800-827-1000 (TTY: 711). You can also notify them in person or by mail. Submitting an intent to file sets a potential start date for your benefits, and you will have 1 year to complete and file your claim.
