VA Form 10-10EZR — Health Benefits Update Form

What is VA Form 10-10EZR?

VA Form 10-10EZR is for veterans who are already enrolled in VA health care. The instructions say VA uses it to update your personal, insurance or financial information after you're enrolled; to apply in the first place, VA uses Form 10-10EZ. All veterans complete Sections I and II and the consent and signature sections.

Section I is your contact details, addresses, marital status, next of kin and emergency contact. Section II is your health insurance, Medicaid and Medicare Part A. Section III updates military service and toxic exposures, from Gulf War and herbicide locations to burn pits and Camp Lejeune water. Sections IV to VI cover a spouse and dependent child and last year's income and deductible expenses, for veterans who want VA to reassess cost-free care or travel benefits.

FileIt pre-fills your name, date of birth and email from your vault, keeps the optional parts switched off until you need them, and prints the answers onto VA's own PDF (FEB 2025 edition) with your name and SSN repeated in the page headers. You sign it in ink and mail it to the Health Eligibility Center; FileIt never sends anything to VA.

Who needs to fill out VA Form 10-10EZR?

• Enrolled veterans who have moved, changed phone numbers or email, or married, separated or divorced.
• Veterans whose health insurance, Medicare or Medicaid status has changed.
• Veterans reporting toxic exposures or service locations they didn't list before.
• Veterans giving last year's income and expenses to update their copay, cost-free care or travel benefit eligibility.

When to use VA Form 10-10EZR

• Whenever your personal, insurance, military or financial information changes after you enroll.
• When VA asks you to renew or update your financial information.
• With VA Form 10-10CG, when an enrolled veteran applies for the family caregiver program and wants to update details at the same time.

What you need before you start

• Your Social Security number, date of birth and current mailing and home addresses with county.
• Next of kin and emergency contact names and phone numbers.
• Your insurance company's name, address and phone, the policy holder, policy number and group code, and your Medicare number and Part A start date.
• For Section III, your last branch, entry and discharge dates, discharge type, service number, and the approximate months and years of any exposures.
• For Sections IV to VI, your spouse's and child's names, SSNs and dates of birth, and last calendar year's income and deductible expenses.

What’s on VA Form 10-10EZR

The 2025 edition has 5 pages. FileIt asks for it in 6 parts:

1. Section I: General informationVeteran
2. Section II: Insurance informationVeteran
3. Section III: Military service informationVeteran
4. Section IV: Dependent informationVeteran
5. Sections V and VI: Last calendar year's income and deductible expensesVeteran
6. Sections VII and VIII: Consent and signatureVeteran

How to fill out VA Form 10-10EZR, step by step

1 Section I: General information

Name and preferred name, SSN, sex, date of birth, home and mobile phones, mailing and home addresses, email, marital status, next of kin and emergency contact.

2 Section II: Insurance

Every health insurer that covers you, including through a spouse, with the policy holder, policy number and group code; whether you're eligible for Medicaid; and whether you're enrolled in Medicare Part A, with its effective date and your Medicare number.

3 Section III: Military service

Last branch and service dates, discharge type and service number; yes or no for Purple Heart, POW, combat after 11/11/1998, disability discharge, Gulf War service and a service-connected rating; then radiation, Gulf War hazard, deployment and herbicide locations, and the exposures in 3E, with approximate dates.

4 Section IV: Dependents

Only with Section V. Your spouse's name, SSN, date of birth, sex, date of marriage and address, then one dependent child's details, whether they were disabled before 18 or in school between 18 and 23, their education expenses, and whether you supported a spouse or child who lived elsewhere.

5 Sections V and VI: Income and expenses

Last calendar year's gross employment income, net farm, ranch, property or business income, and other income for you, your spouse and one child; then non-reimbursed medical expenses, funeral and burial costs for a spouse or child, and your own education expenses.

6 Sections VII and VIII: Consent and signature

Sending the form means agreeing to applicable copays and to VA communications at the contact details you gave. The assignment of benefits lets VA bill your health plan for non-service-connected care. Sign in ink and date it.

Common mistakes to avoid

• Using this form to enroll for the first time. New applicants use Form 10-10EZ.
• Filling in dependents in Section IV without the income in Section V, which the instructions tie together.
• Reporting welfare, SSI, need-based payments, tax refunds, loans or the other excluded items as income.
• Listing a dependent's education expenses as your own in Section VI.
• Forgetting to sign and date the form. The instructions say VA will return it.

After you fill it out

Print the form, sign it in ink and date it, and attach any continuation sheets, supporting papers or power of attorney documents.

Mail it to the Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.

Keep the filed PDF in your vault, and bring your insurance, Medicare and Medicaid cards to appointments, as the instructions ask.

VA Form 10-10EZR: frequently asked questions

Official sources

• Blank form (PDF), published by U.S. Department of Veterans Affairs (VHA): https://www.va.gov/vaforms/medical/pdf/VA%20Form%2010-10EZR.pdf
• Official instructions and guidance: https://www.va.gov/find-forms/about-form-10-10ezr/
• Edition shown on this page: VA Form 10-10EZR, FEB 2025 (OMB No. 2900-0091, expires 07/31/2027) (checked 2026-10-19).

FileIt is not affiliated with or endorsed by U.S. Department of Veterans Affairs (VHA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-19.

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