Please rate Va Form 10 10Ezr Feb 2025
All Veterans must complete Sections I, II, VII, and VIII.
Signing: you or an individual to whom you have delegated your Power of Attorney must sign and date the form.
Mailing: mail the completed VA Form 10-10EZR and any supporting materials to the Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.
Insurance: Section II: include information for all health insurance companies that cover you, this includes coverage provided through a spouse or significant other.
Copays: by submitting this application, you are agreeing to pay the applicable VA copayments for care or services (including urgent care) as required by law.
Financial assessment: Veterans rated 50-100% disabled due to SC conditions and Veterans receiving VA pension are not required to provide a financial assessment.
| Question | Answer |
|---|---|
| Form Name | VA Form 10-10EZR |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 107 |
| Avg. time to fill out | 18 min |
| Edition | FEB 2025 |
| Where to send | Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | 10-10EZR, 1010EZR, 10 10EZR, VA Form 10-10EZR, VA 1010EZR, Health Benefits Update Form |
| Official source | VA Form 10-10EZR (FEB 2025), Department of Veterans Affairs |
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Please rate Va Form 10 10Ezr Feb 2025
