Instructions and definitions
Pages 1 and 2 define terms such as service-connected, compensable, Toxic Exposure Risk Activity and reportable income, and explain what goes in each section.
10-10EZR
Health Benefits Update Form
- Agency
- VA
- Revision
- February 2025
- Fillable fields
- 99
- Pages
- 5
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-10EZR: Health Benefits Update Form
VA Form 10-10EZR is the U.S. Department of Veterans Affairs Health Benefits Update Form. VA's form page says to use it if you already receive VA health care benefits and need to update your personal, insurance, financial or military service history information. The form says VA uses it to update this information after you are enrolled.
The PDF has five pages: two pages of instructions and definitions, then the form in Sections I to VIII, covering general information, insurance, military service, dependents, last calendar year's income and deductible expenses, consent to copays, the Assignment of Benefits and the signature. The form says all Veterans complete Sections I, II, VII and VIII, and the other sections only where they apply. It estimates 27 minutes to complete.
VA's page says you can apply online instead of filling out and sending the paper form. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-10EZR
Section I: General information
Your name and preferred name, Social Security number, sex, date of birth, optional home and mobile phone and email, mailing and home addresses, marital status, next of kin and emergency contact.
Section II: Insurance
Your health insurance company, policy holder, policy number and group code, whether you are eligible for Medicaid, and whether you are enrolled in Medicare Part A, with its effective date and number.
Section III: Military service
Branch, entry and discharge dates, discharge type and service number, yes or no military history questions, and military exposure questions with approximate time frames, from radiation and Gulf War locations to herbicides and burn pits.
Sections IV to VI: Dependents, income and expenses
Spouse and child details, previous calendar year gross annual income for the Veteran, spouse and child, and non-reimbursed medical, funeral and burial, and your own education expenses.
Sections VII and VIII: Consent and signature
Consent to copays and to receive communications, the Assignment of Benefits that lets VA collect from your health plan for nonservice-connected care, and your signature in ink and date.
How to update with VA Form 10-10EZR
- 1
Read the instruction pages
The first two pages define the terms the form uses and say which sections to complete.
- 2
Complete Sections I and II
The form says all Veterans complete Sections I, II, VII and VIII. Use a separate sheet for more than one health insurer.
- 3
Fill in the sections that apply
The form says to complete only the sections that apply to you, and to complete Section IV only if you complete Section V. Use a separate sheet for additional dependents.
- 4
Attach supporting papers
Attach any continuation sheets, supporting materials or Power of Attorney documents. The form also suggests copies of insurance, Medicare or Medicaid cards if you have access to a copier.
- 5
Sign and date it
Sign in ink and date the form. If you sign with an X, the form says 2 people you know witness it, sign and print their names. VA returns a form that is not signed and dated appropriately.
- 6
Mail it or update online
Mail the completed form and any supporting materials to the Health Eligibility Center in Janesville, Wisconsin, or use the online version on VA.gov.
Why fill Form 10-10EZR on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it and getting help
Mailing address
Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.
Online version
VA's form page says you can apply online instead of filling out and sending the paper form. The PDF says the update form is available online at https://www.va.gov/health-care/update-health-information/.
Help with the form
The instructions list calling VA at 1-877-222-VETS (8387), the Enrollment Coordinator at your local VA health care facility, or a National or State Veterans Service Organization.
Copays
Section VII says that by submitting the form you agree to pay the applicable VA copayments for care or services, including urgent care, as required by law. The form does not list amounts.
Edition
The current edition is dated FEB 2025, and the form says previous editions are not to be used. It carries OMB Control No. 2900-0091, which expires 07/31/2027.
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10-10CG
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Request for and Authorization to Release Health Information
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Who uses VA Form 10-10EZR?
VA's form page and the form's instructions describe who fills it in.
Official sources and the blank
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Questions about Form 10-10EZR
Can I update my VA health information online instead?
Yes. VA's form page says you can apply online instead of filling out and sending the paper VA Form 10-10EZR.
Which sections does every Veteran complete?
The form says all Veterans complete Sections I, II, VII and VIII, and only the other sections that apply to them.
Do I have to give a financial assessment?
The form says Veterans may provide one to update eligibility for cost-free care or services and beneficiary travel, and that Veterans rated 50-100% disabled due to SC conditions and Veterans receiving VA pension are not required to.
Which year's income does the form ask for?
The previous calendar year. Sections V and VI ask for last year's gross annual income and deductible expenses.
Can someone else sign VA Form 10-10EZR for me?
The instructions say the Veteran or a person the Veteran has delegated Power of Attorney to signs and dates the form, with the Power of Attorney documents attached. A Veteran who signs with an X needs 2 witnesses who sign and print their names.
Where do I mail VA Form 10-10EZR?
The form lists the Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.