If you have a service-connected disability rating, apply ASAP — you may get Priority Group 1-3

Financial disclosure is optional but may qualify you for lower copays

Combat veterans get 5 years of enhanced enrollment from discharge date

Veterans Affairsmoderate

VA Healthcare Enrollment

VA 10-10EZ · VA

Application for VA health benefits. Requires military service history, current insurance, income/assets, and toxic exposure history.

Form Details

Total fields: 85
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Where to Submit This Form

🌐

VA.gov (recommended)

https://www.va.gov/health-care/apply/application/introduction

Apply online in about 30 minutes.

📬

Mail

Health Eligibility Center 2957 Clairmont Road NE, Suite 200 Atlanta, GA 30329-1647

🏢

In person at any VA Medical Center

https://www.va.gov/find-locations/?facilityType=health

Processing Time

About 1 week. You'll receive a letter with your Priority Group assignment.

What Happens Next

VA will determine your enrollment Priority Group (1-8) based on service-connected disabilities, income, and other factors.

Tips for This Form

✓ If you have a service-connected disability rating, apply ASAP — you may get Priority Group 1-3
✓ Financial disclosure is optional but may qualify you for lower copays
✓ Combat veterans get 5 years of enhanced enrollment from discharge date

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Authorization and consent allowing VA to obtain private medical records from non-VA providers for disability claim adjudication.

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