Apply Online

1. Complete VA Form 10-10EZ, Application for Health Benefitsonline.
   • You may request an appointment when you apply for enrollment
2. Receive submission number
3. Given contact information for Preferred VA health care facility
4. Within 5 – 7 Business Days you will receive written notification of your enrollment status in the VA health care system.  If you are enrolled this letter will provide information on how to obtain a Veteran identification card (VIC)
5. The letter will also give you instructions on how to appeal the decision if you not agree

Apply by Telephone

1. Call 1-877-222-VETS (8387)
2. Complete application with representative
3. Within 2 – 5 business day you will receive an VA Form 10-10EZ, Application for Health Benefits to review, sign and return
4. Once this form is returned, within 5 – 7 Business Days you will receive written notification of your enrollment status in the VA health care system.  If you are enrolled this letter will provide information on how to obtain a Veteran identification card (VIC)
5. The letter will also give you instructions on how to appeal the decision if you not agree
6. Depending on the volume of calls you may experience a waiting period

Apply in Person

1. Go to your local VA heath care facility
2. Complete VA Form 10-10EZ, Application for Health Benefits
3. Take picture for Veteran identification card
4. Within 5 – 7 Business Days you will receive written notification of your enrollment status in the VA health care system.  If you are enrolled you should receive your  identification card within this time period
5. The letter will also give you instructions on how to appeal the decision if you do not agree

Other ways to apply

• Complete VA Form 10-10EZ and apply in person or mail the application to the following address:
  

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

• Call VA toll free at 877-222-VETS (8387), Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern Time.

Applicants for Long Term Care

Applicants for Long Term Care benefits, including community nursing home care, domiciliary care, adult day health care, geriatric evaluation, and respite care may also need to complete VA Form 10-10EC, Application for Extended Care Services. The form is required for nonservice-connected and zero percent service-connected enrolled Veterans with income over the single pension rate.

• VA Form 10-10EC, Instructions for Completing Application for Extended Care Services

You can indicate on the application form if you desire an appointment at the same time you apply.

Assistance Completing the Application

If you need assistance completing the form, contact:

• Online Web Chat
• VA at 877-222-VETS (8387)
• The Enrollment Coordinator at your local VA health care facility

Required Signature

There is not a signature requirement for the online registration.

You or the person acting as your Power of Attorney must sign and date the form. If your Power of Attorney signs and dates the form you must submit a copy of the Power of Attorney with the form..

If you sign with an "X," then two people that you know must witness you as you sign the form. They must also sign and print their names on the form.

Eligibility and Enrollment Status

Once your application for enrollment in VA health care system is processed, VA will send you a letter informing you of your enrollment Priority Group assignment, copay status and whether you were enrolled. The letter will also give you instructions on how to appeal the decision if you do not agree with it.

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