Veterans Affairs Dental Insurance Program (VADIP)
 Online Customer Service Inquiry Form

Are you a dentist? Please use our Online Dentist Inquiry Form.
Are you an enrolled? Register now on our Consumer Toolkit.

REQUESTOR INFORMATION

Required fields are denoted by a red asterisk (*).
*Enrollment Status:  
 
 
 
 
 
USA: (xxx) xxx-xxxx
USA: (xxx) xxx-xxxx

SUBSCRIBER INFORMATION

*
*
* / / MM/DD/YYYY
* (9-digit number without hyphens or spaces)

NATURE OF INQUIRY

A selection is required.

ENROLLED
Benefits and/or eligibility.
If your inquiry is specific to an enrolled dependent, please include their name and date of birth in the Inquiry Details area located at the bottom of this form.
 
Premium billing.
If your inquiry is specific to your monthly premium payment, please enter your comments in the Inquiry Details area located at the bottom of this form.
 
A processed claim.
If your inquiry is specific to a processed claim, please provide the 13-digit Claim Number in the area provided below.
Enter related comments in the Inquiry Details area located at the bottom of this form.

*Please do not use this inquiry form to submit new claims
  * (13-digits)
The Claim Number is located on page 2 in the upper left portion of your Explanation of Benefits.
 
Update your contact information.
If you are providing an update to your contact information, please enter the information in the Inquiry Details area located at the bottom of this form.
 
NOT ENROLLED
Please enter your question in the Inquiry Details area located at the bottom of this form.

INQUIRY DETAILS

Attachments

Only one file may be attached per inquiry. Maximum file size is 15MB.
Accepted file types are doc, docx, xls, xlsx, xlsm, pdf, txt, jpg, jpeg, tif and tiff.

Security Question

Select one verification method     
What letters do you see?