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

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

REQUESTOR INFORMATION

Required fields are denoted by a red asterisk (*).
*
*
* Requestor Status:  

SUBSCRIBER INFORMATION

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

NATURE OF INQUIRY

 * ARE YOU INQUIRING ON A CLAIM?
 
SUBMITTING STUDENT VERIFICATION.
* Attachment required
I AM NEWLY RETIRED AND ELIGIBLE FOR 12-MONTH WAIVER.
If you weren’t able to enroll via the Beneficiary Web Enrollment (BWE) until your retirement was official, and you would like us to consider backdating your coverage effective date so you can avoid a lapse in coverage from the TDP, please notate that in the Inquiry Details area at the bottom of this form
• In order to be eligible for this, you would have had to enroll the same month in which you retired.

 INQUIRY DETAILS

 * Inquiry details are required.

Attachments

A maximum of two files 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?