FSBP Member Forms &
Brochures Library

FSBP Claim Form

Medical Claim form to submit for benefit reimbursement
Health Benefits Election Form SF 2809

Health Benefits Election Form SF 2809 to for plan enrollment
Glossary of Health Coverage and Medical Terms

This glossary defines many commonly used terms.
Network Provider Nomination Form

Form to nominate your provider to join our network
Authorized Representative Form

Authorize a personal representative to obtain/discuss protected health information with us
FSBP Electronic Funds Transfer (EFT) Form

The EFT Authorization Form allows the Plan to deposit funds into your U.S. bank account.
FSBP Electronic Funds Transfer (EFT) Form

The EFT Authorization Form allows the Plan to deposit funds into your U.S. bank account (online submission).
FEHBP Urine Drug Testing Coverage

FEHBP Urine Drug Testing Coverage Form
Notice of Privacy Practices

This describes how medical information about you may be used and disclosed.
Member Rights & Responsibilities

This describes your rights and your risks as a patient when dealing with medical providers.