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FSBP is a Federal Employees Health Benefits (FEHB) high-option closed plan with affordable premiums that covers you everywhere in the world.
When filing a claim for covered services, bills and receipts should be itemized and show:
Click here for more information on how to submit claims.
The process to submit a claim online is simple: login to the Member Portal with your username and password. Once inside the portal, under the Secure Forms tab, select “Submit A Claim.” Follow the screen prompts to upload your PDF claim documents. You have the option to include questions or comments, or to send your claim to a specific Health Benefits Officer. Please ensure your name and member ID number appear on the claim.
If you are serving overseas, note that using State Department mail (Pouch Mail) will delay your claim’s processing significantly.
Visit the FSBP provider search page. Enter your search terms and click “Search.” Choose the appropriate network option: either the “Foreign Service Benefit Plan – Aetna Choice POS II”; or the “NetCare-Guam.”
The provider should call 202-833-5751.
Login to Aetna’s secure member website Select “ID card” at the top of the page, and then choose to print/download additional ID cards or view your ID card. To order a replacement ID card, you can call 202-833-4910.
You can update your address in the Member Portal. Login, or register if you are a first-time user. Go to Member Profile and select the “click to update” button. Then enter the desired information and click save.
Aetna’s secure member website is a system that provides members with access to information and tools regarding their health. Every enrollee and dependents ages 14 and older have their own separate login credentials for this portal.
In your Aetna secure member website account, you can track and sign up for wellness incentives, take your Health Risk Assessment and see your results, enroll in electronic funds transfer (EFT), view your Explanations of Benefits (EOBs) and the status of your claims.
The AFSPA Member Portal is a system for all AFSPA members. It can be used to upload and submit claims, update contact information, and enroll in and manage AFSPA Ancillary Insurance Programs. The Member Portal is only available to the AFSPA member/subscriber, not dependents. We recommend having a Member Portal account in order to allow for the fastest processing of claims.
When you leave Federal service, you may become eligible for Temporary Continuation of Coverage (TCC), the Federal government’s version of COBRA, for up to 18 months. If you lose coverage because you no longer qualify as a family member of a Federal employee, you may become eligible for TCC for up to 36 months. Dependent children may be covered under your Self and Family or Self Plus One enrollment until age 26. At age 26, your child may be eligible for TCC for up to 36 months. For more information about TCC, please visit OPM’s TCC site.
Annuitants who are eligible under the Foreign Service Retirement System may enroll in this Plan for the first time as an annuitant. All other retirees must have been enrolled in the Plan while an active employee to elect the Plan during retirement.
To learn more about continuing your FEHB benefits into retirement, please visit OPM’s website on health insurance for Retirees and Survivors.
FSBP has a special arrangement with the e-Cleveland Clinic to provide our members with the option of a second opinion for certain diagnoses received from a foreign provider. The Overseas Second Opinion benefit provides access to nationally recognized specialists for a second opinion via the e-Cleveland Clinic. Once you obtain the second opinion, you choose whether to proceed with the original course of treatment, seek out another opinion, or arrange care with an alternate physician. To determine if you are eligible to participate, e-mail the Plan at [email protected].
If you would like to see a second provider of your choice while serving overseas, the consultation and any medically necessary tests or services will be covered in the same way as any overseas provider. See Overseas.
FSBP provides access to Aetna’s Aexcel specialists network. Aexcel is a designation for doctors and doctor groups in 12 medical specialty areas:
Doctors with the Aexcel designation will have a blue star next to their listing in the provider search results. The Evaluation Standards are:
For those benefits where copayments, coinsurance or deductibles apply, we pay 100% of the Plan allowance for the rest of the calendar year after your expenses total to:
For Self Plus One and Self and Family enrollments, once any individual family member reaches the Self Only catastrophic protection out-of-pocket maximum during the calendar year, that member’s claims will no longer be subject to associated cost-sharing amounts for the rest of the year. All other family members will be required to meet the balance of the catastrophic protection out-of-pocket maximum.
Any expenses incurred that apply toward the catastrophic out-of-pocket maximum for in-network or out-of-network apply toward both in and out-of-network limits.
This catastrophic protection out-of-pocket maximum is combined for medical/surgical, mental health/substance misuse disorder, and pharmacy. There are some expenses that do not fall under this provision; see your FSBP Brochure , Section 4, Your Costs for Covered Services.
This does not mean the doctor does not provide quality services. It could be that Aetna does not have enough information available to evaluate a particular doctor or the doctor’s specialty is not one of the 12 specialty categories. An Aexcel designation is not a guarantee of service quality or treatment outcome. Therefore, the Aexcel designation should not be the only reason for choosing a specialty doctor. The Aexcel designation is only a guide, and all ratings have a chance for error.
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