When filing a claim for covered services, bills and receipts should be itemized and show:

• Patient name, date of birth, address, phone number, and relationship to enrollee.
• Patient’s Plan identification number.
• Name, address, and tax identification number of the person or company providing the services or supplies.  We do not need the tax ID number for providers outside the U.S.
• Date(s) of service, or date(s) supplies were furnished.
• Diagnosis or a description of your symptoms (not required for prescription medicine receipts).
• Charge for each service or supply.
• A brief description of each service or supply.
• If you have another health plan as your primary payor, you must send a copy of the explanation of benefits (EOB) you received from that payor (for example, the Medicare Summary Notice).
• Bills for private duty nursing care must show that the nurse is a Registered Nurse (R.N.) or Licensed Practical Nurse (L.P.N.). You also should include the initial history and physical, treatment plan indicating expected duration and frequency from your attending physician or other health care professional, and notes from the nurse.
• Claims for rental or purchase of durable medical equipment must include the purchase price, a prescription, and a statement of medical necessity including the diagnosis and estimated length of time needed.
• Claims for dental services submitted to FSBP must include a copy of the dentist’s itemized bill (including the required information listed above) and the dentist’s Federal Tax ID Number. We do not have separate dental claim forms.
• Click here to learn more about filing a massage claim.

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.

• For Self Only (401) enrollment, the deductible is $300 for in-network providers (including Guam) and providers outside the U.S., and $400 for out-of-network providers (including Guam).
• For Self Plus One (403) enrollment, the deductible is $600 for in-network providers (including Guam) and providers outside the U.S., and $800 for out-of-network providers (including Guam).
• Under a Self and Family (402) enrollment, the deductible is $600 for in-network providers (including Guam) and providers outside the U.S., and $800 for out-of-network providers (including Guam).

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, visit https://fsbp.globalvso.io

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. 

FSBP was designed to make it easy for our members to receive the healthcare they need while overseas – anywhere in the world. Simply see the healthcare provider of your choice, pay your bill, and send us an itemized receipt along with the contact information of the provider. No translation or currency exchange information is necessary. (See Claims for more detailed instruction.)

FSBP staff focuses on building new relationships with providers that can serve large populations of our membership.  We rely upon support from local experts, including Regional Medical Officers and staff, and administrative staff at embassies, consulates, and military bases. While we may be unable to pursue every suggestion, you are welcome to share your recommendations about providers that may serve our membership. well. Please contact us.

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 Only enrollment $5,000 and for Self Plus One or Self and Family enrollment $7,000 for in-network providers (including Guam) and providers outside the 50 United States and when you use the Plan’s network retail pharmacy through Express Scripts (ESI), or home delivery (mail order) through the Express Scripts PharmacySM, or purchase prescriptions outside the 50 United States from a retail pharmacy or Military Treatment Facility (including Guam);
• For Self Only enrollment $7,000 and for Self Plus One or Self and Family enrollment $9,000 for in- and out-of-network providers combined (including Guam) and when you use the Plan’s network retail pharmacy through Express Scripts or home delivery (mail order) through the Express Scripts PharmacySM or purchase prescriptions outside the 50 United States from a retail pharmacy or Military Treatment Facility (including Guam).
• 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.