Welcome to the Foreign Service Benefit Plan (FSBP), a Federal Employees Health Benefits high option closed plan with an affordable premium that covers you everywhere in the world. All Federal Executive Branch employees who advance the nation’s foreign and intelligence affairs are eligible to enroll in FSBP, whether they serve at home or abroad. In fact, 60% of our members enjoy our excellent health benefits at home in the U.S.

Check your eligibility!  See a full list of the eligible agencies. 

We know how different it is to receive healthcare overseas and to claim benefits for those services, and we do everything we can to ease the process. Learn more in Overseas. At the same time, we participate in Aetna’s Choice POS II (Open Access) network, one of the largest nationwide networks of healthcare providers encompassing all 50 states, and we participate in the NetCare Guam network for our members in Guam. See Providers for more information or click here to search for an in network provider.

When you choose FSBP, you choose:

  • A plan that has achieved full three-year term comprehensive health plan accreditation by the Accreditation Association for Ambulatory Health Care, which deemed the Plan's practices in quality of care and quality of service in line with national standards.
  • A competitively priced fee-for-service high option plan that offers generous benefits worldwide. 
  • More than 900,000 network providers in the Aetna Choice POS II and NetCare Guam networks.
  • No referrals needed to see specialists – you can self-refer.
  • Coverage of up to $60 per visit for up to 40 visits per calendar year from each of the following professionals - a licensed or certified massage therapist, chiropractor, acupuncturist. 
  • Competitively priced prescription benefits from the largest Pharmacy Benefit Manager in the U.S., Express Scripts.
  • A variety of complementary programs, including a 24-hour Nurse Advice Line, a 24-hour Translation Line, myStrength online mental health support, and more. See Wellness for more information, including incentives you can earn through our Simple Steps Program.
  • A specially designed suite of programs and practices to help members living abroad, including free translation of claims, no out-of-network penalties for providers seen outside of the U.S. or Guam, acceptance of all types of foreign bills, and access to Direct Billing Hospitals so you do not have to pay upfront costs. The Plan generally considers foreign providers’ charges as billed.  See Overseas for more details.
  • No out-of-pocket costs for routine preventive or maternity care and routine preventive immunizations received from an in-network provider or overseas.
  • Secure claim submission through our Member Portal.
  • Quick claim reimbursement through electronic funds transfer (EFT).

FSBP is underwritten by AFSPA, which also performs the customer service function for the Plan. By joining FSBP you become a lifetime member of AFSPA (there are no membership dues). AFSPA works with award-winning partners to bring you generous benefits and programs. Claims and clinical functions are administered by Aetna. Aetna has been recognized numerous times in recent years for its commitment to diversity, its innovative leadership, and its commitment to supporting military families as well as the health of its own employees. Prescription coverage is administered by our Pharmacy Benefit Manager, Express Scripts, named one of the World’s Most Innovative Companies by Forbes in 2015 and one of the World’s Most Ethical Companies in 2014. See a full list of Express Script’s numerous honors here. Learn more about our pharmacy benefits under Prescriptions.

Review our premiums relative to other high option plans in the FEHB Program.

To make an informed decision about whether FSBP is the right plan for you and your family, be sure to review plan documents.  The Benefit Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

2018 Documents

2017 Documents  

You also can click through the tabs above for more information about medical, surgical, and prescription benefits, our premiums, and our many wellness and discount programs exclusively for FSBP members. The Plan Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

Once you’re enrolled in FSBP, nearly every healthcare decision you make can be better informed by using My Online Services, the Plan’s co-branded website with Aetna. You’ll see reference to this information hub throughout this website, as many of our programs are housed there, including signing up for wellness incentives, opting into electronic funds transfer (EFT), learning more about the quality and cost of your healthcare, and viewing your Explanations of Benefits (EOBs).

FSBP encourages all enrolled members to sign up for EFT as the most efficient way to receive claims reimbursements. This is a particularly important benefit for our members who live overseas, as it allows them to receive reimbursements directly into a U.S. bank account without having to wait weeks to receive checks by postal mail.   

 

Your right to access your protected health information

FSBP is HIPAA compliant. The confidential medical information (i.e., Protected Health Information (PHI)) that you provide to us is kept strictly confidential and secure in our records. Click here for our Notice of Privacy Practices.

By law, you or your legal representative has the right to view and/or get copies of your protected health information from health care providers who treat you, or by health plans that pay for your care. You also have the right to have a provider or plan send copies of your information to a third party that you choose, such as other providers who treat you, a family member, a researcher, or a mobile “app” you use to manage your PHI.

This includes:

  • Medical and billing records (except psychotherapy notes)
  • Information related to your enrollment in health plans
  • Claims and case management records
  • Any other records that contain information that doctors or health plans use to make decisions about you or others

Your providers and plans should have an easy process for you to ask for your health information, and you should be able to ask for it at a time and place that’s convenient for you. You may have to fill out a health information “request” form, and pay a reasonable, cost-based fee for copies. Your providers or plans must tell you about the fee when you make the request. The fee can only be for the labor to make the copies, copying supplies, and postage (if needed). In most cases, you shouldn’t be charged for viewing, searching, downloading, or sending your information through an electronic portal.

Generally, you can get your information on paper or electronically. If your providers or plans store your information electronically, they generally must give you electronic copies unless there are security concerns. However, you do have a right to get your records through unencrypted email if you prefer.

You have the right to get your information as quickly as possible, but it may take up to 30 days to fill the request.

For more information, visit HHS's HIPAA information page.  


Enrollment codes for the Foreign Service Benefit Plan (FSBP) are:

  • 401 High Option – Self Only
  • 403 High Option – Self Plus One
  • 402 High Option – Self and Family

Enroll online using your agency’s preferred method:

Or, fill out the SF 2809 Form and submit a copy to your Human Resource office.

Annuitants of the Foreign Service are eligible to enroll also; to do so, please contact the Foreign Service Retirement System through the Retirement Division of the Department of State.

Once the Plan has been notified of your enrollment, we will mail you your FSBP ID card, including cards for any dependents you enrolled. The FSBP ID Card is a combined health and prescription plan ID card.  You should carry your ID card with you at all times, even when you travel or reside in a foreign country. Showing your ID card to your healthcare providers and pharmacies in the U.S. and to those facilities abroad with whom we have Direct Billing Arrangements will enable them to bill us appropriately – so you don’t have to pay additional costs.

You may enroll during the annual Federal Employees Health Benefits Open Season. In addition, you may be eligible to enroll or change your enrollment if you have a qualifying life event (QLE). QLEs include marriage, divorce, or the birth or adoption of a child.  For a complete list of QLEs visit OPM’s website.

 

2017 Rate Information for the FSBP

Type of Enrollment

Enrollment Code

Premium

Biweekly

Monthly

Gov’t. Share

Your Share*

Gov’t. Share

Your Share*

Self Only

 401

 $ 193.32

 $   64.44

 $  418.86

 $ 139.62

Self Plus One

 403

 $ 473.52

 $ 157.84

 $ 1,025.96

 $ 341.99

Self and Family

 402

 $ 478.25

 $ 159.41

 $ 1,036.20

 $ 345.40

*We display here the government share of the premium for informational purposes. The column labeled "Your Share" under "Biweekly" or "Monthly" equals your premium payment.

 


General claim submission for members

Claims should be submitted via the AFSPA Member Portal for the quickest processing. To submit a claim using the Member Portal, you should complete a claim form with your first claim submission for each family member, and at least once per year per covered member, so that we have current address and other insurance information. Use the fillable PDF here. The completed form must be saved (or scanned) and then uploaded to the Member Portal with a PDF of your claim.

If you cannot scan the completed claim form to upload it to our Member Portal, please mail it and your claim to us at Foreign Service Benefit Plan, 1620 L Street, NW, Suite 800, Washington, DC 20036-5629.

For massage therapy claims, please make sure the therapist’s license or certification number (and Tax ID number if available, for providers in the U.S.) are on the bill; and if you paid for these services, please provide a receipt.

 

How a member submits a claim – U.S.

If your provider is in our network, generally, your provider will bill us with the appropriate information.  If we need more information, we will contact your provider or you directly. 

If your provider is not in our network and he or she will not bill us, you should obtain a fully itemized bill prepared by the provider that contains the information referenced in Section 7 of the FSBP Brochure, Filing a claim for covered services

You do not need to fill out a claim form for each claim you submit. We do, however, ask you to complete one claim form each year for every covered member of your family in order to make sure we have your current address and other insurance information. Your payroll/HR office does not advise us of address changes.  You also can update your address in the Member Portal.

 

How a member submits a claim – Overseas

Be sure to provide us with the member name, address, and dependent name if applicable; include a description of the sickness or accident and physician’s name and address (if not included on the bill).

If the bill from your provider is not fully itemized, please provide the following information on a separate sheet of paper submitted with your claim and the bill:

  • Patient name and date of birth
  • Subscriber ID number
  • Provider name and address (if not included on the bill)
  • Date(s) of service
  • Diagnosis or a description of your symptoms (not required for prescription medicine receipts)
  • A brief description of each service or supply
  • Charge for each service or supply

Be sure to submit this information on a separate piece of paper. Do not write on the bill itself.

If you have received care from a provider with whom we have a Direct Billing Arrangement, you should not have paid for anything except for any deductible or coinsurance you might owe. The provider will bill us directly and we pay the provider for covered services.

All of this information can be submitted online in the Member Portal. And, you will receive reimbursement more quickly if you not only submit your claim online in the Member Portal, but also use Electronic Funds Transfer (EFT) for your claim reimbursement (complete the registration form for EFT found in My Online Services). 

 

Coordination of Benefits according to the National Association of Insurance Commissioners (NAIC)

The most common rules for determining the order of payment are the Non-Dependent / Dependent Rule, the Active / Inactive Rule and the Birthday Rule.

  • Non-dependent / Dependent Rule: The plan that covers an individual as an enrollee or subscriber is the primary payer over a plan that covers an individual as a dependent, for example, as a spouse.
  • Active / Inactive Rule: The plan that covers an individual as an active employee or as the dependent of an active employee is the primary payer over the plan that covers the individual as a retired or laid off employee or as the dependent of such an employee.
  • Birthday Rule: This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents' benefit plans and those parents live together. The plan covering the parent whose birthday (month and day only) falls first in a calendar year provides primary coverage for the child. If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.

A different set of rules applies to a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:

  1. If a court decree states that one of the parents is responsible for the child’s health care expenses / coverage (“health care coverage responsibility”) and the plan covering that parent has actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child’s health care expenses, but that parent’s spouse does, that parent’s spouse’s plan is the primary plan.
  2. If a court decree states that both parents are responsible for the child’s health care expenses / coverage, the Birthday Rule determines the order of benefits;
  3. If a court decree states that the parents have joint custody without specifying that one parent has health care coverage responsibility, the Birthday Rule determines the order of benefits; or
  4. If there is no court decree allocating health care coverage responsibility for the child, the order of benefits for the child is as follows:
    1. The plan covering the custodial parent;
    2. The plan covering the custodial parent’s spouse;
    3. The plan covering the non-custodial parent; and then
    4. The plan covering the non-custodial parent’s spouse.

For additional information on NAIC rules regarding the coordinating of benefits, visit NAIC.


We understand the unique challenges our members face when they are outside the U.S. When processing claims from outside the U.S., we will:

  • Translate your claims.
  • Use the U.S. dollar exchange rate applicable on the date the claim was processed, if you do not supply us with a currency exchange rate (see FSBP Brochure, Section 7, Overseas claims  for exceptions).
  • Accept foreign providers’ charges generally as billed. In other words, there are no reductions to Plan allowance or fee schedules. However, we reserve the right to request information that will enable us to determine medical necessity or an allowance on charges that we deem to be excessive.
  • Process all types of foreign bills as a priority, generally within 15 days.
  • Provide you with access to Direct Billing Hospitals so you do not have to worry about up-front costs.
  • Provide secure electronic claim and correspondence submission.
  • Offer Electronic Funds Transfer (EFT), so that you can receive claim reimbursements more quickly.
  • Offer you Overseas Second Opinion through the eCleveland Clinic (see below for details)

For the most efficient processing of claims – and to receive your reimbursements as quickly as possible:

  1. Register to use the AFSPA Member Portal so you can submit claims electronically, thereby eliminating mail time.
  2. Complete registration for EFT using the Authorization Form found in My Online Services, thereby reducing your wait time for claim reimbursement. See Convenience for instructions.

Or, you can mail in your claim the Foreign Service Benefit Plan, 1620 L Street, NW, Suite 800, Washington DC, 20036-5629. 

Bear in mind, mail from overseas significantly increases the time for you to receive claim reimbursement.

For more information about how to submit a claim, please visit Claims or review the FAQs below. 


FSBP uses the Aetna Choice POS II (Open Access) network, one of the largest nationwide networks of healthcare providers encompassing all 50 states. For our members living in Guam, FSBP uses the NetCare Guam network, with access to primary care and specialists on the island.

Find a provider.

 

About in- and out-of-network providers

When you use an in-network provider, you receive covered services at a reduced cost; and your liability after our benefit payment is lower than for a non-network provider. Thus, seeing an in-network provider will reduce your out-of-pocket costs significantly. 

You do not have to choose a primary care physician and you can self-refer to see a specialist. We encourage you to find a primary care provider you are comfortable with in order optimize your health outcomes. 

To ensure you receive in-network benefits, verify that the provider you will see is in-network at the time you make the appointment. Verify that the address at which you will be seen is the address on file when you use the Provider Lookup (sometimes a provider chooses to be in-network at one location but not another). Be sure to have your FSBP ID card on hand at the time of your appointment. 

Generally, you will not need to pay an in-network provider at the time of your visit. You have no out-of-pocket costs for covered routine preventive care and immunizations when rendered by an in-network provider. In-network providers will bill the plan directly and will bill you for any remaining balance after they receive our payment.

If your provider is not in-network, you may nominate him or her to be in the Plan’s network by completing and submitting this form. Aetna will reach out to the provider to begin negotiations.

If you choose to see an out-of-network provider within the 50 U.S. states or Guam, you may be charged at least a portion of the cost of care at the time of your appointment. The provider may bill us or ask you to submit the claim to receive reimbursement (click over to the grey Claims tab here for step-by-step instructions).   

 

About Overseas Providers

The FSBP considers all covered providers outside the U.S. and Guam (including Military Treatment Facilities) as if they are in the Plan’s network. We provide the same coinsurance rates as we do for in-network providers. We generally consider foreign providers’ charges as billed. However, we reserve the right to request information that will enable us to determine medical necessity or an allowance on charges we deem to be excessive.  

 

About Medicare and Providers

When Medicare is your primary insurer, FSBP coordinates benefits with Medicare and generally pays the balance of covered charges, whether you use an in- or out-of-network provider. In most cases, members who have Medicare as primary coverage are not affected by the choice of an out-of-network provider because of coordination of benefits between Medicare and FSBP.  For more information, see our brochure and video.


At FSBP, we want to make accessing information about healthcare, the plan, and claims, as well as claims submission, as easy as possible for our members. We offer several convenience programs to make life a little easier.

 

Online Claim Submission

Register to use the AFSPA Member Portal so you can submit claims electronically, thereby eliminating mail time.

 

Electronic Funds Transfer (EFT)

This is the quickest way to get your claims reimbursement into your bank account, whether you reside in the U.S. or abroad. Signing up for this service is simple. You can find the Authorization Form using this EFT link. Complete the form in full and return it by mail or fax with a voided check or savings withdrawal slip attached to it.

Important things to know:

  • Only one bank account per family is permitted.
  • The Authorization Form only allows the Plan to deposit funds into your bank account. The Plan cannot retrieve funds from your bank account.
  • The plan does not charge a fee for EFT service but your bank may charge a small transaction fee.

When you receive claim reimbursement via EFT, your Explanation of Benefits (EOB) will be available to you and will no longer be mailed to you. To view your EOB, logon to My Online Services (MOS).

You may opt to have a paper copy of your EOB mailed to you by checking the box at the bottom of the Authorization Form indicating your desire to continue to receive a paper EOB.

Quest Diagnostics – Outpatient Lab Card

Members may use our voluntary program for covered outpatient lab tests at no cost- no deductible, no copays and no coinsurance! This benefit can be used only in the 50 United States. Members returning to the 50 United States for vacation, or for seeking medical care and/or treatment while visiting the 50 United States, can utilize this benefit for covered outpatient lab tests.

A Lab Card packet mailed to subscribing members contains a welcome letter, a document explaining how the Lab Card program works, two (2) Lab Cards and four (4) stickers to affix to the FSBP ID card(s) or personal files at the Doctors office. All Lab Cards will contain the subscriber’s information but can also be used by dependents.

To use the benefit, simply present your Quest Diagnostics Lab Card and/or FSBP ID card with the Lab Card sticker affixed to it and tell your physician you would like to use the Quest Outpatient Lab Card benefit.

If the physician draws the specimen, he/she can call 800-646-7788 for pick up; or you can go to an approved collection site and show your FSBP ID card and /or Quest Diagnostics Lab Card along with the test requisition form from your physician and have the specimen drawn there.

To find an approved collection site near you, call 800-646-7788 or visit www.LabCard.com , select the option “collection site finder.”

To get a temporary Lab card, call 800-646-7788; visit www.Labcard.com, select the option “print a temporary card” or email [email protected]

 

Telehealth Services

FSBP is pleased to offer members residing in the 50 United States, through American Well (Amwell our telehealth vendor), 24/7 access to telehealth consultations with Doctors of Medicine (MD); Registered Dieticians (RD); Licensed Clinical Social Workers (LSCW) and Psychologists. With telehealth, you can address problems ranging from colds, flu, fever, wound care to therapist counseling for concerns such as depression, anxiety, stress as well as a dietician for diet nutrition help.   Telehealth can be accessed via video visits through the web or mobile device to obtain a consultation, diagnosis and prescription (when appropriate).

To sign up

1. Download the iOS or Android App by searching for "Amwell" at your mobile device's app store.

2. Sign-up on the web at https://amwell.com/landing.htm or sign-up by phone, call 844-733-3627.

3. To learn more, click here to go to AmWell’s homepage.

Because of the complexity of medical licensure/prescribing laws among the 50 United States and foreign countries, we cannot offer this service to members outside the United States.  We are working with Aetna and Amwell regarding this.

 

24-Hour Hotlines

To provide you with necessary expertise when you need it, no matter when you need it, we offer two 24-hour hotlines. 

  • The Nurse Advice Line allows members to speak with a live registered nurse for urgent needs.  Dial 1-855-482-5750, or 1-705-834-6782, and choose option 1.
  • The Translation Line provides telephonic language translation services in an emergency for our overseas members.  Dial 1-855-482-5750, or 1-705-834-6782, and choose option 2. 
  • Find more information in More Wellness Programs.

 

FSAFEDS Paperless Reimbursement

If you take advantage of this health flexible savings account, FSBP offers a Paperless Reimbursement option. 

  • You will receive reimbursement for your out-of-pocket expenses directly into your bank account from your FSAFEDS account. 
  • In many cases, you will receive your reimbursement before your provider’s bill is due. 
  • To participate, you must enroll in paperless reimbursement with FSAFEDS as a new hire, during open season, or when you have a qualifying life event. 

 

Mobile Apps

The simplest way to access information about your healthcare when on-the-go, two apps are available to be downloaded for free onto your mobile device. 

You can use the Coventry® mobile app to:

  • Monitor deductibles and current out-of-pocket balances.
  • Review status of medical claims.
  • Use the symptom checker to learn about conditions and treatment options.
  • Manage health and wellness.
  • View or email a copy of your member ID card.
  • Keep your personal My Health Record updated.
  • Search for a doctor, hospital, urgent care center, or pharmacy.
  • Change member view to access dependent information.

You can use the Express Scripts Mobile App to:

  • Register for online access directly (no need to already have an account at Express-Scripts.com in order to use the app).
  • Order refills and renewals and check delivery status on home delivery prescriptions.
  • Locate a participating pharmacy.
  • Access My RX Choices® to compare medicine costs.
  • Transfer existing prescriptions to home delivery.
  • Find detailed drug information by medication name, condition or drug category; and see potential side effects, drug interactions, pill images, proper usage.
  • Receive pharmacy care alerts.

FSBP and Aetna want you to be able to make the best decisions for your care and the care of your family members, and to do that you need information. Aetna’s My Right to Know program is a comprehensive health information tool for members: it provides cost and quality information about hospitals, providers, and medications, as well as information about diagnoses, tests, treatments, and other medical issues.  

The program includes the following three tools:

  • My cost of care for diagnostic procedures, diseases and conditions, inpatient stays, physician visits, and surgical procedures.  Access it in My Online Services under the “Benefits” menu.
  • Quality measures about your physician or hospital.  In My Online Services, find “Hospital Quality Comparison” under “My Benefits” to find information such as a provider’s specialty and whether board certified, and a hospital’s accreditation and number of patient beds. Then, check the “Compare Provider” box next to each provider you are interested in and click “My Comparison” to bring up a chart directly comparing the providers you’ve selected. 
  • Healthwise ® Knowledgebase Decision Points. In My Online Services, click on “Wellness Tools” and then “Health Information/Library” to access the Healthwise Knowledgebase, which provides information on a wide variety of medical tests, medicines, surgeries, treatments, and other issues, all of which can help you make an informed decision about your medical condition and/or treatment. Then, scroll down and click on “Health Decision Tools” to access a Decision Points guide for the item you need to learn about. 

FSBP enrollees have access to several discount programs, from gym memberships to vision care. These programs are not part of the FEHB contract or premium and you cannot file an FEHB disputed claim about them. Fees you pay for these services do not count toward FEHB deductibles, copayments or catastrophic protection out-of-pocket maximums.  

Trying to Conceive? Aetna's Institutes of Excellence™ (IOE) can assist. FSBP members have access to these specialty trained providers with a  track record of improving fertility and achieving pregnancy.

Aetna's IOE Infertility network providers meet higher medical standards. This results in better quality outcomes and lower medical costs for FSBP members.

View videos on infertility treatment at: http://www.aetnainfertilitycare.com.

Find an IOE Infertility network provider at:http://fsbp.coventryhealthcare.com/

For benefit coverage, see Section 5(a), Infertility services, of the FSBP Brochure.

Plan members can receive $10 off a 3-month subscription to Weight Watchers Online. Sign up using our special Weight Watchers Promotion Code, found in your FSBP BrochureNon-FEHB benefits available to Plan members Section.

The Jawbone is a wristband that connects to a free app on your smartphone that together monitor your physical activity, including sleep cycles and eating habits. To learn more about how to use this discount, sign-in to My Online Services, select “Wellness Tools” and “Discount Programs.” For full details on this discount, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

If you’re looking for a gym to make good on your resolution to exercise more, consider joining GlobalFit first. GlobalFit offers access to thousands of gyms in the U.S., both national chains and independent local facilities, at discounted rates. GlobalFit offers flexible membership options and easy billing. They also offer guest privileges at participating network gyms when you travel, and the ability to transfer your membership to another participating gym or person – benefits of special importance to our worldwide membership. Learn more about how to take advantage of this program now by either logging on to My Online Services and selecting “Wellness tools” and then “Discount Programs” or by calling 1-800-298-7800. For full details on GlobalFit, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

AFSPA offers FSBP members special discounts on eye care in the U.S.  

The EyeMed Vision Care Program gives members the opportunity to save up to 35% off exams, glasses, and contact lenses.  

If you’ve ever thought about LASIK eye surgery, learn more about the QualSight LASIK program. The program gives FSBP members savings of 40%-50% off the overall national average price for traditional LASIK at qualified providers.  

To learn more about EyeMed Vision Care or QualSight LASIK, log on to My Online Services, select “Wellness Tools” and then “Discount Programs” or refer to the FSBP BrochureNon-FEHB benefits available to members Section.  

Overview

Welcome to the Foreign Service Benefit Plan (FSBP), a Federal Employees Health Benefits high option closed plan with an affordable premium that covers you everywhere in the world. All Federal Executive Branch employees who advance the nation’s foreign and intelligence affairs are eligible to enroll in FSBP, whether they serve at home or abroad. In fact, 60% of our members enjoy our excellent health benefits at home in the U.S.

Check your eligibility!  See a full list of the eligible agencies. 

We know how different it is to receive healthcare overseas and to claim benefits for those services, and we do everything we can to ease the process. Learn more in Overseas. At the same time, we participate in Aetna’s Choice POS II (Open Access) network, one of the largest nationwide networks of healthcare providers encompassing all 50 states, and we participate in the NetCare Guam network for our members in Guam. See Providers for more information or click here to search for an in network provider.

When you choose FSBP, you choose:

  • A plan that has achieved full three-year term comprehensive health plan accreditation by the Accreditation Association for Ambulatory Health Care, which deemed the Plan's practices in quality of care and quality of service in line with national standards.
  • A competitively priced fee-for-service high option plan that offers generous benefits worldwide. 
  • More than 900,000 network providers in the Aetna Choice POS II and NetCare Guam networks.
  • No referrals needed to see specialists – you can self-refer.
  • Coverage of up to $60 per visit for up to 40 visits per calendar year from each of the following professionals - a licensed or certified massage therapist, chiropractor, acupuncturist. 
  • Competitively priced prescription benefits from the largest Pharmacy Benefit Manager in the U.S., Express Scripts.
  • A variety of complementary programs, including a 24-hour Nurse Advice Line, a 24-hour Translation Line, myStrength online mental health support, and more. See Wellness for more information, including incentives you can earn through our Simple Steps Program.
  • A specially designed suite of programs and practices to help members living abroad, including free translation of claims, no out-of-network penalties for providers seen outside of the U.S. or Guam, acceptance of all types of foreign bills, and access to Direct Billing Hospitals so you do not have to pay upfront costs. The Plan generally considers foreign providers’ charges as billed.  See Overseas for more details.
  • No out-of-pocket costs for routine preventive or maternity care and routine preventive immunizations received from an in-network provider or overseas.
  • Secure claim submission through our Member Portal.
  • Quick claim reimbursement through electronic funds transfer (EFT).

FSBP is underwritten by AFSPA, which also performs the customer service function for the Plan. By joining FSBP you become a lifetime member of AFSPA (there are no membership dues). AFSPA works with award-winning partners to bring you generous benefits and programs. Claims and clinical functions are administered by Aetna. Aetna has been recognized numerous times in recent years for its commitment to diversity, its innovative leadership, and its commitment to supporting military families as well as the health of its own employees. Prescription coverage is administered by our Pharmacy Benefit Manager, Express Scripts, named one of the World’s Most Innovative Companies by Forbes in 2015 and one of the World’s Most Ethical Companies in 2014. See a full list of Express Script’s numerous honors here. Learn more about our pharmacy benefits under Prescriptions.

Review our premiums relative to other high option plans in the FEHB Program.

To make an informed decision about whether FSBP is the right plan for you and your family, be sure to review plan documents.  The Benefit Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

2018 Documents

2017 Documents  

You also can click through the tabs above for more information about medical, surgical, and prescription benefits, our premiums, and our many wellness and discount programs exclusively for FSBP members. The Plan Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

Once you’re enrolled in FSBP, nearly every healthcare decision you make can be better informed by using My Online Services, the Plan’s co-branded website with Aetna. You’ll see reference to this information hub throughout this website, as many of our programs are housed there, including signing up for wellness incentives, opting into electronic funds transfer (EFT), learning more about the quality and cost of your healthcare, and viewing your Explanations of Benefits (EOBs).

FSBP encourages all enrolled members to sign up for EFT as the most efficient way to receive claims reimbursements. This is a particularly important benefit for our members who live overseas, as it allows them to receive reimbursements directly into a U.S. bank account without having to wait weeks to receive checks by postal mail.   

 

Your right to access your protected health information

FSBP is HIPAA compliant. The confidential medical information (i.e., Protected Health Information (PHI)) that you provide to us is kept strictly confidential and secure in our records. Click here for our Notice of Privacy Practices.

By law, you or your legal representative has the right to view and/or get copies of your protected health information from health care providers who treat you, or by health plans that pay for your care. You also have the right to have a provider or plan send copies of your information to a third party that you choose, such as other providers who treat you, a family member, a researcher, or a mobile “app” you use to manage your PHI.

This includes:

  • Medical and billing records (except psychotherapy notes)
  • Information related to your enrollment in health plans
  • Claims and case management records
  • Any other records that contain information that doctors or health plans use to make decisions about you or others

Your providers and plans should have an easy process for you to ask for your health information, and you should be able to ask for it at a time and place that’s convenient for you. You may have to fill out a health information “request” form, and pay a reasonable, cost-based fee for copies. Your providers or plans must tell you about the fee when you make the request. The fee can only be for the labor to make the copies, copying supplies, and postage (if needed). In most cases, you shouldn’t be charged for viewing, searching, downloading, or sending your information through an electronic portal.

Generally, you can get your information on paper or electronically. If your providers or plans store your information electronically, they generally must give you electronic copies unless there are security concerns. However, you do have a right to get your records through unencrypted email if you prefer.

You have the right to get your information as quickly as possible, but it may take up to 30 days to fill the request.

For more information, visit HHS's HIPAA information page.  

Enroll

Enrollment codes for the Foreign Service Benefit Plan (FSBP) are:

  • 401 High Option – Self Only
  • 403 High Option – Self Plus One
  • 402 High Option – Self and Family

Enroll online using your agency’s preferred method:

Or, fill out the SF 2809 Form and submit a copy to your Human Resource office.

Annuitants of the Foreign Service are eligible to enroll also; to do so, please contact the Foreign Service Retirement System through the Retirement Division of the Department of State.

Once the Plan has been notified of your enrollment, we will mail you your FSBP ID card, including cards for any dependents you enrolled. The FSBP ID Card is a combined health and prescription plan ID card.  You should carry your ID card with you at all times, even when you travel or reside in a foreign country. Showing your ID card to your healthcare providers and pharmacies in the U.S. and to those facilities abroad with whom we have Direct Billing Arrangements will enable them to bill us appropriately – so you don’t have to pay additional costs.

You may enroll during the annual Federal Employees Health Benefits Open Season. In addition, you may be eligible to enroll or change your enrollment if you have a qualifying life event (QLE). QLEs include marriage, divorce, or the birth or adoption of a child.  For a complete list of QLEs visit OPM’s website.

 

2017 Rate Information for the FSBP

Type of Enrollment

Enrollment Code

Premium

Biweekly

Monthly

Gov’t. Share

Your Share*

Gov’t. Share

Your Share*

Self Only

 401

 $ 193.32

 $   64.44

 $  418.86

 $ 139.62

Self Plus One

 403

 $ 473.52

 $ 157.84

 $ 1,025.96

 $ 341.99

Self and Family

 402

 $ 478.25

 $ 159.41

 $ 1,036.20

 $ 345.40

*We display here the government share of the premium for informational purposes. The column labeled "Your Share" under "Biweekly" or "Monthly" equals your premium payment.

 

Claims

General claim submission for members

Claims should be submitted via the AFSPA Member Portal for the quickest processing. To submit a claim using the Member Portal, you should complete a claim form with your first claim submission for each family member, and at least once per year per covered member, so that we have current address and other insurance information. Use the fillable PDF here. The completed form must be saved (or scanned) and then uploaded to the Member Portal with a PDF of your claim.

If you cannot scan the completed claim form to upload it to our Member Portal, please mail it and your claim to us at Foreign Service Benefit Plan, 1620 L Street, NW, Suite 800, Washington, DC 20036-5629.

For massage therapy claims, please make sure the therapist’s license or certification number (and Tax ID number if available, for providers in the U.S.) are on the bill; and if you paid for these services, please provide a receipt.

 

How a member submits a claim – U.S.

If your provider is in our network, generally, your provider will bill us with the appropriate information.  If we need more information, we will contact your provider or you directly. 

If your provider is not in our network and he or she will not bill us, you should obtain a fully itemized bill prepared by the provider that contains the information referenced in Section 7 of the FSBP Brochure, Filing a claim for covered services

You do not need to fill out a claim form for each claim you submit. We do, however, ask you to complete one claim form each year for every covered member of your family in order to make sure we have your current address and other insurance information. Your payroll/HR office does not advise us of address changes.  You also can update your address in the Member Portal.

 

How a member submits a claim – Overseas

Be sure to provide us with the member name, address, and dependent name if applicable; include a description of the sickness or accident and physician’s name and address (if not included on the bill).

If the bill from your provider is not fully itemized, please provide the following information on a separate sheet of paper submitted with your claim and the bill:

  • Patient name and date of birth
  • Subscriber ID number
  • Provider name and address (if not included on the bill)
  • Date(s) of service
  • Diagnosis or a description of your symptoms (not required for prescription medicine receipts)
  • A brief description of each service or supply
  • Charge for each service or supply

Be sure to submit this information on a separate piece of paper. Do not write on the bill itself.

If you have received care from a provider with whom we have a Direct Billing Arrangement, you should not have paid for anything except for any deductible or coinsurance you might owe. The provider will bill us directly and we pay the provider for covered services.

All of this information can be submitted online in the Member Portal. And, you will receive reimbursement more quickly if you not only submit your claim online in the Member Portal, but also use Electronic Funds Transfer (EFT) for your claim reimbursement (complete the registration form for EFT found in My Online Services). 

 

Coordination of Benefits according to the National Association of Insurance Commissioners (NAIC)

The most common rules for determining the order of payment are the Non-Dependent / Dependent Rule, the Active / Inactive Rule and the Birthday Rule.

  • Non-dependent / Dependent Rule: The plan that covers an individual as an enrollee or subscriber is the primary payer over a plan that covers an individual as a dependent, for example, as a spouse.
  • Active / Inactive Rule: The plan that covers an individual as an active employee or as the dependent of an active employee is the primary payer over the plan that covers the individual as a retired or laid off employee or as the dependent of such an employee.
  • Birthday Rule: This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents' benefit plans and those parents live together. The plan covering the parent whose birthday (month and day only) falls first in a calendar year provides primary coverage for the child. If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.

A different set of rules applies to a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:

  1. If a court decree states that one of the parents is responsible for the child’s health care expenses / coverage (“health care coverage responsibility”) and the plan covering that parent has actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child’s health care expenses, but that parent’s spouse does, that parent’s spouse’s plan is the primary plan.
  2. If a court decree states that both parents are responsible for the child’s health care expenses / coverage, the Birthday Rule determines the order of benefits;
  3. If a court decree states that the parents have joint custody without specifying that one parent has health care coverage responsibility, the Birthday Rule determines the order of benefits; or
  4. If there is no court decree allocating health care coverage responsibility for the child, the order of benefits for the child is as follows:
    1. The plan covering the custodial parent;
    2. The plan covering the custodial parent’s spouse;
    3. The plan covering the non-custodial parent; and then
    4. The plan covering the non-custodial parent’s spouse.

For additional information on NAIC rules regarding the coordinating of benefits, visit NAIC.

Overseas

We understand the unique challenges our members face when they are outside the U.S. When processing claims from outside the U.S., we will:

  • Translate your claims.
  • Use the U.S. dollar exchange rate applicable on the date the claim was processed, if you do not supply us with a currency exchange rate (see FSBP Brochure, Section 7, Overseas claims  for exceptions).
  • Accept foreign providers’ charges generally as billed. In other words, there are no reductions to Plan allowance or fee schedules. However, we reserve the right to request information that will enable us to determine medical necessity or an allowance on charges that we deem to be excessive.
  • Process all types of foreign bills as a priority, generally within 15 days.
  • Provide you with access to Direct Billing Hospitals so you do not have to worry about up-front costs.
  • Provide secure electronic claim and correspondence submission.
  • Offer Electronic Funds Transfer (EFT), so that you can receive claim reimbursements more quickly.
  • Offer you Overseas Second Opinion through the eCleveland Clinic (see below for details)

For the most efficient processing of claims – and to receive your reimbursements as quickly as possible:

  1. Register to use the AFSPA Member Portal so you can submit claims electronically, thereby eliminating mail time.
  2. Complete registration for EFT using the Authorization Form found in My Online Services, thereby reducing your wait time for claim reimbursement. See Convenience for instructions.

Or, you can mail in your claim the Foreign Service Benefit Plan, 1620 L Street, NW, Suite 800, Washington DC, 20036-5629. 

Bear in mind, mail from overseas significantly increases the time for you to receive claim reimbursement.

For more information about how to submit a claim, please visit Claims or review the FAQs below. 

Providers

FSBP uses the Aetna Choice POS II (Open Access) network, one of the largest nationwide networks of healthcare providers encompassing all 50 states. For our members living in Guam, FSBP uses the NetCare Guam network, with access to primary care and specialists on the island.

Find a provider.

 

About in- and out-of-network providers

When you use an in-network provider, you receive covered services at a reduced cost; and your liability after our benefit payment is lower than for a non-network provider. Thus, seeing an in-network provider will reduce your out-of-pocket costs significantly. 

You do not have to choose a primary care physician and you can self-refer to see a specialist. We encourage you to find a primary care provider you are comfortable with in order optimize your health outcomes. 

To ensure you receive in-network benefits, verify that the provider you will see is in-network at the time you make the appointment. Verify that the address at which you will be seen is the address on file when you use the Provider Lookup (sometimes a provider chooses to be in-network at one location but not another). Be sure to have your FSBP ID card on hand at the time of your appointment. 

Generally, you will not need to pay an in-network provider at the time of your visit. You have no out-of-pocket costs for covered routine preventive care and immunizations when rendered by an in-network provider. In-network providers will bill the plan directly and will bill you for any remaining balance after they receive our payment.

If your provider is not in-network, you may nominate him or her to be in the Plan’s network by completing and submitting this form. Aetna will reach out to the provider to begin negotiations.

If you choose to see an out-of-network provider within the 50 U.S. states or Guam, you may be charged at least a portion of the cost of care at the time of your appointment. The provider may bill us or ask you to submit the claim to receive reimbursement (click over to the grey Claims tab here for step-by-step instructions).   

 

About Overseas Providers

The FSBP considers all covered providers outside the U.S. and Guam (including Military Treatment Facilities) as if they are in the Plan’s network. We provide the same coinsurance rates as we do for in-network providers. We generally consider foreign providers’ charges as billed. However, we reserve the right to request information that will enable us to determine medical necessity or an allowance on charges we deem to be excessive.  

 

About Medicare and Providers

When Medicare is your primary insurer, FSBP coordinates benefits with Medicare and generally pays the balance of covered charges, whether you use an in- or out-of-network provider. In most cases, members who have Medicare as primary coverage are not affected by the choice of an out-of-network provider because of coordination of benefits between Medicare and FSBP.  For more information, see our brochure and video.

Convenience

At FSBP, we want to make accessing information about healthcare, the plan, and claims, as well as claims submission, as easy as possible for our members. We offer several convenience programs to make life a little easier.

 

Online Claim Submission

Register to use the AFSPA Member Portal so you can submit claims electronically, thereby eliminating mail time.

 

Electronic Funds Transfer (EFT)

This is the quickest way to get your claims reimbursement into your bank account, whether you reside in the U.S. or abroad. Signing up for this service is simple. You can find the Authorization Form using this EFT link. Complete the form in full and return it by mail or fax with a voided check or savings withdrawal slip attached to it.

Important things to know:

  • Only one bank account per family is permitted.
  • The Authorization Form only allows the Plan to deposit funds into your bank account. The Plan cannot retrieve funds from your bank account.
  • The plan does not charge a fee for EFT service but your bank may charge a small transaction fee.

When you receive claim reimbursement via EFT, your Explanation of Benefits (EOB) will be available to you and will no longer be mailed to you. To view your EOB, logon to My Online Services (MOS).

You may opt to have a paper copy of your EOB mailed to you by checking the box at the bottom of the Authorization Form indicating your desire to continue to receive a paper EOB.

Quest Diagnostics – Outpatient Lab Card

Members may use our voluntary program for covered outpatient lab tests at no cost- no deductible, no copays and no coinsurance! This benefit can be used only in the 50 United States. Members returning to the 50 United States for vacation, or for seeking medical care and/or treatment while visiting the 50 United States, can utilize this benefit for covered outpatient lab tests.

A Lab Card packet mailed to subscribing members contains a welcome letter, a document explaining how the Lab Card program works, two (2) Lab Cards and four (4) stickers to affix to the FSBP ID card(s) or personal files at the Doctors office. All Lab Cards will contain the subscriber’s information but can also be used by dependents.

To use the benefit, simply present your Quest Diagnostics Lab Card and/or FSBP ID card with the Lab Card sticker affixed to it and tell your physician you would like to use the Quest Outpatient Lab Card benefit.

If the physician draws the specimen, he/she can call 800-646-7788 for pick up; or you can go to an approved collection site and show your FSBP ID card and /or Quest Diagnostics Lab Card along with the test requisition form from your physician and have the specimen drawn there.

To find an approved collection site near you, call 800-646-7788 or visit www.LabCard.com , select the option “collection site finder.”

To get a temporary Lab card, call 800-646-7788; visit www.Labcard.com, select the option “print a temporary card” or email [email protected]

 

Telehealth Services

FSBP is pleased to offer members residing in the 50 United States, through American Well (Amwell our telehealth vendor), 24/7 access to telehealth consultations with Doctors of Medicine (MD); Registered Dieticians (RD); Licensed Clinical Social Workers (LSCW) and Psychologists. With telehealth, you can address problems ranging from colds, flu, fever, wound care to therapist counseling for concerns such as depression, anxiety, stress as well as a dietician for diet nutrition help.   Telehealth can be accessed via video visits through the web or mobile device to obtain a consultation, diagnosis and prescription (when appropriate).

To sign up

1. Download the iOS or Android App by searching for "Amwell" at your mobile device's app store.

2. Sign-up on the web at https://amwell.com/landing.htm or sign-up by phone, call 844-733-3627.

3. To learn more, click here to go to AmWell’s homepage.

Because of the complexity of medical licensure/prescribing laws among the 50 United States and foreign countries, we cannot offer this service to members outside the United States.  We are working with Aetna and Amwell regarding this.

 

24-Hour Hotlines

To provide you with necessary expertise when you need it, no matter when you need it, we offer two 24-hour hotlines. 

  • The Nurse Advice Line allows members to speak with a live registered nurse for urgent needs.  Dial 1-855-482-5750, or 1-705-834-6782, and choose option 1.
  • The Translation Line provides telephonic language translation services in an emergency for our overseas members.  Dial 1-855-482-5750, or 1-705-834-6782, and choose option 2. 
  • Find more information in More Wellness Programs.

 

FSAFEDS Paperless Reimbursement

If you take advantage of this health flexible savings account, FSBP offers a Paperless Reimbursement option. 

  • You will receive reimbursement for your out-of-pocket expenses directly into your bank account from your FSAFEDS account. 
  • In many cases, you will receive your reimbursement before your provider’s bill is due. 
  • To participate, you must enroll in paperless reimbursement with FSAFEDS as a new hire, during open season, or when you have a qualifying life event. 

 

Mobile Apps

The simplest way to access information about your healthcare when on-the-go, two apps are available to be downloaded for free onto your mobile device. 

You can use the Coventry® mobile app to:

  • Monitor deductibles and current out-of-pocket balances.
  • Review status of medical claims.
  • Use the symptom checker to learn about conditions and treatment options.
  • Manage health and wellness.
  • View or email a copy of your member ID card.
  • Keep your personal My Health Record updated.
  • Search for a doctor, hospital, urgent care center, or pharmacy.
  • Change member view to access dependent information.

You can use the Express Scripts Mobile App to:

  • Register for online access directly (no need to already have an account at Express-Scripts.com in order to use the app).
  • Order refills and renewals and check delivery status on home delivery prescriptions.
  • Locate a participating pharmacy.
  • Access My RX Choices® to compare medicine costs.
  • Transfer existing prescriptions to home delivery.
  • Find detailed drug information by medication name, condition or drug category; and see potential side effects, drug interactions, pill images, proper usage.
  • Receive pharmacy care alerts.
My Right to Know

FSBP and Aetna want you to be able to make the best decisions for your care and the care of your family members, and to do that you need information. Aetna’s My Right to Know program is a comprehensive health information tool for members: it provides cost and quality information about hospitals, providers, and medications, as well as information about diagnoses, tests, treatments, and other medical issues.  

The program includes the following three tools:

  • My cost of care for diagnostic procedures, diseases and conditions, inpatient stays, physician visits, and surgical procedures.  Access it in My Online Services under the “Benefits” menu.
  • Quality measures about your physician or hospital.  In My Online Services, find “Hospital Quality Comparison” under “My Benefits” to find information such as a provider’s specialty and whether board certified, and a hospital’s accreditation and number of patient beds. Then, check the “Compare Provider” box next to each provider you are interested in and click “My Comparison” to bring up a chart directly comparing the providers you’ve selected. 
  • Healthwise ® Knowledgebase Decision Points. In My Online Services, click on “Wellness Tools” and then “Health Information/Library” to access the Healthwise Knowledgebase, which provides information on a wide variety of medical tests, medicines, surgeries, treatments, and other issues, all of which can help you make an informed decision about your medical condition and/or treatment. Then, scroll down and click on “Health Decision Tools” to access a Decision Points guide for the item you need to learn about. 
Non-FEHB Programs

FSBP enrollees have access to several discount programs, from gym memberships to vision care. These programs are not part of the FEHB contract or premium and you cannot file an FEHB disputed claim about them. Fees you pay for these services do not count toward FEHB deductibles, copayments or catastrophic protection out-of-pocket maximums.  

Trying to Conceive? Aetna's Institutes of Excellence™ (IOE) can assist. FSBP members have access to these specialty trained providers with a  track record of improving fertility and achieving pregnancy.

Aetna's IOE Infertility network providers meet higher medical standards. This results in better quality outcomes and lower medical costs for FSBP members.

View videos on infertility treatment at: http://www.aetnainfertilitycare.com.

Find an IOE Infertility network provider at:http://fsbp.coventryhealthcare.com/

For benefit coverage, see Section 5(a), Infertility services, of the FSBP Brochure.

Plan members can receive $10 off a 3-month subscription to Weight Watchers Online. Sign up using our special Weight Watchers Promotion Code, found in your FSBP BrochureNon-FEHB benefits available to Plan members Section.

The Jawbone is a wristband that connects to a free app on your smartphone that together monitor your physical activity, including sleep cycles and eating habits. To learn more about how to use this discount, sign-in to My Online Services, select “Wellness Tools” and “Discount Programs.” For full details on this discount, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

If you’re looking for a gym to make good on your resolution to exercise more, consider joining GlobalFit first. GlobalFit offers access to thousands of gyms in the U.S., both national chains and independent local facilities, at discounted rates. GlobalFit offers flexible membership options and easy billing. They also offer guest privileges at participating network gyms when you travel, and the ability to transfer your membership to another participating gym or person – benefits of special importance to our worldwide membership. Learn more about how to take advantage of this program now by either logging on to My Online Services and selecting “Wellness tools” and then “Discount Programs” or by calling 1-800-298-7800. For full details on GlobalFit, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

AFSPA offers FSBP members special discounts on eye care in the U.S.  

The EyeMed Vision Care Program gives members the opportunity to save up to 35% off exams, glasses, and contact lenses.  

If you’ve ever thought about LASIK eye surgery, learn more about the QualSight LASIK program. The program gives FSBP members savings of 40%-50% off the overall national average price for traditional LASIK at qualified providers.  

To learn more about EyeMed Vision Care or QualSight LASIK, log on to My Online Services, select “Wellness Tools” and then “Discount Programs” or refer to the FSBP BrochureNon-FEHB benefits available to members Section.  

FAQs (11)

What information should I include when I submit a claim?

If the bill from your provider is not fully itemized, please provide the following information on a separate sheet of paper submitted with your claim and the bill:

  • 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.
How do I submit a claim online?

The process to submit a claim online is simple: login to the AFSPA Member Portal with your username and password. Once inside the portal, scroll down to the FSBP section. Click on the “Secure Docs” tab on the right and 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 significantly delay your claim’s processing.

How do I find an in-network provider?

Visit the FSBP provider search page. Choose the appropriate link: either the “Aetna Choice POS II (Open Access)” link, which will take you to the Aetna network provider search and should be used by most of our enrollees; or, the “NetCare-Guam” link, which will take you to the Guam provider search. The “NetCare-Guam” link should ONLY be used if you are looking for a provider in Guam. All other locations should use the Aetna link. In either case, enter your search terms (zip code and provider name or specialty, or just zip code) and click “Go.”  

How can my provider verify my enrollment under the FSBP?

The provider should use the website www.directprovider.com; this website is listed on the front and back of your ID card. They can also dial (202) 833-5751.

What is the calendar year deductible?
  • 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 provides (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).

Once your deductible is satisfied, you have “Catastrophic Protection.” You can think of this as a ceiling on your out-of-pocket expenses. For those services charging coinsurance, rather than a copay, FSBP pays 100% of the Plan allowance for the remainder of the calendar year when payments exceed $5,000 for Self Only enrollment or $7,000 per person for Self Plus One or Self and Family for in-network providers and providers outside the United States and Guam.  For out-of-network providers on services charging coinsurance, the corresponding limits are $7,000 for Self Only and $9,000 for Self Plus One or Self and Family.  There are some expenses that do not fall under this rule; see your Plan Brochure, Section 4, Your Costs for Covered Services. 

How do I order a replacement ID card?

Login to My Online Services (if it is your first time, you will need to follow the instructions at the site to register as a user). Select “Member Info” at the top of the page, and then choose to either have a new ID card mailed to you or to view your ID card. If you choose to view your ID card, you will see a PDF copy, which you can save and/or print.

I need to update my address. How can I do that online?

You can update your address in the AFSPA 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.   

What's the difference between My Online Services and the AFSPA Member Portal?

My Online Services (MOS) is an Aetna system that provides members with greater access to information and tools regarding their health. Every enrollee and dependents ages 14 and older have their own separate login credentials for this site.

Many FSBP programs are housed in your MOS account, including signing up for wellness incentives, seeing your Health Risk Assessment results, opting into electronic funds transfer (EFT), learning more about the quality and cost of your healthcare, and viewing your Explanations of Benefits (EOBs).

The AFSPA Member Portal is a custom system for AFSPA members. It can be used to upload claims, update addresses, and enroll in and manage certain Ancillary Insurance Programs. The Member Portal is only open to the AFSPA member, not dependents. We recommend having a Member Portal account in order to allow for the fastest processing of claims.

I'm leaving Federal service, or, my dependent is about to turn 26. Can we continue to use FSBP?

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 Temporary Continuation of Coverage (TCC), the Federal government’s version of COBRA, for up to 36 months. You may become eligible for TCC yourself, for up to 18 months, if you leave Federal service or if you lose coverage because you no longer qualify as a family member of a Federal employee. For more information about TCC, please visit OPM’s TCC site.  

Only 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.

I'm currently overseas and in need of a second opinion. What are my options for seeing another provider?

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 choosing while serving overseas, the consultation and any tests or services they require will be covered in the same way as any overseas provider. See Overseas in All About FSBP

What does the blue dot mean next to my doctor's name in the online search? Or, what is the Aexcel network?

FSBP provides access to Aetna’s Aexcel specialists network. Aexcel is a designation for doctors and doctor groups in 12 medical specialty areas:

  • Cardiology
  • Obstetrics and gynecology
  • Cardiothoracic surgery
  • Orthopedics
  • Gastroenterology
  • Otolaryngology/ENT
  • General surgery
  • Plastic surgery
  • Neurology
  • Urology
  • Neurosurgery
  • Vascular surgery

Doctors with the Aexcel designation will have a blue star next to their listing in the provider search results or you may choose the option to “Show Only Aexcel Providers” when you submit your search terms. The Evaluation Standards are:

  • Volume: In order to compare like practices, Aetna first evaluates volume by identifying doctors who have managed at least 20 episodes of care for Aetna members over the past three years.
  • Clinical Performance: Doctors must meet standards in one of five categories.  Those categories are (1) use of technology; (2) alignment with Institutes of Quality®; (3) certification by an external entity such as the National Committee for Quality Assurance; (4) performance-based improvement model; or (5) claim-based measures.
  • Efficiency: Aetna examines what these doctors charge Aetna members for services and how many and what types of services they perform.  Aetna considers all costs of care, the number of patients served with chronic or complex conditions, and risk-adjustment factors like age, gender, and disease risk.

What if a specialist does not have a blue star? 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.

 

FORMS & BROCHURES (9)

Form

Description

Action

FSBP Claim Form
FSBP Claim Form
Health Benefits Registration Form (sf2809)
Health Benefits Registration Form (sf2809)
FEHBP Urine Drug Testing Coverage
FEHBP Urine Drug Testing Coverage
How to Read Your Explanation of Benefits (EOB)
How to Read Your Explanation of Benefits (EOB)
Network Provider Nomination Form
Network Provider Nomination Form
Ask FSBP Benefits and Claims Questions
Ask FSBP Benefits and Claims Questions
Authorized Representative Form
Authorize a personal representative to obtain/discuss protected health information with us.
Deemed Exhaustion Notice
How to file a formal appeal with us regarding a benefit determination
FSBP Electronic Funds Transfer (EFT) Form
FSBP Electronic Funds Transfer (EFT) Form