Welcome to the Foreign Service Benefit Plan (FSBP), a Federal Employees Health Benefits (FEHB) 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 health care overseas and to claim benefits for those services, and we do everything we can to ease the process. Learn more in Overseas. In the United States we participate in Aetna’s Choice POS II (Open Access) network, one of the largest nationwide networks of health care 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 (AAAHC), 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 1 million 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 and Healthwise Knowledgebase, a 24-hour Translation Line, Health Coaching, 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 care, routine immunizations or complete maternity care received from an in-network provider or overseas provider.
  • 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 Admired Companies by Fortune in 2017 and one of DiversityInc’s 25 Noteworthy Companies in 2016. 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 FSBP 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 FSBP Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

Once you’re enrolled in FSBP, you can make better informed decisions about your health by using Aetna Navigator, the Plan’s website tool. You’ll see reference to this throughout this website, as many of our programs are housed there, including interactive health tools, signing up for wellness incentives, opting into electronic funds transfer (EFT), learning more about the quality and cost of your health care, 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:

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. The card will list covered family members. The FSBP ID Card is a combined health and prescription plan ID card.  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 health care providers and pharmacies in the U.S. and to those providers 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, the birth or adoption of a child or death of a spouse/dependent. For a complete list of QLEs visit OPM’s website.

 

2018 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

 $ 198.17

 $   66.05

 $  429.36

 $ 143.12

Self Plus One

 403

 $ 485.36

 $ 161.78

 $ 1,051.61

 $ 350.53

Self and Family

 402

 $ 490.22

 $ 163.40

 $ 1,062.14

 $ 354.04

*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 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. Your payroll/HR office does not advise us of address changes. Use the fillable PDF Claim Form 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 and upload your claim to our Member Portal, please mail it 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 itemized bill; and if you paid for these services, please provide a receipt.

Click here to learn more about filing a massage claim.

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

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).

When filing a claim for services rendered by an overseas provider, bills and receipts should be itemized and show:

  • 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

If you have received care from a provider with whom we have a Direct Billing Arrangement, the only expense you may be responsible for is your deductible and/or coinsurance and any non-covered services. The provider will bill us directly and we pay the provider for covered services.

All of the information for your claim can be submitted via the Member Portal. And, you will receive reimbursement faster if you submit your claim in the Member Portal and also use Electronic Funds Transfer (EFT) for your claim reimbursement. The registration form for EFT can also be found in Aetna Navigator. 

*You can still access you claims for December 31, 2017, and earlier at My Online Services (MOS). You may want to download your claims and EOBs before the site is taken down at the end of 2018.

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 service was incurred, if you do not supply us with a currency exchange rate along with a paid receipt (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 10 business 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 faster.
  • Offer you Overseas Second Opinion through the e-Cleveland Clinic
    For the most efficient processing of claims – and to receive your reimbursements as quickly as possible:
  1. Register to use the Member Portal so you can submit claims electronically, thereby eliminating mail time.
  2. Complete registration for EFT using the Authorization Form found in Aetna Navigator thereby reducing your wait time for claim reimbursement.See Convenience for instructions.

Or, you can mail in your claim to:
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 health care 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 a Provider Nomination Form Aetna will reach out to the provider to begin negotiations.

If you choose to see an out-of-network provider within the 50 United 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 (see Claims 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 Medicare and Foreign Service Benefit Plan Pamphlet and Medicare and the FEHB Program Video.


At FSBP, we want to make accessing information about health care, 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 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. Complete the Authorization 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 electronically and will no longer be mailed to you. To view your EOB, logon to Aetna Navigator.

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.

To use the benefit, simply present your FSBP ID card, which shows the Quest Diagnostics Lab Card logo 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 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].com.

Telehealth Services

Telehealth Services in the 50 United States

FSBP offers 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, rash, ear infections and migraines to therapist counseling for concerns such as depression, anxiety, stress as well as a dietician for diet and 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, Amwell cannot offer this service to members outside the United States.

Telehealth Services Outside the 50 United States

Telehealth consultations are available for members outside the 50 United States for mental health and substance misuse disorder services when your covered provider uses a Health Insurance Portability and Accountability Act (HIPAA) compliant tool such as Vidyo or Bluejeans for facilitating telehealth consultations. Members will be responsible for 10% of the Plan allowance after the calendar year deductible is satisfied.

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. 

  • Informed Health Line (the Plan’s 24-Hour Nurse Advice Line) provides members with telephone access to registered nurses experienced in providing information on a variety of health topics. Dial 855-482-5750, or 704-834-6782, and choose option 1.
  • The Translation Line provides telephonic language translation services in an emergency for our overseas members.  Dial 855-482-5750, or 704-834-6782, and choose option 2.
  • Find more information in More Wellness Programs.


FSAFEDS Paperless Reimbursement

If you take advantage of this health care 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 health care when on-the-go, two apps are available to be downloaded for free onto your mobile device. 

You can use the Aetna Mobile App to:

  • Find doctors and facilities using location and see maps for directions
  • Save doctors and facilities to contacts to use text and email
  • Locate urgent care - walk-in clinics, urgent care clinics, emergency rooms
  • View claims and claim details
  • View benefits and balances
  • Track out-of-pocket dollars
  • View ID card information
  • Store ID card offline
  • Save money by using Member Payment Estimator to compare cost estimates
  • View your Health History

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 pharmacy including Smart90® pharmacies;
  • Access Price a Medication to find and compare medicine costs;
  • Transfer existing prescriptions to home delivery;
  • Find all your detailed drug information by medication name, dosage condition or drug category and see potential side effects, drug interactions, pill images, proper usage;
  • Set dosage and refill reminders; and Receive pharmacy care alerts.

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: provider search

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

Plan members can receive a three-month program plus $50 in food savings or save 50% off premium programs. To learn more, visit the Plan’s Aetna Navigator, look for the “Stay Healthy” icon, select “Discounts” and then “Weight Management” to locate the Jenny Craig offerings. Click on the ‘Register online” link to sign up.

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 logging on to Aetna Navigator, look for the “Stay Healthy” icon and select “Discounts” and then “Fitness.”. For full details on GlobalFit, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

You may purchase non-covered (off-plan) prescription drugs at a discount directly from the Express Scripts PharmacySM such as:

• Dermatologicals (Renova)
• Erectile dysfunction agents
• Drugs labeled for cosmetic indications (Propecia)

You pay 100% of the discounted price. You cannot file a claim for off-plan prescriptions. Call the Pharmacy first at 800-818-6717 to find out the price of off-plan prescriptions. Obtain a prescription from your prescriber, complete a home delivery form and enclose the prescription with your check or credit card number. Include full payment.

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.  

Save 15% off standard prices or 5% off promotional prices for LASIK services obtained
through the U.S. Laser Network. Call U.S. Laser Network customer service at
800-422-6600 to get started. To learn more about EyeMed Vision Care, log on to Aetna Navigator, look for the “Stay Healthy” icon, select “Discounts” and then “Vision” or refer to the FSBP BrochureNon-FEHB benefits available to members Section.  

Check out AFSPA's Ancillary Insurance Programs to learn about other programs and services available to AFSPA members.

 

Overview

Welcome to the Foreign Service Benefit Plan (FSBP), a Federal Employees Health Benefits (FEHB) 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 health care overseas and to claim benefits for those services, and we do everything we can to ease the process. Learn more in Overseas. In the United States we participate in Aetna’s Choice POS II (Open Access) network, one of the largest nationwide networks of health care 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 (AAAHC), 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 1 million 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 and Healthwise Knowledgebase, a 24-hour Translation Line, Health Coaching, 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 care, routine immunizations or complete maternity care received from an in-network provider or overseas provider.
  • 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 Admired Companies by Fortune in 2017 and one of DiversityInc’s 25 Noteworthy Companies in 2016. 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 FSBP 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 FSBP Brochure has complete information about all benefits, programs, and costs, as well as how to enroll. 

Once you’re enrolled in FSBP, you can make better informed decisions about your health by using Aetna Navigator, the Plan’s website tool. You’ll see reference to this throughout this website, as many of our programs are housed there, including interactive health tools, signing up for wellness incentives, opting into electronic funds transfer (EFT), learning more about the quality and cost of your health care, 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:

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. The card will list covered family members. The FSBP ID Card is a combined health and prescription plan ID card.  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 health care providers and pharmacies in the U.S. and to those providers 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, the birth or adoption of a child or death of a spouse/dependent. For a complete list of QLEs visit OPM’s website.

 

2018 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

 $ 198.17

 $   66.05

 $  429.36

 $ 143.12

Self Plus One

 403

 $ 485.36

 $ 161.78

 $ 1,051.61

 $ 350.53

Self and Family

 402

 $ 490.22

 $ 163.40

 $ 1,062.14

 $ 354.04

*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 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. Your payroll/HR office does not advise us of address changes. Use the fillable PDF Claim Form 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 and upload your claim to our Member Portal, please mail it 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 itemized bill; and if you paid for these services, please provide a receipt.

Click here to learn more about filing a massage claim.

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

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).

When filing a claim for services rendered by an overseas provider, bills and receipts should be itemized and show:

  • 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

If you have received care from a provider with whom we have a Direct Billing Arrangement, the only expense you may be responsible for is your deductible and/or coinsurance and any non-covered services. The provider will bill us directly and we pay the provider for covered services.

All of the information for your claim can be submitted via the Member Portal. And, you will receive reimbursement faster if you submit your claim in the Member Portal and also use Electronic Funds Transfer (EFT) for your claim reimbursement. The registration form for EFT can also be found in Aetna Navigator. 

*You can still access you claims for December 31, 2017, and earlier at My Online Services (MOS). You may want to download your claims and EOBs before the site is taken down at the end of 2018.

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 service was incurred, if you do not supply us with a currency exchange rate along with a paid receipt (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 10 business 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 faster.
  • Offer you Overseas Second Opinion through the e-Cleveland Clinic
    For the most efficient processing of claims – and to receive your reimbursements as quickly as possible:
  1. Register to use the Member Portal so you can submit claims electronically, thereby eliminating mail time.
  2. Complete registration for EFT using the Authorization Form found in Aetna Navigator thereby reducing your wait time for claim reimbursement.See Convenience for instructions.

Or, you can mail in your claim to:
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 health care 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 a Provider Nomination Form Aetna will reach out to the provider to begin negotiations.

If you choose to see an out-of-network provider within the 50 United 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 (see Claims 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 Medicare and Foreign Service Benefit Plan Pamphlet and Medicare and the FEHB Program Video.

Convenience

At FSBP, we want to make accessing information about health care, 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 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. Complete the Authorization 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 electronically and will no longer be mailed to you. To view your EOB, logon to Aetna Navigator.

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.

To use the benefit, simply present your FSBP ID card, which shows the Quest Diagnostics Lab Card logo 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 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

Telehealth Services in the 50 United States

FSBP offers 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, rash, ear infections and migraines to therapist counseling for concerns such as depression, anxiety, stress as well as a dietician for diet and 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, Amwell cannot offer this service to members outside the United States.

Telehealth Services Outside the 50 United States

Telehealth consultations are available for members outside the 50 United States for mental health and substance misuse disorder services when your covered provider uses a Health Insurance Portability and Accountability Act (HIPAA) compliant tool such as Vidyo or Bluejeans for facilitating telehealth consultations. Members will be responsible for 10% of the Plan allowance after the calendar year deductible is satisfied.

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. 

  • Informed Health Line (the Plan’s 24-Hour Nurse Advice Line) provides members with telephone access to registered nurses experienced in providing information on a variety of health topics. Dial 855-482-5750, or 704-834-6782, and choose option 1.
  • The Translation Line provides telephonic language translation services in an emergency for our overseas members.  Dial 855-482-5750, or 704-834-6782, and choose option 2.
  • Find more information in More Wellness Programs.


FSAFEDS Paperless Reimbursement

If you take advantage of this health care 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 health care when on-the-go, two apps are available to be downloaded for free onto your mobile device. 

You can use the Aetna Mobile App to:

  • Find doctors and facilities using location and see maps for directions
  • Save doctors and facilities to contacts to use text and email
  • Locate urgent care - walk-in clinics, urgent care clinics, emergency rooms
  • View claims and claim details
  • View benefits and balances
  • Track out-of-pocket dollars
  • View ID card information
  • Store ID card offline
  • Save money by using Member Payment Estimator to compare cost estimates
  • View your Health History

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 pharmacy including Smart90® pharmacies;
  • Access Price a Medication to find and compare medicine costs;
  • Transfer existing prescriptions to home delivery;
  • Find all your detailed drug information by medication name, dosage condition or drug category and see potential side effects, drug interactions, pill images, proper usage;
  • Set dosage and refill reminders; and Receive pharmacy care alerts.
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: provider search

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

Plan members can receive a three-month program plus $50 in food savings or save 50% off premium programs. To learn more, visit the Plan’s Aetna Navigator, look for the “Stay Healthy” icon, select “Discounts” and then “Weight Management” to locate the Jenny Craig offerings. Click on the ‘Register online” link to sign up.

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 logging on to Aetna Navigator, look for the “Stay Healthy” icon and select “Discounts” and then “Fitness.”. For full details on GlobalFit, please see the FSBP BrochureNon-FEHB benefits available to Plan members Section.

You may purchase non-covered (off-plan) prescription drugs at a discount directly from the Express Scripts PharmacySM such as:

• Dermatologicals (Renova)
• Erectile dysfunction agents
• Drugs labeled for cosmetic indications (Propecia)

You pay 100% of the discounted price. You cannot file a claim for off-plan prescriptions. Call the Pharmacy first at 800-818-6717 to find out the price of off-plan prescriptions. Obtain a prescription from your prescriber, complete a home delivery form and enclose the prescription with your check or credit card number. Include full payment.

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.  

Save 15% off standard prices or 5% off promotional prices for LASIK services obtained
through the U.S. Laser Network. Call U.S. Laser Network customer service at
800-422-6600 to get started. To learn more about EyeMed Vision Care, log on to Aetna Navigator, look for the “Stay Healthy” icon, select “Discounts” and then “Vision” or refer to the FSBP BrochureNon-FEHB benefits available to members Section.  

Check out AFSPA's Ancillary Insurance Programs to learn about other programs and services available to AFSPA members.

 

FAQs (13)

What information should I include when I submit a claim?

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.
How do I submit a claim online?

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 significantly delay your claim’s processing.

How do I find an in-network provider?

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.”

How can my provider verify my enrollment under the FSBP?

The provider should call 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 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).
How do I obtain an additional/replacement ID card?

Login to Aetna Navigator 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.

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

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.   

What's the difference between Aetna Navigator and the Member Portal?

Aetna Navigator 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 site.

Many FSBP programs are housed in your Aetna Navigator 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 health care, and viewing your Explanations of Benefits (EOBs).


The 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.

*You can still access your claims for December 31, 2017, and earlier at My Online Services (MOS). You may want to download your claims and EOBs before the site is taken down at the end of 2018.

 

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

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.

 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 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

What does the blue star 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. 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.
Does the Plan have a catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments?

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. 

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