All About FSBP

FSBP is a Federal Employees Health Benefits (FEHB) high option closed plan with affordable premiums 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 you serve at home or abroad. In fact, 60% of our members enjoy our excellent health benefits at home in the U.S.

When you choose FSBP, you are choosing:

Comprehensive Worldwide Coverage

For members living in the U.S., you have access to one of the largest nationwide networks of health care providers (over 1.4 million) through the Aetna Choice POS II (Open Access) network, encompassing all 50 states. For members living in Guam, FSBP participates in Guam's vast NetCare network . For members living overseas, FSBP treats every overseas provider as "in-network" and has direct billing arrangements with over 200 international facilities.

National Standards of Quality of Care

FSBP has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) since 2017 and has achieved a full three-year term comprehensive health plan reaccreditation in 2020. Achieving this accreditation shows our commitment to providing the highest levels of quality care to our members by sustaining the same high level of quality in our business practices.

FSBP is audited annually by the National Committee on Quality Assurance (NCQA) Quality of Care. These audits ensure that we continuously review medical data to improve the quality of medical care provided to our members.

Competitive Premiums with Generous Alternative Benefits

We pride ourselves in offering competitive premiums for a fee-for-service high option plan. We invite you to compare our premiums relative to other high options plans in the FEHB Program here. FSBP offers no out-of-pocket costs for routine preventive care, routine immunizations or complete maternity care received from an in-network provider or overseas provider. We offer competitively priced prescription benefits from the largest Pharmacy Benefit Manager in the U.S., Express Scripts.

FSBP provides generous coverage for unique benefits. We cover up to $60 per visit for up to 50 visits per calendar year from each of the following professionals - a licensed or certified massage therapist, chiropractor, acupuncturist.

Convenience and Overall Wellness

FSBP offers variety of complementary programs including:

• 24-hour Nurse Advice Line and Healthwise Knowledgebase
• 24-hour Translation Line
• Health coaching and mental health support programs
• Disease management programs
• Generous Wellness Rewards Program where you can earn up to $400 in Wellness Incentives every year. Learn more about our Simple Steps To Living Well Together Program.

FSBP offers 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
• Access to Direct Billing Providers so you do not have to pay upfront costs. FSBP generally considers foreign providers’ charges as billed.
• Secure claim submission through our Member Portal
• Quick claim reimbursement through electronic funds transfer (EFT)

The American Foreign Service Protective Association (AFSPA) is the self-funded carrier of FSBP and also performs the customer service function for the Plan.

Claims and clinical functions of FSBP 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, the largest pharmacy benefit management organization in the United States. Learn more about

2021 Documents

2020 Documents

• FSBP Benefit Brochure 2020
• Summary of Benefits and Programs 2020
• Summary of Benefits and Coverage (SBC) 2020
  • SBC Uniform Glossary

  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 PHI 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.

  • 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 be only 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.

  Foreign Service Benefit Plan (FSBP) 2021 Rates and Enrollment Codes:

  

  *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.

  

  Enroll online using your agency’s preferred method:

  • Employee Express: See a list of agencies participating in Employee Express
  • Department of Defense: DoD automated enrollment systems
  • Employees of agencies paid through the National Finance Center: Employee Personal Page
  • 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.

  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.

  Once we 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.

  Filing a Claim for Covered Services

  

  Enter the appropriate unique “W” ID number located on the front side of your FSBP Member ID card when submitting claims online via our secure Member Portal. We are streamlining our claims management process to improve efficiency and enhance the security of your Protected Health Information (PHI). Effective January 1, 2021, we have eliminated the option to use the last four digits of your social security number (SSN) when submitting FSBP claims online.

  How to submit a claim - U.S.

  

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

  • Patient’s 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. (Tax ID number not required for providers outside the U.S.)
  • Dates that services or supplies were furnished
  • Diagnosis
  • Type of each service or supply
  • Charge for each service or supply
  • Valid medical or ADA dental code (not required for overseas claims) or description of each service or supply

  Click here to download a claim form. We encourage you to submit your claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

  

  If you are not able to 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.

  If you are submitting an online claim for the first time, generally, you need to fill out only one claim form per year, per member. You should also fill out a claim form if you submit a claim due to accidental injury, you have changed your address, or if the member’s other insurance/Medicare status has changed.

  How to submit a claim - Overseas

  

  FSBP pays for claims for providers outside the U.S. at the in-network co-insurance benefit. When filing a claim for services rendered by an overseas provider, bills and receipts should be itemized and show:

  • Patient’s name, date of birth, address, phone number and relationship to enrollee
  • Patient’s Plan identification number
  • Full name and address of the provider, including city, postal code and country
  • Dates that services or supplies were furnished
  • Diagnosis/reason for visit Overseas Claims (include a description of the sickness or accident)
  • Type of each service or supply
  • Charge for each service or supply

  Note: We will provide translation and currency conversion services for claims for overseas (foreign) services. For more information, click here.

  We encourage you to submit your overseas claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

  

  Massage Therapy Claims - U.S. and Overseas

  

  The following information is needed on an itemized bill for reimbursement:

  • Patient’s name
  • Patient’s date of birth
  • Patient’s ID number
  • Provider/massage therapist name and business address
  • License or certification number and Federal Tax ID (for U.S. providers only)
  • Date of each service
  • Description of service rendered
  • Cost for each service
  • Copy of your paid receipt

  We encourage you to submit your documents via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

  

  Direct Billing Arrangement (DBA) Overseas Providers & Facilities

  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.

  If you have paid a direct billing provider prior to your claim submission, we request that you provide us with a copy of your paid receipt along with the exchange rate you used to convert the currency.

  We encourage you to submit your claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

  

  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.

  

  The Foreign Service Benefit Plan (FSBP) is proud to cover all providers outside the 50 U.S. at the in-network benefit. To further simplify your overseas care, FSBP also has Direct Billing Arrangements (DBA) with over 200 health care providers across the world. By using these DBA providers when available, you avoid prepaying the bill. To learn more about our DBA providers, click here.

  We use the following methods to process your foreign claims:

  • We will translate your claim(s), if you do not provide a translation.
  • We will use the U.S. dollar exchange rate, benchmarked against the rate reported by Oanda (www.oanda.com), 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 claimsfor exceptions).
  • We will 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.
  • We will process all types of foreign bills as a priority, generally within 10 business days.

  Where do I to submit foreign claims:

  1. Submit your claims via our secure Member Portal.
  2. Complete and sign an Electronic Funds Transfer (EFT) form for faster reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time. Click here for more information about signing up for EFT.
  3. For more information about how to submit an overseas claim, click here or review the FAQs below.

  You can also mail in your claim to:
  Foreign Service Benefit Plan
  1620 L Street, NW, Suite 800
  Washington DC, 20036-5629

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

  Virtual Second Opinions by Cleveland Clinic

  

  FSBP has a special arrangement with the Cleveland Clinic to provide patients who receive treatment in foreign countries a second opinion for certain diagnoses through the Cleveland Clinic.

  Patients who receive treatment in foreign countries and with qualifying diagnoses as determined by the Plan will have convenient access to the Cleveland Clinic’s nationally-recognized specialists for a second opinion. This second opinion program is available in most locations throughout the world. Click here to learn more.

  To determine if you are an appropriate candidate for this second opinion benefit, visit https://fsbp.globalvso.io.

  

  FSBP participates in 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.

  

  Choosing an In-network Provider

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

  To ensure you receive in-network benefits:

  1. Verify that the provider you will see is in-network at the time you make the appointment.
  2. 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).
  3. 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.

  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 physician you are comfortable to optimize your health outcomes.

  Choosing an Out-of-network Provider

  

  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 (click here for instructions).

  If your provider is out-of-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.

  About Overseas Providers

  FSBP considers all 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 the 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.

  Online Claims Submission

  FSBP members are encouraged to register for our secure 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 U.S. bank account, whether you reside in the U.S. or abroad. Signing up for this service is simple! Complete the EFT Authorization Form in full and submit securely.

  Important things to know:

  • Only one bank account per family is permitted.
  • The EFT 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’s secure member website.

  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.

  Lab Savings Program

  You may use this voluntary program for covered outpatient lab tests performed at Quest Diagnostics™ or LabCorp®.

  Show your FSBP identification (ID) card each time you obtain lab work and tell your physician you would like to use Quest Diagnostics™ LabCorp®. If the physician draws the specimen, he/she can call Quest Diagnostics at 800-646-7788 or LabCorp at 888-522-2677 for pick up. You can also go to an approved collection site and show your FSBP ID card along with the test requisition from your physician and have the specimen drawn there.

  Note: To find an approved collection site near you, call Quest Diagnostics™ at 800-646-7788 or LabCorp® at 888-522-2677 or search for Quest Diagnostics or LabCorp using your Zip Code in the Plan's Online Provider Directory.

  This benefit can be used only in the 50 United States. Members returning to the 50 United States for vacation or who seek medical care and/or treatment while visiting the 50 United States can utilize this benefit for covered outpatient lab tests.

  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.

  FSAFEDS Paperless Reimbursement

  If you take advantage of this health care flexible spending 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.

  Aetna HealthSM App

  You can use the Aetna HealthSM App to:

  Text “Aetna” to 90156 to receive a link to download the Aetna HealthSM app (message and data rates may apply).

  Express Scripts Mobile App

  You can use the Express Scripts Mobile App to:

  

  FSBP members have access to several discounts and insurance programs designed to enhance your wellness and provide you with extra security.

  Note: 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.

  Find an IOE Infertility network provider using the provider search tool.

  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’s secure member website, 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.

  When you join a gym in the GlobalFit network you get:

  • Access to thousands of gyms in the United States including national chains and independent local facilities
  • Free guest passes* to try gyms before you join
  • Guaranteed lowest rates** on gym memberships
  • Flexible membership options
  • Convenient billing options through your major credit card or bank account
  • Use of gyms for your spouse or domestic partner and your dependent children
  • Guest privileges*** at participating network gyms when you travel
  • Transfer of your membership*** to another participating gym or another person

  You also can get discounts on the following through GlobalFit:

  • At-home weight loss programs
  • Home exercise kits and other small products
  • One-on-one health coaching services to quit smoking, lower stress, lose weight and more

  Learn more about how to take advantage of this program now by logging on to Aetna’s secure member website, look for the “Stay Healthy” icon and select “Discounts” and then “Fitness.” You also may call GlobalFit toll free at 800-294-1500.

  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’s secure member website, look for the “Stay Healthy” icon, select “Discounts” and then “Vision.”

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

  AFSPA offers four dental insurances and do not require an open season to enroll. Each plan covers dependent children, up to age 26.

  Two Dental HMO plans are available stateside. Dominion National is available in the MidAtlantic area and Cigna HMO has coverage nationwide. No claim forms are needed and there is no deductible. Members pay reduced fees for procedures without waiting periods. The HMO plans only cover services performed by in-network dentists.

  The Cigna Dental PPO plan offers nationwide coverage. No deductibles. Child and Adult Orthodontia available, after a waiting period. Choose from over 146,000 in-network dentists, in 48 states.

  The Cigna International Dental plan is designed for overseas members and covers worldwide. This plan translates claims, and reimbursement is available in foreign currencies. No overseas fee schedule or out of-network penalties. Choose from over 100,000 prescreened international dentists, in 160 countries.

  Learn more at afspa.org/dental.

  AFSPA offers several medical plans for Members of Household, which include unmarried domestic partners, parents and dependent children over age 26 who do not qualify for coverage under the Federal Employees Health Benefits Program. These policies offer a choice of deductibles and medical coverages. Separate coverage applies for treatment received inside the U.S. and Canada.

  Learn more at afspa.org/moh.

  Our Disability Plans fill a particular gap in coverage when you are unable to work for a long period of time due to an illness or an injury but are not permanently disabled. Consider buying a Plan if you are a newly hired employee, do not have a substantial amount of sick leave, or just want some extra protection. The Cigna Global Plan does not require a health application and covers maternity when conception occurs after the effective date. AFSPA’s two disability plans pay 60% of your salary (up to $5,000/month), if you cannot work for an extended period due to illness or injury.

  Learn more at afspa.org/disability.

  Coverage is available up to $600,000. This policy can be purchased as your main source of protection or to supplement any existing coverage. It includes benefits for loss due to acts of war or terrorism. There are no exclusions. Members can keep this policy in the event they leave government service. Spouses and children age 19 and older are eligible for their own individual policy.

  Learn more at afspa.org/life.

  This plan provides protection up to $600,000 against accidental injuries or death anywhere in the world. It includes a Home Alteration and Vehicle Modification Benefit of 10% of the Insurance principal amount or $10,000. The policy includes benefits for loss due to acts of terrorism. Spouses and children age 19 and older are eligible for their own individual policy.

  Learn more at afspa.org/life.

  AFSPA offers a term life insurance plan that is available to employees of selected agencies to cover immediate expenses, such as mortgage payments, funeral expenses and final medical costs upon the death of a loved one.

  • A benefit of $15,000 ($7,500 at age 70) or $20,000 ($10,000 at age 70) paid to the beneficiary, generally within two business days upon AFSPA’s receipt of notification of employee’s death.
  • No medical questions to answer when enrolling during a qualifying event (new hire, open enrollment period, or first overseas assignment).

  Learn more at afspa.org/life.

  Dental & Vision Discounts – AFSPA partners with Careington International Corporation to offer a combined dental and vision discount plan. U.S. residents save on routine and major dental services, eyecare and eyewear, and LASIK eye surgery. Plans available for a minimal monthly fee. Some services are excluded from certain states. Learn more at www.careington.com/co/afspa or call 833-237-5856.

  
  Hearing Aid Discounts – AFSPA members receive TruHearing’s hearing aid discount plan at no-cost. Choose from a variety of digital hearing aids, priced 30-60% below the national average. Over 3,800 providers participate nationwide. Not available in IL. Learn more at www.TruHearing.com or call 855-205-6252. This discount can be used with FSBP’s Hearing Aid benefits.

  For more information about AFSPA's Discount Care Program, click here.

  
  Discount Plans are NOT insurance

  AFSPA has been sponsoring long term care plans since 1990 as we believe strongly that this coverage can be a very important part of an individual’s portfolio. One plan does not fit all, so as long-term care products have evolved, we enhanced our long-term care offerings. Our broker, Signature Financial Partners LLC, assists members with finding a long-term care plan that best suits their needs. The State Department Federal Credit Union also offers financial options for long term care planning.

  Beers, Hamerman, Cohen & Burger, P.C., offers services from a group of five CPA tax accountants, each with at least 10 years of accounting experience. They offer:

  • A complimentary 20-minute consultation to AFSPA members and retirees who have tax questions.
  • A 10% discount on standard hourly rates.
  • A dedicated secure e-mail address for members to ask their questions.

  Prior to services being rendered, they will issue a letter of understanding.

  AFSPA recognizes the importance of financial planning for the future. There is not a magic formula or set of criteria that works for all members. We offer several financial planning options with knowledgeable advisors to help navigate the overwhelming amount of information pertaining to planning for the future. Knowledge/education is the key to financial planning.

  AFSPA offers four (4) travel insurance options that cover a wide range of services and circumstances including emergency medical evacuation, on-the-spot emergency medical payments, worldwide medical referrals, medical monitoring, prescription replacement assistance, repatriation of remains benefits, trip cancellation/interruption/delay, accidental death and dismemberment and more. These plans are designed to help with overseas travel, as well as trips within the U.S.*

  *State and geographic restrictions apply.

  Learn more at afspa.org/travel.

  AFSPA partners with several U.S. consulting and law firms to offer discounted services to members. These include legal, tax, long term care, and financial planning. Seek advice for taxes, estate planning, etc. These experts understand the unique challenges of living overseas.

  Learn more at afspa.org/legal.

  FSAFEDS, in partnership with the FSBP, offers a Paperless Reimbursement option allowing you to be reimbursed from your FSAFEDS health care account without submitting a claim. When you receive benefits through the FSBP, your out-of-pocket liability – the amount of money you paid to your provider – will be sent automatically to FSAFEDS for processing. FSAFEDS will review your claims and reimburse you for any eligible out-of-pocket expenses – no need for a claim form or receipt (in most cases – check with the Plan for exceptions). In many cases, you will receive your reimbursement before your provider’s bill is due. Reimbursement will be made directly from your FSAFEDS account to you via Electronic Funds Transfer.

  Visit www.FSAFEDS.com or call toll-free 877-FSAFEDS (372-3337) to learn more about how you can save money on your out-of-pocket health care expenses.

  Welcome to the Foreign Service Benefit Plan (FSBP)!

  

  FSBP is a Federal Employees Health Benefits (FEHB) high option closed plan with affordable premiums 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 you serve at home or abroad. In fact, 60% of our members enjoy our excellent health benefits at home in the U.S.

  

  When you choose FSBP, you are choosing:

  Comprehensive Worldwide Coverage

  For members living in the U.S., you have access to one of the largest nationwide networks of health care providers (over 1.4 million) through the Aetna Choice POS II (Open Access) network, encompassing all 50 states. For members living in Guam, FSBP participates in Guam's vast NetCare network . For members living overseas, FSBP treats every overseas provider as "in-network" and has direct billing arrangements with over 200 international facilities.

  National Standards of Quality of Care

  FSBP has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) since 2017 and has achieved a full three-year term comprehensive health plan reaccreditation in 2020. Achieving this accreditation shows our commitment to providing the highest levels of quality care to our members by sustaining the same high level of quality in our business practices.

  FSBP is audited annually by the National Committee on Quality Assurance (NCQA) Quality of Care. These audits ensure that we continuously review medical data to improve the quality of medical care provided to our members.

  Competitive Premiums with Generous Alternative Benefits

  We pride ourselves in offering competitive premiums for a fee-for-service high option plan. We invite you to compare our premiums relative to other high options plans in the FEHB Program here. FSBP offers no out-of-pocket costs for routine preventive care, routine immunizations or complete maternity care received from an in-network provider or overseas provider. We offer competitively priced prescription benefits from the largest Pharmacy Benefit Manager in the U.S., Express Scripts.

  FSBP provides generous coverage for unique benefits. We cover up to $60 per visit for up to 50 visits per calendar year from each of the following professionals - a licensed or certified massage therapist, chiropractor, acupuncturist.

  Convenience and Overall Wellness

  FSBP offers variety of complementary programs including:

  • 24-hour Nurse Advice Line and Healthwise Knowledgebase
  • 24-hour Translation Line
  • Health coaching and mental health support programs
  • Disease management programs
  • Generous Wellness Rewards Program where you can earn up to $400 in Wellness Incentives every year. Learn more about our Simple Steps To Living Well Together Program.

  FSBP offers 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
  • Access to Direct Billing Providers so you do not have to pay upfront costs. FSBP generally considers foreign providers’ charges as billed.
  • Secure claim submission through our Member Portal
  • Quick claim reimbursement through electronic funds transfer (EFT)

  The American Foreign Service Protective Association (AFSPA) is the self-funded carrier of FSBP and also performs the customer service function for the Plan.

  Claims and clinical functions of FSBP 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, the largest pharmacy benefit management organization in the United States. Learn more about

  2021 Documents

  2020 Documents

  • FSBP Benefit Brochure 2020
  • Summary of Benefits and Programs 2020
  • Summary of Benefits and Coverage (SBC) 2020
    • SBC Uniform Glossary

    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 PHI 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.

    • 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 be only 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.

    Foreign Service Benefit Plan (FSBP) 2021 Rates and Enrollment Codes:

    

    *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.

    

    Enroll online using your agency’s preferred method:

    • Employee Express: See a list of agencies participating in Employee Express
    • Department of Defense: DoD automated enrollment systems
    • Employees of agencies paid through the National Finance Center: Employee Personal Page
    • 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.

    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.

    Once we 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.

    Filing a Claim for Covered Services

    

    Enter the appropriate unique “W” ID number located on the front side of your FSBP Member ID card when submitting claims online via our secure Member Portal. We are streamlining our claims management process to improve efficiency and enhance the security of your Protected Health Information (PHI). Effective January 1, 2021, we have eliminated the option to use the last four digits of your social security number (SSN) when submitting FSBP claims online.

    How to submit a claim - U.S.

    

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

    • Patient’s 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. (Tax ID number not required for providers outside the U.S.)
    • Dates that services or supplies were furnished
    • Diagnosis
    • Type of each service or supply
    • Charge for each service or supply
    • Valid medical or ADA dental code (not required for overseas claims) or description of each service or supply

    Click here to download a claim form. We encourage you to submit your claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

    

    If you are not able to 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.

    If you are submitting an online claim for the first time, generally, you need to fill out only one claim form per year, per member. You should also fill out a claim form if you submit a claim due to accidental injury, you have changed your address, or if the member’s other insurance/Medicare status has changed.

    How to submit a claim - Overseas

    

    FSBP pays for claims for providers outside the U.S. at the in-network co-insurance benefit. When filing a claim for services rendered by an overseas provider, bills and receipts should be itemized and show:

    • Patient’s name, date of birth, address, phone number and relationship to enrollee
    • Patient’s Plan identification number
    • Full name and address of the provider, including city, postal code and country
    • Dates that services or supplies were furnished
    • Diagnosis/reason for visit Overseas Claims (include a description of the sickness or accident)
    • Type of each service or supply
    • Charge for each service or supply

    Note: We will provide translation and currency conversion services for claims for overseas (foreign) services. For more information, click here.

    We encourage you to submit your overseas claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

    

    Massage Therapy Claims - U.S. and Overseas

    

    The following information is needed on an itemized bill for reimbursement:

    • Patient’s name
    • Patient’s date of birth
    • Patient’s ID number
    • Provider/massage therapist name and business address
    • License or certification number and Federal Tax ID (for U.S. providers only)
    • Date of each service
    • Description of service rendered
    • Cost for each service
    • Copy of your paid receipt

    We encourage you to submit your documents via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

    

    Direct Billing Arrangement (DBA) Overseas Providers & Facilities

    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.

    If you have paid a direct billing provider prior to your claim submission, we request that you provide us with a copy of your paid receipt along with the exchange rate you used to convert the currency.

    We encourage you to submit your claim via our secure Member Portal for the quickest processing. You are also encouraged to complete an Electronic Funds Transfer (EFT) form for your claim reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time.

    

    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.

    

    The Foreign Service Benefit Plan (FSBP) is proud to cover all providers outside the 50 U.S. at the in-network benefit. To further simplify your overseas care, FSBP also has Direct Billing Arrangements (DBA) with over 200 health care providers across the world. By using these DBA providers when available, you avoid prepaying the bill. To learn more about our DBA providers, click here.

    We use the following methods to process your foreign claims:

    • We will translate your claim(s), if you do not provide a translation.
    • We will use the U.S. dollar exchange rate, benchmarked against the rate reported by Oanda (www.oanda.com), 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 claimsfor exceptions).
    • We will 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.
    • We will process all types of foreign bills as a priority, generally within 10 business days.

    Where do I to submit foreign claims:

    1. Submit your claims via our secure Member Portal.
    2. Complete and sign an Electronic Funds Transfer (EFT) form for faster reimbursement. The EFT form allows us to deposit reimbursements directly into your U.S. bank account, reducing paper and time. Click here for more information about signing up for EFT.
    3. For more information about how to submit an overseas claim, click here or review the FAQs below.

    You can also mail in your claim to:
    Foreign Service Benefit Plan
    1620 L Street, NW, Suite 800
    Washington DC, 20036-5629

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

    Virtual Second Opinions by Cleveland Clinic

    

    FSBP has a special arrangement with the Cleveland Clinic to provide patients who receive treatment in foreign countries a second opinion for certain diagnoses through the Cleveland Clinic.

    Patients who receive treatment in foreign countries and with qualifying diagnoses as determined by the Plan will have convenient access to the Cleveland Clinic’s nationally-recognized specialists for a second opinion. This second opinion program is available in most locations throughout the world. Click here to learn more.

    To determine if you are an appropriate candidate for this second opinion benefit, visit https://fsbp.globalvso.io.

    

    FSBP participates in 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.

    

    Choosing an In-network Provider

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

    To ensure you receive in-network benefits:

    1. Verify that the provider you will see is in-network at the time you make the appointment.
    2. 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).
    3. 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.

    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 physician you are comfortable to optimize your health outcomes.

    Choosing an Out-of-network Provider

    

    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 (click here for instructions).

    If your provider is out-of-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.

    About Overseas Providers

    FSBP considers all 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 the 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

    Online Claims Submission

    FSBP members are encouraged to register for our secure 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 U.S. bank account, whether you reside in the U.S. or abroad. Signing up for this service is simple! Complete the EFT Authorization Form in full and submit securely.

    Important things to know:

    • Only one bank account per family is permitted.
    • The EFT 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’s secure member website.

    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.

    Lab Savings Program

    You may use this voluntary program for covered outpatient lab tests performed at Quest Diagnostics™ or LabCorp®.

    Show your FSBP identification (ID) card each time you obtain lab work and tell your physician you would like to use Quest Diagnostics™ LabCorp®. If the physician draws the specimen, he/she can call Quest Diagnostics at 800-646-7788 or LabCorp at 888-522-2677 for pick up. You can also go to an approved collection site and show your FSBP ID card along with the test requisition from your physician and have the specimen drawn there.

    Note: To find an approved collection site near you, call Quest Diagnostics™ at 800-646-7788 or LabCorp® at 888-522-2677 or search for Quest Diagnostics or LabCorp using your Zip Code in the Plan's Online Provider Directory.

    This benefit can be used only in the 50 United States. Members returning to the 50 United States for vacation or who seek medical care and/or treatment while visiting the 50 United States can utilize this benefit for covered outpatient lab tests.

    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.

    FSAFEDS Paperless Reimbursement

    If you take advantage of this health care flexible spending 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.

    Aetna HealthSM App

    You can use the Aetna HealthSM App to:

    Text “Aetna” to 90156 to receive a link to download the Aetna HealthSM app (message and data rates may apply).

    Express Scripts Mobile App

    You can use the Express Scripts Mobile App to:

    Non-FEHB Programs

    

    FSBP members have access to several discounts and insurance programs designed to enhance your wellness and provide you with extra security.

    Note: 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.

    Find an IOE Infertility network provider using the provider search tool.

    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’s secure member website, 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.

    When you join a gym in the GlobalFit network you get:

    • Access to thousands of gyms in the United States including national chains and independent local facilities
    • Free guest passes* to try gyms before you join
    • Guaranteed lowest rates** on gym memberships
    • Flexible membership options
    • Convenient billing options through your major credit card or bank account
    • Use of gyms for your spouse or domestic partner and your dependent children
    • Guest privileges*** at participating network gyms when you travel
    • Transfer of your membership*** to another participating gym or another person

    You also can get discounts on the following through GlobalFit:

    • At-home weight loss programs
    • Home exercise kits and other small products
    • One-on-one health coaching services to quit smoking, lower stress, lose weight and more

    Learn more about how to take advantage of this program now by logging on to Aetna’s secure member website, look for the “Stay Healthy” icon and select “Discounts” and then “Fitness.” You also may call GlobalFit toll free at 800-294-1500.

    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’s secure member website, look for the “Stay Healthy” icon, select “Discounts” and then “Vision.”

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

    AFSPA offers four dental insurances and do not require an open season to enroll. Each plan covers dependent children, up to age 26.

    Two Dental HMO plans are available stateside. Dominion National is available in the MidAtlantic area and Cigna HMO has coverage nationwide. No claim forms are needed and there is no deductible. Members pay reduced fees for procedures without waiting periods. The HMO plans only cover services performed by in-network dentists.

    The Cigna Dental PPO plan offers nationwide coverage. No deductibles. Child and Adult Orthodontia available, after a waiting period. Choose from over 146,000 in-network dentists, in 48 states.

    The Cigna International Dental plan is designed for overseas members and covers worldwide. This plan translates claims, and reimbursement is available in foreign currencies. No overseas fee schedule or out of-network penalties. Choose from over 100,000 prescreened international dentists, in 160 countries.

    Learn more at afspa.org/dental.

    AFSPA offers several medical plans for Members of Household, which include unmarried domestic partners, parents and dependent children over age 26 who do not qualify for coverage under the Federal Employees Health Benefits Program. These policies offer a choice of deductibles and medical coverages. Separate coverage applies for treatment received inside the U.S. and Canada.

    Learn more at afspa.org/moh.

    Our Disability Plans fill a particular gap in coverage when you are unable to work for a long period of time due to an illness or an injury but are not permanently disabled. Consider buying a Plan if you are a newly hired employee, do not have a substantial amount of sick leave, or just want some extra protection. The Cigna Global Plan does not require a health application and covers maternity when conception occurs after the effective date. AFSPA’s two disability plans pay 60% of your salary (up to $5,000/month), if you cannot work for an extended period due to illness or injury.

    Learn more at afspa.org/disability.

    Coverage is available up to $600,000. This policy can be purchased as your main source of protection or to supplement any existing coverage. It includes benefits for loss due to acts of war or terrorism. There are no exclusions. Members can keep this policy in the event they leave government service. Spouses and children age 19 and older are eligible for their own individual policy.

    Learn more at afspa.org/life.

    This plan provides protection up to $600,000 against accidental injuries or death anywhere in the world. It includes a Home Alteration and Vehicle Modification Benefit of 10% of the Insurance principal amount or $10,000. The policy includes benefits for loss due to acts of terrorism. Spouses and children age 19 and older are eligible for their own individual policy.

    Learn more at afspa.org/life.

    AFSPA offers a term life insurance plan that is available to employees of selected agencies to cover immediate expenses, such as mortgage payments, funeral expenses and final medical costs upon the death of a loved one.

    • A benefit of $15,000 ($7,500 at age 70) or $20,000 ($10,000 at age 70) paid to the beneficiary, generally within two business days upon AFSPA’s receipt of notification of employee’s death.
    • No medical questions to answer when enrolling during a qualifying event (new hire, open enrollment period, or first overseas assignment).

    Learn more at afspa.org/life.

    Dental & Vision Discounts – AFSPA partners with Careington International Corporation to offer a combined dental and vision discount plan. U.S. residents save on routine and major dental services, eyecare and eyewear, and LASIK eye surgery. Plans available for a minimal monthly fee. Some services are excluded from certain states. Learn more at www.careington.com/co/afspa or call 833-237-5856.

    
    Hearing Aid Discounts – AFSPA members receive TruHearing’s hearing aid discount plan at no-cost. Choose from a variety of digital hearing aids, priced 30-60% below the national average. Over 3,800 providers participate nationwide. Not available in IL. Learn more at www.TruHearing.com or call 855-205-6252. This discount can be used with FSBP’s Hearing Aid benefits.

    For more information about AFSPA's Discount Care Program, click here.

    
    Discount Plans are NOT insurance

    AFSPA has been sponsoring long term care plans since 1990 as we believe strongly that this coverage can be a very important part of an individual’s portfolio. One plan does not fit all, so as long-term care products have evolved, we enhanced our long-term care offerings. Our broker, Signature Financial Partners LLC, assists members with finding a long-term care plan that best suits their needs. The State Department Federal Credit Union also offers financial options for long term care planning.

    Beers, Hamerman, Cohen & Burger, P.C., offers services from a group of five CPA tax accountants, each with at least 10 years of accounting experience. They offer:

    • A complimentary 20-minute consultation to AFSPA members and retirees who have tax questions.
    • A 10% discount on standard hourly rates.
    • A dedicated secure e-mail address for members to ask their questions.

    Prior to services being rendered, they will issue a letter of understanding.

    AFSPA recognizes the importance of financial planning for the future. There is not a magic formula or set of criteria that works for all members. We offer several financial planning options with knowledgeable advisors to help navigate the overwhelming amount of information pertaining to planning for the future. Knowledge/education is the key to financial planning.

    AFSPA offers four (4) travel insurance options that cover a wide range of services and circumstances including emergency medical evacuation, on-the-spot emergency medical payments, worldwide medical referrals, medical monitoring, prescription replacement assistance, repatriation of remains benefits, trip cancellation/interruption/delay, accidental death and dismemberment and more. These plans are designed to help with overseas travel, as well as trips within the U.S.*

    *State and geographic restrictions apply.

    Learn more at afspa.org/travel.

    AFSPA partners with several U.S. consulting and law firms to offer discounted services to members. These include legal, tax, long term care, and financial planning. Seek advice for taxes, estate planning, etc. These experts understand the unique challenges of living overseas.

    Learn more at afspa.org/legal.

    FSAFEDS, in partnership with the FSBP, offers a Paperless Reimbursement option allowing you to be reimbursed from your FSAFEDS health care account without submitting a claim. When you receive benefits through the FSBP, your out-of-pocket liability – the amount of money you paid to your provider – will be sent automatically to FSAFEDS for processing. FSAFEDS will review your claims and reimburse you for any eligible out-of-pocket expenses – no need for a claim form or receipt (in most cases – check with the Plan for exceptions). In many cases, you will receive your reimbursement before your provider’s bill is due. Reimbursement will be made directly from your FSAFEDS account to you via Electronic Funds Transfer.

    Visit www.FSAFEDS.com or call toll-free 877-FSAFEDS (372-3337) to learn more about how you can save money on your out-of-pocket health care expenses.

    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.
    • Click here to learn more about filing a massage claim.
    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 delay your claim’s processing significantly.

    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’s secure member website Select “ID card” at the top of the page, and then choose to print/download additional ID cards or view your ID card. To order a replacement ID card, you can call 202-833-4910.

    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’s secure member website is a system that provides members with access to information and tools regarding their health. Every enrollee and dependents ages 14 and older have their own separate login credentials for this site.

    Many FSBP programs are housed in your Aetna’s secure member website 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.

    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.

    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 Cleveland Clinic to provide patients who receive treatment in foreign countries a second opinion for certain diagnoses through the Cleveland Clinic.

    Patients who receive treatment in foreign countries and with qualifying diagnoses as determined by the Plan will have convenient access to the Cleveland Clinic’s nationally-recognized specialists for a second opinion. This second opinion program is available in most locations throughout the world. Click here to learn more.

    To determine if you are an appropriate candidate for this second opinion benefit, visit https://fsbp.globalvso.io.

    If you would like to see a second provider of your choice while serving overseas, the consultation and any medically necessary tests or services will be covered in the same way as any overseas provider. Click here to learn more.

    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.