Foreign Service Benefit Plan Form Library
Below are official plan documents you may need to properly understand or receive benefits under your plan.
| Title | Description | Download |
|---|---|---|
| OFFICIAL PLAN BROCHURE | 2023 FSBP Plan Brochure | |
| SUMMARY OF BENEFITS AND COVERAGE CHART | 2023 Summary of Benefits & Coverage Chart (SBC) | |
| OFFICIAL PLAN BROCHURE | 2023 Medicare Evidence of Coverage | |
| OFFICIAL PLAN BROCHURE | 2023 Medicare Summary of Benefits Guide | |
| OFFICIAL PLAN BROCHURE | 2023 Medicare Schedule of Cost Sharing | |
| OFFICIAL PLAN BROCHURE | 2022 FSBP Plan Brochure | |
| SUMMARY OF BENEFITS AND COVERAGE CHART | 2022 Summary of Benefits & Coverage Chart (SBC) | |
| MEMBER GUIDE | Know Where to Go Guide | |
| MEMBER FORMS | Medical Claim Form | |
| MEMBER FORMS | Contraceptive Management Exception Form | |
| MEMBER FORMS | Urine Drug Testing Coverage Guidelines | |
| MEMBER FORMS | EFT/Direct Deposit Authorization form | |
| MEMBER FORMS | Authorization for Release of Protected Health Information (PHI) form | |
| MEMBER FORMS | Wellness Incentive Claim Form |