Below are official plan documents you may need to properly understand or receive benefits under your plan.
| Title | Description | Download |
|---|---|---|
| OFFICIAL PLAN BROCHURE | 2018 FSBP Plan Brochure | |
| SUMMARY OF BENEFITS & PROGRAMS | 2018 Summary of Benefits & Programs | |
| SUMMARY OF BENEFITS & COVERAGE CHART | 2018 Summary of Benefits & Coverage Chart (SBC) | |
| OFFICIAL PLAN BROCHURE | 2017 FSBP Plan Brochure | |
| MEMBER FORMS | Provider Nomination Form | |
| MEMBER FORMS | Medical Claim 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 | 2018 Deemed Exhaustion Notice | |
| MEMBER FORMS | Wellness Incentive Claim Form |
| Title | Description | Download |
|---|---|---|
| Member Document | CAHPS Member Satisfaction Scores | |
| Member Document | HEDIS Clinical Performance Scores | |
| Member Document | Program Description - Quality Management FEHBP | |
| Member Document | Provider Satisfaction Post-Call Survey Scores - San Antonio, TX | |
| Member Document | Provider Satisfaction Post-Call Survey Scores - Scottsdale, AZ |