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 |