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Form Library

Foreign Service Benefit Plan Form Library

Below are official plan documents you may need to properly understand or receive benefits under your plan.

Member Forms & Documents
Title Description Download
OFFICIAL PLAN BROCHURE 2020 FSBP Plan Brochure PDF
SUMMARY OF BENEFITS & PROGRAMS 2020 Summary of Benefits & Programs PDF
OFFICIAL PLAN BROCHURE 2019 FSBP Plan Brochure PDF
SUMMARY OF BENEFITS & PROGRAMS 2019 Summary of Benefits & Programs PDF
SUMMARY OF BENEFITS & COVERAGE CHART 2019 Summary of Benefits & Coverage Chart (SBC) PDF
MEMBER FORMS Provider Nomination Form PDF
MEMBER FORMS Medical Claim Form PDF
MEMBER FORMS Urine Drug Testing Coverage Guidelines PDF
MEMBER FORMS EFT/Direct Deposit Authorization form PDF
MEMBER FORMS Authorization for Release of Protected Health Information (PHI) form PDF
MEMBER FORMS Wellness Incentive Claim Form PDF