Get Foreign Service Benefit Plan Fillable Claim Form

Completing the Foreign Service Benefit Plan fillable claim form can seem daunting, but this guide provides you with clear, step-by-step instructions to ensure that you fill it out correctly and efficiently. Follow these guidelines to manage your claim submission seamlessly.

Follow the steps to fill out the form online effectively.

1. Click the ‘Get Form’ button to obtain the fillable claim form and open it in your preferred PDF editor.
2. Fill in the personal information section: Enter your full name, address, phone number, and email address as requested in the form.
3. Complete the member identification area: Provide your member identification number associated with the Foreign Service Benefit Plan.
4. Detail the services provided: List all relevant services received, including dates, names of providers, and any applicable procedure codes.
5. Include medical expense information: State the total amount for each service, being careful to follow the guidelines outlined on the form.
6. Sign and date the claim declaration: Confirm the accuracy of the information provided by signing as the claimant; if applicable, a signature of the provider can also be required.
7. Save the changes made to your form: After completing all sections, save the document to retain your inputs.
8. Submit the claim: You can either print the form and send it by mail, or use the secure online submission method to send it electronically.

Take the first step towards managing your healthcare expenses by completing your claims online now.