Get Foreign Service Benefits Plan Reimbursement Questionnaire

This guide provides clear instructions on how to complete the Foreign Service Benefits Plan Reimbursement Questionnaire online. By following these steps, users can ensure accurate and efficient submission of their reimbursement requests.

Follow the steps to successfully complete the questionnaire online:

1. Press the ‘Get Form’ button to access the questionnaire and open it in the editing tool.
2. Enter the date on the form in the designated field.
3. Fill in the patient's name and date of birth accurately.
4. Provide the FSBP ID number in the specified section.
5. Indicate the patient's relationship to the enrollee in the relevant field.
6. If you are not the patient, fill in your name and relationship to the enrollee.
7. Enter your contact phone number, including area code.
8. If available, provide your fax number.
9. Choose your preferred method of contact: Telephone or Email.
10. Include your email address for correspondence.
11. Select the preferred time for contact (AM or PM).
12. Indicate the cause of the injury or illness by selecting the appropriate option.
13. Provide the location where the injury or illness occurred by selecting from the options provided.
14. Enter the date of injury or illness.
15. If applicable, describe the cause of the injury or illness, and ensure to include copies of any accident reports.
16. Complete the attorney details section if you have hired one, including name, firm, address, and contact information.
17. Fill in the insurance company details if there are other insurers involved, including policyholder and adjustor information.
18. Agree to the statement by signing and dating the form.
19. Review the completed form for accuracy.
20. Once satisfied, save your changes, and choose to download, print, or share the completed questionnaire.

Complete your Foreign Service Benefits Plan Reimbursement Questionnaire online today to ensure timely processing of your benefits.