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Foreign Service Benefit Plan (FSBP) Brochures:
The FSBP member’s obligations concerning liability insurance and third party actions (subrogation) are described in the annual plan brochures. Below you will find links to recent editions of the FSBP brochures, with the relevant on-line page referenced for convenience:

  Year 2008 FSBP brochure (see page 77)
  Year 2007 FSBP brochure (see pages 75 and 76)
  Year 2006 FSBP brochure (see page 76)
  Year 2005 FSBP brochure (see page 75)
  Year 2004 FSBP brochure (see page 64)
  Year 2003 FSBP brochure (see page 61)
  Year 2002 FSBP brochure (see page 61)
  Year 2001 FSBP brochure (see page 65)
  Year 2000 FSBP brochure (see page 33)

Below is a link to the FSBP Individual’s Authorization for Release of Information Form used to confirm the direction of an individual that we use or disclose Protected Health Information (PHI) for a particular purpose, as well as the Assignment of Proceeds of Recovery/ Reimbursement Agreement required under the terms of the Plans’ brochures to be executed and returned to us on behalf of the Plan.

Individual’s Authorization for Release of Information (FSBP)
Assignment of Proceeds of Recovery/Reimbursement Agreement (Attorney)
Assignment of Proceeds of Recovery/Reimbursement Agreement (Enrollee)

 


Visit FEHBlog, an Ermer & Brownell, PLLC service providing Federal Employees Health Benefits Program and general health benefits law, policy commentary, and news filter -- written and maintained by David M. Ermer, managing partner of Ermer & Brownell, PLLC, a Washington, DC law firm.

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