Not Just For The Foreign Service Anymore - AFSPA

Foreign Service Benefit PlanNot just for the Foreign Service anymoreSUMMARY OF 2021 BENEFITS

SUMMARY OF 2021 BENEFITS FOR THE FOREIGNSERVICE BENEFIT PLANWe PayWe PayIn-Network and ProvidersOutside the 50 United StatesHigh Option BenefitsOut-of-Network(Networks: Aetna Choice POS II in U.S., NetCare in Guam)MEDICAL SERVICES —SECTION5(a)Preventive care, routine immunizations, and tests(includes dietary &nutrutional counseling)100%of Plan allowance100%of Plan allowance at CVS Minute Clinic 100%of Plan allowance after a 10 copay at otherConvenient Care Clinics90%of Plan allowance*All covered diagnostic, professional, andtreatment services90%Plan allowance*70%Plan allowance*70%of Plan allowance*Telehealth (Teladoc) consultations100%of Plan allowanceOut of network and outside the50 United States – no benefitInpatient hospital100%of Plan allowance80%after a 200 copay70%of Plan allowance*Telehealth Teladoc – In the U.S., consult with MDs,DOs, RDs, LCSWs, and PsychologistsvHealth – Outside the U.S., general medicine only100%of Plan allowanceN/AComplete maternity (obstetrical) care100%of Plan allowance70%of Plan allowanceEDUCATIONAL CLASSES ANDPROGRAMS —SECTION5(a) See page 6 for details on our Wellness ProgramsTobacco cessationSee Sections 5(a), 5(f ), and 5(h) of the FSBP Brochure forHealth Coaching and Wellness Programinformation90%of Plan allowanceMassage therapy, chiropractic, and acupunctureRetail pharmacyUp to a 30-day supply of non-specialty medicationsHome delivery (mail order through the ExpressScripts PharmacySM[ESI] or Smart90 Retail)Up to a 90-day supply of non-specialtymaintenance medicationsIn this prescription section only, the payment reference is what YOUpayNetwork pharmacies in the U.S.Tier I – Generic: 10 copayTier II – Preferred: 25%( 30 min, 100 max)Tier III – Non-Preferred: 35%( 60 min, 200 max)Tier IV – Generic Specialty: 25%( 150 max)Tier V – Preferred Specialty: 25%( 200 max)Tier VI – Non-Preferred Specialty: 35%( 300 max)Tier I – Generic Drug: 15Tier II – Preferred: 60Tier III – Non-Preferred Brand: 35%( 80 min; 500 max)Tier IV – Generic Specialty: 25%( 150 max)Tier V – Preferred Specialty: 25%( 200 max)Tier VI – Non-Preferred Specialty: 35%( 300 max)DENTAL CARE —SECTION5(g)Up to 60 per visit; 50 visits per year for each type of serviceOrthodontics50% of Plan allowance, up to 1,000 per course of treatmentSPECIAL FEATURES 5(h)SURGICAL SERVICES - SECTION5(b)90%of Plan allowance70%of Plan allowanceSERVICES PROVIDEDBY A HOSPITAL —SECTION5(c)Inpatient100%of Plan allowance80%after a 200 copayOutpatient90%of Plan allowance*70%of Plan allowance*EMERGENCY BENEFITS —SECTION5(d)Accidental injury: Initial treatment in an emergencyroom, urgent care center or doctor’s office,including physician’s charges/ancillary services100%of Plan allowanceMedical emergency90%of Plan allowance*Urgent care center100%after a 35 copay, per occurrence2PRESCRIPTIONDRUGS —SECTION5(f)70%of Plan allowanceCHIROPRACTIC ANDALTERNATIVE SERVICES —SECTION5(a)Inpatient and outpatient(Networks: Aetna Choice POS II in U.S., NetCare in Guam)70%of Plan allowance*70%of Plan allowance* 100%of Plan allowance at LabCorp &Quest DiagnosticLabs (U.S. only)90%of Plan allowance*Lab, X-ray, and other diagnostic testsDiabetic educationHigh Option BenefitsOut-of-NetworkMENTAL HEALTHANDSUBSTANCE USE DISORDER BENEFITS —SECTION5(e)Convenient care clinicOffice &Telemedicine visitsIn-Network and ProvidersOutside the 50 United States24-Hour Nurse Advice Line and Healthwise Knowledgebase24-Hour Translation LineAbleTo – online treatment support programAexcel Designated ProvidersElectronic copies of Explanations of BenefitsElectronic Funds Transfer (EFT) of claimreimbursementsExpress Scripts Specialist PharmacistsFlexible benefits optionHealth Coaching ProgramInstitutes of Excellence for organ/tissue transplants Touch Care Program– addresses advanced illnesses, diseaseInmanagement, and moreLivongo – remote diabetes and hypertension monitoring programs obile Apps – Express Scripts and Aetna Health (download forMfree on your mobile device)myStrengthTM online mental health support programOverseas Second OpinionPre-diabetic Alert ProgramScanned claimsubmission via secure Internet connectionWeb based customer service: Aetna secure member website and ESISimple Steps to Living Well Together Programand Wellness Rewards (See page 6.)These charts summarize certain expenses/services. All benefits are subject to the definitions, limitations, and exclusions in the FOREIGNSERVICEBENEFIT PLANBrochure(RI 72-001). “Section” refers to the Brochure section in which the benefit is fully described.An asterisk(*) means the deductible is 300 per person ( 600 per Self Plus One enrollment or 600 per Self and Family enrollment) for In-Network providers (including Guam)and providers outside the 50 United States; or 400 per person ( 800 per Self Plus One enrollment or 800 per Self and Family enrollment) for Out-of-Network providers(including Guam). And after FSBP pays, you generally pay any difference between the Plan allowance and the billed amount if you use an Out-of-Network physician or otherhealth care professional.3

PROGRAMS TOSUPPORT YOUR NEEDS AbleTo – Your PersonalEmotional Support TeamWhen facing a medical recovery, a life transition, a chroniccondition, or even a mental health issue – stress can becomeoverwhelming. Learn to feel better through AbleTo.This program addresses your emotional and behavioralneeds through 8-weeks of personalized web-based videoconferencing. U.S. residents can access 600 certifiednationwide therapists and coaches – from the comfort of yourhome. Use AbleTo’s tools to practice positive thinking, sethealth goals, and manage ongoing stress. Ultimately, graduateto a healthier life.Learn more at AbleTo.com or by calling 866-287-1802.Digital Coach ProgramsWhen you are working towards a health goal, ithelps to have support. Digital Coach programs aredesigned to guide you through unique health challengesto find wellness solutions.Receive online resources for weight management,tobacco usage, sleep improvement, and more. Gainnew tools to develop healthy living strategies andstay motivated along the way.For more information, see Section 5(h) of the 2021FSBP Brochure or call 202-833-4910.FSBP Lab Savings ProgramVisit Quest Diagnostics and the newly added LabCorp,for covered outpatient lab tests – at no cost to you.This benefit improves your access to care and offers youadditional savings on lab services. Just show your FSBP IDcard at any approved collection site.To find a collection site, call Quest Diagnostics at800-646-7788, LabCorp at 888-522-2677, or searchthe Provider Directory at fsbphealth.com.4Health Coaching Physical, Occupational,and Speech TherapiesThis program allows you to work with a health careprofessional to transform your health goals into action.Your Health Coach provides guidance, support, and resources.Ultimately, you can learn how to overcome obstacles thatmay be keeping you from achieving your optimal health.Bodily therapies can address motor function, communication,and even daily living challenges. And, physical therapy isdesigned specifically to ease pain to help you function andmove better.Talk to a Health Coach about:visits annually. Each covered family member can receivea combination of all three therapies, every year. For thosediagnosed with autism and development delays, FSBP coversan unlimited number of these therapies. Tobacco Cessation Weight Management & Nutrition Exercise Stress ManagementTo learn more about Health Coaching, visit trestletree.comor call 855-406-5122.Livongo Two voluntary programs to address two commonconditionsManage your diabetes and high blood pressure. Receivean advanced blood glucose meter and/or a blood pressuremonitor, along with on-demand coaching. ivongo for Diabetes offers diabetic supplies and real-timeLinterventions by Certified Diabetes Educators. Thisprogram provides a glucose meter, a mobile app, andunlimited test strips and lancets. Participants receivepersonalized tips and free supplies to assist with theirdiabetes management. ivongo for Hypertension offers clinical expertise to helpLmodify behavior and control blood pressure. Track yourhealth with an advanced blood pressure monitor, a mobileapp, and expert coaching. This program helps you takecharge of your blood pressure and work towards yourlong-term health goals.To learn more about both Livongo programs, visitget.livongo.com/fsbp or call 800-945-4355.FSBP covers 125 physical, occupational, and speech therapyThe Plan pays 90% of the Plan Allowance of each visit toan in-network provider. These benefits can be used in additionto FSBP’s alternative services – acupuncture, chiropractic,and massage therapy. Gain therapeutic skills and techniqueswith trained rehabilitation specialists.For more information, see Section 5(a) of the 2021FSBP Brochure or call 202-833-4910.Find an in-network therapist through the Provider Directoryat fsbphealth.com.Worldwide TelehealthVirtual and remote care have increased in popularity.In response, FSBP has expanded its telehealth coverage.You can receive 24/7 non-emergency health servicesfrom a medical professional – via app, web, or phone.Telehealth may be used to diagnose ailments and receivetreatments. Providers can write prescriptions and sendthem to your pharmacy. FSBP covers 100% of telehealthvisits – with no cost to you.Non-FEHB Programs offered by the American Foreign Service Protective Association (AFSPA),sponsor of FSBP Institutes of Excellence Infertility Providers – Access to infertility providers with proven outcomes throughAetna’s Institutes of Excellence Infertility Network.J enny Craig Discount –Receive a three month programplus 50 in food savings or save 50%off premiumprograms. ruHearing –Save 30%to 60%on digital hearing aids,Tfree batteries, and follow-up visits. GlobalFit –Save on gymmemberships and home exercise kits.Additional Programs Accidental Death &Dismemberment Insurance Legal Services Critical Illness Plan Members of HouseholdHealth Insurance Disability IncomeProtection Insurance Long-TermCare Planning Retirement Planning Discount Care Programs Tax Consultation Services Financial Planning TermLife Insurance Global Dental Insurance Travel Insurance Immediate Benefit Plan(select agencies)Note: The non-FEHBbenefits are not part of the FEHBcontract or premium, and youcannot file an FEHBdisputed claimabout them. Fees you pay for these services do notcount toward FEHBdeductibles, copayments, or catastrophic protection out-of-pocketmaximums. All appeals must followthe programs’ guidelines.U.S. Based Members Teladocgives you access to psychologists, licensedclinical social workers, registered dietitians, or medicaldoctors. You can schedule ongoing appointmentswith a dietitian or mental health provider. Learn moreat teledoc.com/aetna.Overseas Based Membersv Health by Aetna, FSBP’s overseas telehealth benefit,offers general medical advice and consultations.These telehealth services are available specificallyto members living or traveling outside of the U.S.Learn more at globalcareondemand.com/aetna.5