You have completed 100% of the Mediterranean Wellness Program Curriculum and are now eligible to submit your claim to the FOREIGN SERVICE BENEFIT PLAN (FSBP) to receive your$50 Health Savings Account credit. availability.

Submitting Your Claim Is Easy: Simply complete the fields below, sign the form and send in your claim. Your claim will be processed under the Plan's Nutritional Counseling Benefit.

First Name: Cert.first

Last Name: Cert.last

Start Date: Cert.startdate

Please submit your claim through one of the following methods:
• • Via our secure Web site (PDF only): https://www.afspa.org/site/insurance/fsbp/fsbp_askafspas_claim.html
• • Via e-mail: www.health@afspa.org
• • Via Mail: FOREIGN SERVICE BENEFIT PLAN1716 N Street, NWWashington, DC 20036-2902