Mediterranean Wellness Program
Certificate of Completion

Congratulations!

You have completed at least 75% of the Mediterranean Wellness Program Curriculum and now are eligible to submit your claim to the Foreign Service Benefit Plan (FSBP) for reimbursement of the program fee of $140.00 (subject to 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.

Member First Name:	cert.first
Member Last Name:	cert.last
Program Start Date:	cert.startdate

Member's Signature___________________________________ Date___________

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: health@afspa.org
Via fax: (202) 464-4508
Via Mail:
Foreign Service Benefit Plan
1716 N Street, NW
Washington, DC 20036-2902

1716 N Street, NW Washington, DC 20036-2902 (202) 833-4910
Website: www.AFSPA.org/FSBP E-Mail: health@AFSPA.org Fax: (202) 833-4918