Mediterranean Wellness Program
Certificate of Completion
Congratulations!
You have completed 100% of the Mediterranean Wellness Program Curriculum and now are eligible to submit
your claim to the
Foreign Service Benefit Plan (FSBP) to receive your $50 Health
Savings Account credit.
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
