Mediterranean Wellness Program
Certificate of Completion

Congratulations!

You have completed at least 80% of the Mediterranean Wellness Program Curriculum and now are eligible to receive reimbursement of the program fee of $140.00 under the Plan's Educational classes and programs, Nutritional counseling benefit, Section 5(a) of the FOREIGN SERVICE BENEFIT PLAN (FSBP) Brochure.

You will receive reimbursement for the $140 fee and our Explanation of Benefits shortly.

Once you complete 100% of the Mediterranean Wellness Program you will earn $50 to be deposited in a Wellness Incentive Coventry Fund Account to reimburse you for certain unreimbursed medical expenses (e.g. your deductible, coinsurance and copayments incurred by you or your covered dependents) as described in Section 5(h), Special features. Refer to page 72 of your 2013 FSBP Brochure for details.

	very good			very poor
Circle your answer:	5	4	3	2	1

Please return this form with your rating via:

- 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

If you have any questions or comments, please let us know.

Sincerely,

FOREIGN SERVICE BENEFIT PLAN

Mediterranean Wellness Program
Certificate of Completion

Congratulations!

You have completed at least 80% of the Mediterranean Wellness Program Curriculum and now are eligible to receive reimbursement of the program fee of $140.00 under the Plan's Educational classes and programs, Nutritional counseling benefit, Section 5(a) of the FOREIGN SERVICE BENEFIT PLAN (FSBP) Brochure.

You will receive reimbursement for the $140 fee and our Explanation of Benefits shortly.

Once you complete 100% of the Mediterranean Wellness Program you will earn $50 to be deposited in a Wellness Incentive Coventry Fund Account to reimburse you for certain unreimbursed medical expenses (e.g. your deductible, coinsurance and copayments incurred by you or your covered dependents) as described in Section 5(h), Special features. Refer to page 72 of your 2013 FSBP Brochure for details.

	very good			very poor
Circle your answer:	5	4	3	2	1

Please return this form with your rating via:

- 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

If you have any questions or comments, please let us know.

Sincerely,

FOREIGN SERVICE BENEFIT PLAN