Understand Your Explanation of Benefits (EOB)
An important part of making the most of your health care coverage is understanding how your claim is paid.

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Health Care Reform
For information on Health Care Reform impact on the Federal Employees Health Benefits Program and effective dates, including the dependent age limit, visit OPM. The Service Benefit Plan fully complies with decisions made by OPM governing the FEHBP.

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Need a Form

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Need a claims form? If you use a provider or hospital that participates in the Service Benefit Plan network, you will not have to fill out any claim forms - the provider will take care of it for you. In situations where you use a provider outside of the network, receive care overseas or require prior approval for a medication, you will need to complete and file a claim form to be reimbursed by your health plan. 
To download these forms online, choose from the menu below.  
 
Health Benefits Claim Form 
English [PDF 79 KB] 
 
Dental Benefits Claim Form  
English [PDF 125 KB] 
 
Retail Pharmacy Claim Form  
English [PDF 175 KB] 
 
Home Delivery Prescription Drug Form
(Standard Option only) 
English [PDF PDF 1,168 KB] 
 
Overseas Medical Claim Form  
English [PDF 139 KB] 
 
Overseas Retail Pharmacy Claim Form 
English [PDF 176 KB]  
 
Do you need to know where to submit the claim form? Click here!  
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