FSBP will continue to cover Coronavirus (COVID-19) testing performed in clinical settings – e.g., doctor’s offices, urgent care centers, hospitals, lab locations, etc. – will continue to be covered at 100%.

Members may be required by their provider to pay at the time of service and seek reimbursement from the Plan.

Click here to see COVID TESTING FAQs

Over the Counter COVID-19 Testing

Effective May 12, 2023

FSBP will offer provide coverage for four (4) over the counter (OTC) COVID-19 tests per member per rolling 30 days. Members may purchase OTC tests and submit a claim to the Plan for reimbursement up to $12 per test.

Effective June 1, 2023

FSBP members may resume purchasing OTC tests with no up-front costs through retail pharmacy locations or ESI Home Delivery Pharmacy – the only change is that the limit will remain at four (4) OTC tests per member per 30 rolling days.

There are two options to take advantage of direct coverage:

• Express Scripts Home Delivery pharmacy
  • To order from the Express Scripts Home Delivery pharmacy, log into Express-Scripts.com and click on the link for the “COVID-19 Resource Center.” You will find a link to place an order in that Resource Center. You also can call 800-818-6717 and a Patient Care Advocate can assist you.
  • Please note that supplies of OTC testing kits are low. The pharmacy will hold member orders until supplies are available.

• Express Scripts Network Retail pharmacy locations
  • You also can take advantage of the direct coverage option at any Express Scripts network retail pharmacy locations. You can find nearby network pharmacies at www.express-scripts.com/fsbp, click on “Locate A Pharmacy.”

FSBP strongly recommends that you utilize the ESI program options whenever possible to purchase OTC COVID-19 tests. This program helps you avoid out-of-pocket costs and eliminate time spent filing claims.

Stateside members may wish to purchase other tests or tests from other retailers. In those cases, you will still pay for the test at the time of purchase and file a claim with the Plan. We recommend you submit claims through our online Member Portal using the “Claims for COVID-19 Over-The-Counter Testing Kits” submission option. 

Overseas members will still receive 100% coverage for the cost of OTC COVID-19 tests approved by local health authorities and purchased at overseas retail locations. If you are overseas and purchase tests from a US-based retailer, then the stateside coverage rules outlined above will apply.

To receive your reimbursement as quickly as possible, please submit a detailed receipt through our online Member Portal. Please use the new “Claims for COVID-19 Over-The-Counter Testing Kits” option and include the information requested on the submission form. If submitting claims by mail, please include an itemized receipt listing the type and number of tests purchased as well as a note detailing the quantity purchased for each covered family.

Medicare Part B primary members can obtain Over-the-Counter (OTC) COVID tests at no cost at participating retail pharmacies. Please visit the Medicare COVID-19 webpage  for full details about this coverage and a list of participating pharmacies. 

Coverage of treatment for Coronavirus (COVID-19) will be per the terms of the FSBP Brochure.”

• Coding entered by providers on claims for members receiving care in the US should allow the Plan to identify these claims for proper payment
• Overseas members submitting claims directly to the Plan should indicate on their submission that the claim is related to Coronavirus (COVID-19)

Administered by a pharmacy in the U.S.

PARTICIPATING PHARMACY

Vaccines obtained at a participating network pharmacy are covered at 100% per Section 5(f) of the FSBP Brochure. The network pharmacy should submit a claim for payment directly to the Plan with no cost sharing from the member. Click here to find your nearest network pharmacy.

NON-PARTICIPATING PHARMACY

COVID-19 vaccines obtained at pharmacies not participating in the network also will be covered at 100% of the billed charges. Members will have to file a claim to obtain reimbursement for the cost of the vaccine. No letter of explanation is needed for a claim for a COVID-19 vaccine obtained at a non-network pharmacy. The claims submitted to FSBP must contain all the elements outlined in Section 7 of the FSBP Brochure for processing.

ADMINISTERED IN A DOCTOR’S OFFICE OR OTHER SETTING IN THE U.S.

COVID-19 vaccines obtained from non-pharmacy provider will be covered at 100% of the billed charges for both adults and children, per Section 5(a) of the FSBP Brochure. The coverage for this vaccine will be the same for both in network and out of network providers according to the current regulations. If you required by the provider to pay for the vaccine at the time of service, you can submit a claim to the Plan for reimbursement. Please make sure your claim submission includes all the elements outlined in Section 7 of the FSBP Brochure.

Administered by a pharmacy Overseas

Vaccines obtained outside the United States will be reimbursed at 100%.

COVID-19 Vaccine and Booster Incentive

AFSPA members aged 18 years or older who received the COVID-19 vaccine and booster are eligible to earn a $25 wellness reward for each shot per calendar year. To earn the incentive, AFSPA members must upload documentation (i.e. copy of vaccination card) through our AFSPA member portal. Once we review the documentation and verify that the member is fully vaccinated, we will deposit the wellness reward into the member’s Wellness Fund Account.*

*Funds can only be used for Eligible Medical Expenses as defined by the Internal Revenue Code Section 213(d) as it is today under the current Simple Steps to Living Well Together Program and Wellness Incentives.

FSBP members in the U.S. can access care 24/7 through our telehealth vendor, Teladoc, covered at 100%.  You can find coverage details and information to access these services in Section 5(a) and 5(e) of the FSBP Brochure.

Additional Behavioral Health Televideo Services

Behavioral Health Televideo Services is a rapidly growing and evolving form of treatment. Licensed health care professionals provide services using real-time video conferencing. With this state-of-the-art communications technology, health care professionals can provide services to members who may not have been able to access services in the past. Health care professionals who provide Behavioral Health Televideo Services comply with all relevant laws in the jurisdiction where they and the member getting services are located. We expect health care professionals providing Behavioral Health Televideo Services to comply with the Clinical, Technical and Administrative Guidelines of the American Telemedicine Association.

The following Behavioral Health Televideo Providers are available to you depending on which state you live in.

MDLIVE

• Available in all 50 states
• Behavioral health and employee assistance program (EAP) services
• Accepts patients 10+
• Appointments available from 7 AM to 9 pm,
• Monday through Friday (Some providers may offer weekend appointments)
• Call 1-855-824-2170; go to www.mdlive.com/BHCOMM

ARRAY ATHOME CARE (formerly Inpathy)

• Available in CA, DE, FL, IL, MO, NJ, NY, PA, TX and VA
• Behavioral health services only
• Accepts patients 5+
• Appointments available from 7 AM to 11 PM, 7 days a week
• Call 1-800-442-8938; go to https://insightportal.mahlerhealth.com/

TELEMYND (formerly Arcadian Telepsychiatry)

• Available in all states not covered by Array AtHome Care
• Behavioral health and EAP services
• Accepts patients 18+
• Appointments available from 9 AM to 9 PM, Monday through Friday
• Call 1-866-991-2103

Please note: Members located overseas cannot access services through FSBP’s stateside telehealth vendor, Teladoc. Overseas members must use vHealth (Worldwide) for general medicine telehealth consultations.

FSBP members with an overseas address (including APO, DPO, Embassy, and Consulate addresses) and members with a stateside address who are traveling outside the U.S., can access general telehealth consultations overseas through vHealth (Worldwide), covered at 100%. You can find coverage details and information to access these services in Section 5(a) and 5(e) of the FSBP Brochure.

Even if you visit the U.S., but maintain your overseas address, you still will access vHealth for any telehealth needs. At this time telehealth consultations from vHealth are only available for general/primary medicine. This may include preventive care as well as treatment for acute and chronic illnesses. A provider may also give referrals and prescribe medications, when appropriate.

 Telemedicine visits (virtual visits with an established provider or PCP) will be covered like in-person office visits: subject to the calendar year deductible and paid at 90% of the Plan allowance for in network providers and 70% of the Plan allowance for out of network providers. Providers should employ a HIPAA-compliant platform for such visits.

• • •

What’s the difference between telehealth and telemedicine? When you are utilizing services from Teladoc or vHealth, we refer to this as a “telehealth” visit. When you consult with an established provider or primary care physician (PCP) for clinical services on a virtual/remote level (via video conference or by telephone) we refer to this as a “telemedicine” visit.

• • •

AFSPA has removed the restrictions for all stateside members to obtain an early refills of non-specialty medications by visiting their network retail pharmacy. Maintenance medications can be obtained in 90-day supplies from participating Smart90 pharmacies or through home delivery at www.express-scripts.com.

Staff at the Plan’s specialty pharmacy Accredo stand ready to guide members who typically receive infusion treatments at infusion centers or hospitals. You can reach out to Accredo at 800-922-8279 to learn about alternatives to facility care and ensure that you continue receiving your treatment.

AFSPA has removed the restrictions for overseas members to obtain an early refill of their prescription drugs by home delivery. Overseas members needing support should contact the dedicated Expat Team at Express Scripts via email at ExpatriateProcessingGEN@express-scripts.com or call 877-846-3630 to order a refill. Members should include their member ID and/or date of birth when they contact the Expat Team to ensure timelier service.

For locations in which a state of emergency is declared (for Stateside members), AFSPA will work with our partners at Aetna and Express Scripts to ensure you have access to necessary prescription drugs.