AFSPA – Caring For Your Health Worldwide

Please fill in all mandatory fields marked with an asterisk (*).

1. Why did you leave the Foreign Service Benefit Plan? *

Returning to the U.S. from overseas post Claims Handling Enrolled Under Spouse Price Looking for benefits available in another plan (please elaborate below) Customer Service (please elaborate below)

Other (please explain)

So that we can examine the service we provide members, please provide us with answers to the following questions.

2. How quickly did we process your claims? *

0-10 days 11-20 days 21-30 days 31 days or longer

3. Did we process your claims correctly, as stated in the Brochure? *

Always Usually Sometimes Never

4. Did our Explanation of Benefits (EOBs) provide you with the necessary information about your claims?

Always Usually Sometimes Never

5. Did you call us at (202) 833-4910 to get information or help? *

Yes No

a. If yes, were you able to get the help you needed?

Always Usually Sometimes Never

b. Was our Staff professional and courteous?

Always Usually Sometimes Never

6. Did you write us (including email) to get information or help? *

Yes No

a. If yes, was our explanation clear?

Always Usually Sometimes Never

b. If you contacted us by email, within how many business days did we reply?

1 day 2 days 3 days 4 days 5 days or more Did not contact you by email

c. Were your questions or concerns resolved to your satisfaction?

Always Usually Sometimes Never

7. If you had to contact us more than once to resolve your concern, how many times did you do so? *

2 times 3 times 4 times 5 times or more Did not contact you more than once

8. When you contacted us with a concern, what was the reason? Please check all that apply.

Benefit questions Claim payment questions Currency conversion questions Explanation of Benefits (EOB) questions In-network Provider Pharmacy benefit questions

9. (U.S. only) If you saw a doctor, did you try to locate one in the Plan’s Provider Network? *

Yes No

a. (U.S. only) If you used the Plan’s Provider Network, was the choice of providers a factor in your decision to leave the Plan?

Yes No

10. Please select the area(s) in which you would like to see improvement (check all that apply): *

Benefits Timeliness of claim payment Timeliness of resolving your concern Telephone communication Written communication Explanation of Benefits (EOBs) In-Network Provider Premium

11. Please use the space below to provide us with any additional comments you may have.

12. Please note your name, preferred contact information and topic you would like to discuss, if you would like one of our HBOs to contact you: