NewsletterVol. 27 No. 1October 2011

A Message from the CEOI am pleased to provide you with our annual AFSPA newsletter. 2011 has proven

to be a busy year for the Protective Association. Th e articles in this newsletter

refl ect our work in developing new programs and services that are coming your

way in 2012.

In 2012, the Foreign Service Benefit Plan will continue to provide excellent

benefi ts at very competitive premiums. While the average FEHB premium will

increase in 2012 by 3.8%, the FSBP is pleased to announce minimal changes in

ours. In fact, over the last 25 years, the FSBP premiums have increased only

about 35% - in 25 years!

FSBP – 2012 Rates

Bi-Weekly Premium Monthly Premium

Self Only 401

$56.99

Self & Family 402

$141.85

Self Only 401

$123.49

Self & Family 402

$307.34

Also, we have enhanced our benefi ts by increasing the amount we pay for certain

services and, in some cases, decreasing the amount you pay. Please review some

of our benefi t changes on page 3 of this Newsletter.

At the same time, our focus is expanding to provide programs that help you

manage your own health. Th e FSBP’s new motto of “Caring for Your Health

Worldwide”™ is more than just a slogan, as you will learn when you review the

programs and tools we off er our members in 2012.

We are very excited about the new services and programs coming to members,

such as Electronic Funds Transfer (EFT) for claims payments and mobile apps

that allow you to use your smart phone to search for a PPO Provider or keep track

of your medication list, just to name a few.

For those active employees of the Department of State, an Open Enrollment

Period for the Immediate Benefi t Plan (IBP) is underway until November 30th.

Th is $15,000 term life insurance policy will help provide your benefi ciary with

the funds to pay immediate and pressing expenses while waiting for other life

insurance settlements, such as FEGLI. At $2 per pay period, it is an inexpensive

In this issueOpen Enrollment Period

for the Immediate

Benefi t Plan ......................................2

Expanded and Enhanced

FSBP’s 2012 Benefi ts ....................3

Long Term Care: The

Missing Piece in Your

Financial Portfolio ..........................3

AFSPA’s Dental Programs

Continue to be Competitive .......4

Disability/Income

Replacement Insurance:

A Necessary Discussion ..............5

Where Do I Go in Case

I Need Urgent or

Emergency Care? ...........................6

The Move to Generic

Drugs—Patent Expirations ...........8

A Continuing Education—

Medicare and the FEHB ............... 11

Upcoming Changes

to Our Web Site ............................ 13

Understanding Your

Leave Options ............................... 13

The Protective Association

is “Going Green” ............................ 14

Your Rights to Disability ............. 14

Scan Your Claims and

Send Them to Us Securely ........ 15

HIPAA Compliance ....................... 15

Fall2011

2Fall 2011

and simple way to provide your loved ones with a little piece of mind. Please read

the article below for more information. I encourage all those who are eligible to

consider adding this important protection to your fi nancial portfolio.

Th e Protective Association strives every day to deliver the level of service our

members have come to expect from us. We appreciate the opportunity to serve

you and welcome your feedback and ideas.

To Your Health,

Paula S. Jakub, RHU

Executive Vice President

AFSPA was founded in 1929

“to promote in all lawful

and legitimate ways, the

advancement of the welfare of its

members including the welfare

of their dependents and their

designated benefi ciaries.” Th ere

are no initiation fees or dues.

Board Of Directors

Th omas M. Tracy, Chairman

Richard J. Shinnick, Vice Chairman

Sarah R. Horsey, Secretary/Treasurer

Kathleen Austin-Ferguson, Director

Joan M. Clark, Director

Frank J. Coulter, Jr., Director

Jan A. Mohr, Director

Phyllis E. Oakley, Director

James D. Whitten, Director

Chief Executive Offi cer

Paula S. Jakub, RHU

Executive Vice President

Members of the Board of Directors

are Career Foreign Service or other

Executive Branch personnel, on

active duty or retired. Th ey serve the

Association without compensation.

The Open Enrollment Period for the Immediate Benefi t Plan Ends on November 30th

AFSPA is currently off ering an Open Enrollment Period for the Immediate Benefi t

Plan. During this period, you are not required to provide proof of good health.

Simply enroll in the plan via our Web site www.AFSPA.org/IBP. Th e premium is

$2 per pay period via payroll deduction.

Th e IBP is available to active duty, U.S. citizen, direct hire Foreign Service and Civil

Service employees of the Department of State, the U.S. Agency for International

Development, Foreign Agricultural Service and only Foreign Service employees

of the U.S. and Foreign Commercial Service.

Th e Immediate Benefi t Plan provides the enrollee’s benefi ciary $15,000 to assist

with some of the immediate costs, such as funeral arrangements, visits from family

and friends, mortgages, fi nal medical expenses and unforeseen travel expenses,

which can cause a signifi cant fi nancial burden.

Th is optional term life insurance plan is a stand-alone policy and should

supplement your other life insurance coverage. Your eff ective date of coverage is

the fi rst of the month following AFSPA’s receipt of your initial payroll deduction.

Th e Immediate Benefi t Plan was established in 2003 aft er the bombings of the

U.S. Embassies in Kenya and Tanzania. Many family members, who experienced

the loss of a loved one, were left in fi nancial limbo while waiting for life insurance

payments and pension settlements. As a result, AFSPA collaborated with the

Offi ce of Casualty Assistance at the Department of State to develop the Immediate

Benefi t Plan for the Department of State employees.

Your coverage in this plan will terminate at retirement, resignation, or involuntary

separation from the Department of State, USAID, FAS and FCS.

For more information or to enroll, please contact us via e-mail at IBP@AFSPA.org

or phone at 202-833-4910.

Note: At age 70, the benefi t reduces to $7,500.

1716 N Street, NW

Washington, DC 20036-2902

Phone: (202) 833-4910

Fax: (202) 833-4918

E-mail: AFSPA@AFSPA.org

Web site: www.AFSPA.org

Founded in 1929

Fall 20113

The Foreign Service Benefi t Plan Has Expanded and Enhanced our 2012 Benefi ts

Every year, when the Foreign Service Benefit

Plan (FSBP) negotiates our benefi ts with the Offi ce of

Personnel Management (OPM), we strive to enhance

already existing benefi ts and add new ones that benefi t

your health as well as your convenience. 2012 is no

exception. We are extremely pleased to provide you

a plan with excellent High Option benefi ts as well as

several special features unique to the FSBP. A brief

description of some of the changes is below. Do not rely

on this chart alone. Please refer to Section 2 of the 2012

FSBP offi cial Plan Brochure for complete details on all

of the benefi t changes.

Increase the Infertility benefi t to $7,500 per

lifetime

Increase the combined annual visit limit for

physical, occupational and speech therapies to 125

Increase the Orthotics benefi t to $500 per calendar

year

Increase the Acupuncture benefi t and massage

therapy benefi ts per visit dollar maximum to $50

for up to 30 visits per person per calendar year

Combine the Nutritional counseling benefi t and

the Weight Management Program to a maximum

of $2,000 per person per calendar year

Add a Mediterranean Wellness Program Benefi t

Remove the lifetime limit for Hospice care and pay

at Plan allowance for preauthorized care. Non-

preauthorized care limited to $4,500 and pay at

Plan allowance

Reduce the Urgent care copay for Medical

emergency to $35

Lower the mail order copay on generic drugs to

$10; increase the mail order copay for brand name

drugs to $55; and multi-source drugs to $70

Add a Pre-Diabetic Alert Program

Add an FSBP 24-Hour Nurse Advice Line

Add a Translation Line for members overseas

Add an Electronic Funds Transfer feature

Long Term Care: The Missing Piece in Your Financial Portfolio

Long term care insurance can be

considered an important part of

one’s fi nancial portfolio. In the past,

it oft en has been overlooked when

reviewing your fi nancial health and

planning for your future. Th at is not

the case these days. In fact, most

fi nancial planners discuss long term care insurance as

part of the entire portfolio.

What is it?

Long term care insurance pays for confi nement in a

nursing home and an assisted living facility when one

can’t live alone and needs a little extra care, but not

necessarily in a nursing home setting. It also pays for

certain home health care, adult day care and even respite

care. Th ese are all things we think we will never need.

Why do we need it?

(FACT) 75% of people age 65 and over will

eventually need long term care.1

(FACT) By 2020, approximately 1 in 3 workers

will need to provide some form of care for their

parents.2

(FACT) National average cost of care for just 1

year in a nursing home = $80,500.3

(FACT) About 75% of single people & 50% of

couples spend entire savings within 1 year of

entering a nursing home.4

(FACT) 92% of all LTC insurance claims are about

3 years.5

Don’t count on Medicare. While Medicare does cover

some skilled nursing home stays, it is very limited.

In a nutshell, LTC insurance provides benefi ts that are

NOT covered under any other type of insurance policy,

including the FEHB or a commercial health policy.

Unless you have a LTC policy, this is an uninsured cost.

For those who have the resources to cover these costs

and, at the same time, provide for a spouse at a quality

level, then you probably don’t need long term care

insurance. But for most of us, it is worth considering.

4Fall 2011

A few things to know about long term care:

It is “medically underwritten”. Th is means you must

complete a detailed health questionnaire to determine

your eligibility for coverage per the company’s standard

underwriting guidelines.

It is guaranteed renewable. Th is means you can keep it

as long as you pay the premium, which is based on your

age when the policy is issued.

It has a level premium structure. Th is means your

premium will remain the same and you cannot be

singled out and charged more because of your age or

health status. Th erefore, the earlier that you apply (we

recommend between ages 40-55), the less expensive

your premium.

LTC insurance has been around since the 1980s and

clearly is here to stay. Th e Protective Association

began off ering LTC in 1990 because we understood the

importance of this type of protection for our members.

Th e good news is that there are hundreds of policies to

choose from—that is the bad news, too. We believe we

off er an excellent plan in Prudential Solid Solutions,

but it certainly isn’t the only one out there. Whatever

you decide, make an educated decision regarding the

purchase of a long term care policy. It is always easier

to be objective when you are healthy and well informed.

If we can assist you with any questions you might have,

please contact us at 202-833-4910 or e-mail us via the

Ask AFSPA feature on our Web site www.AFSPA.org.

We are more than happy to help you through the maze

of long term care insurance.

1-5 Sources: Long Term Care Statistics,

www.longtermcareinsurancetree.com, last updated 29 June 2010.

AFSPA’s Dental Programs Continue to be Competitive

DentaQuest Access ePPO

Th is is a preferred provider plan with a

network primarily in the Washington,

DC metropolitan area. You must

access services with a dentist in the

ePPO network for services to be covered. For the fi rst

time in eight years, DentaQuest has increased their rates

due to the rising costs of dental services in the Mid-

Atlantic area. Over the past several years, this plan’s

benefi ts have been enhanced to address the current

needs of our members.

Some advantages of DentaQuest are:

Dental implants are off ered as a standard benefi t.

A roll over benefi t that allows you to carry over a

portion of your unused annual maximum to the

next benefi t year.

Each enrolled family member can select their own

dentist in the ePPO network for treatment.

Out-of-pocket expenses are predictable as they are

based upon a set fee schedule.

Optional Orthodontic (braces) coverage is

available.

CIGNA HMO, PPO and International

Th ese plans have NOT increased their premiums for

2012. You will continue to receive the comprehensive

coverage these plans off er at this year’s rates.

Th e only diff erence in the CIGNA HMO dental plan

for 2012 is an updated fee schedule eff ective January 1,

2012. You may fi nd this updated fee schedule on our

Web site www.AFSPA.org/Dental. Th e fee schedule lists

all of the covered dental services provided by this plan.

Remember that the CIGNA HMO dental plan requires

you to utilize a dentist in the CIGNA network to receive

these discounted rates.

Th e CIGNA PPO Plan is a bit more fl exible as it provides

benefi ts for out-of-network dentists. Th e benefi ts are

payable on a coinsurance basis (100%/80%/50% for

in-network services and 100%/50%/25% for out-of-

network services), depending on the service you receive.

Fall 20115

Th e CIGNA International plan is designed to be used

primarily overseas. Also, if you need to receive treatment

stateside, when on home leave or TDY, benefi ts are

available, but at a reduced benefi t allowance. Standard

waiting periods apply before receiving treatment for

Class II and Class III services in the U.S.

Th e limited domestic coverage in the CIGNA

International plan is intended to provide members with

the option of using a dentist for routine services, such as

cleanings and prophylaxis. We recommend that you use

a network dentist to take advantage of the negotiated

PPO discounts so your benefi ts go further and you

don’t bump up against the calendar year maximum so

quickly. Obviously, it is in the best fi nancial interest of

the member with this plan to take care of their dental

needs outside the U.S.

Th e biggest advantage of our CIGNA International Plan

is that it is a true overseas plan. Unlike the plans that

participate in the Federal Employees Dental and Vision

Program (FEDVIP), our benefi ts are not subject to

overseas fee schedules or out-of-network penalties.

Periodically review you and your family’s dental needs

to ensure that a dental plan makes the most fi nancial

sense. If you have any questions regarding these

plans, please feel free to contact us at 202-833-4910 or

e-mail us via the Ask AFSPA feature on our Web site

www.AFSPA.org.

Disability/Income Replacement Insurance: A Necessary Discussion

We make decisions each and every

day; some are made on the spur of

the moment and others take a

considerable amount of time to

contemplate. One thing that is for

sure, we do have an overload of

information via the Internet that can

guide us or confuse us when it comes to disability/

income protection insurance.

While we might believe it won’t happen to us, the fact

is that an illness or accident will keep 1 in 5 workers

out of work for at least a year before the age of 65.

Th is fact alone should make us take action to protect

our future and preserve our current standard of living

should a disability cross our path.

If you are permanently disabled, you might be eligible

for Social Security Disability Insurance (SSDI). To

determine if you qualify, contact your Social Security

Administration Offi ce or go to their Web site,

www.socialsecurity.gov. SSDI disability benefi ts are

generally meant for those whose disability will last 12

months or longer or will ultimately result in death. As

a Federal employee, you could qualify for excellent

disability retirement benefi ts through your employing

agency should you become permanently disabled (see

article on page 14).

On the other hand, advances in medical technology

have allowed us to not only fi ght many previously

debilitating conditions, but also return to our jobs

and careers. We use words like “chronic”, “cured”

or “beatable” to describe previously devastating

diagnoses, like cancer or the loss of a limb. Th ey, in

many cases, no longer cause permanent disability and

people coping with their conditions return to work

aft er a lengthy recovery period.

So the question is, “Do I have enough resources to

provide for me and my family if I am recuperating and

unable to work for 6 months or longer?” If you have

enough savings or sick leave, then you probably don’t

need disability insurance.

“As you probably know well, this is a stressful

time for those of us who have the options of

changing health plans…I stumbled upon one

of your customer service representatives (CSR)

when I became aware of the DentaQuest

coverage. And of course, I wanted all the

information I could get to compare it with the

coverage I had through FEDVIP. And I really

lucked out.

Th e CSR has been wonderful—knowledgeable,

full of facts, pleasant, patient, understanding,

and, most important, interested in helping me

make my decision.

Th anks for such great service.”

6Fall 2011

However, if your answer was “no”, then you might

want to look at options. When considering disability/

income protection insurance, here are some questions

to ask:

What savings are in place that would meet all of

your needs if you were unable to work? Th e reality

is that your savings may carry you fi nancially for

only a few months.

What amount and duration of coverage will you

need to meet your needs?

Is there a waiting period that must be met before

benefi ts are paid?

Is partial disability an available benefi t under the

plan?

Before deciding what to do, consider the now…

Educate yourself between the diff erences of short-term

and long-term disability plans. Generally, a short-term

disability plan provides coverage from 6 months up to

2 years. Long-term disability plans can provide 5 years

of benefi ts or coverage up to age 65. Also, disability

policies were designed to replace approximately 60% of

your current base salary.

If you are considering a disability policy, we invite you

to review the Lloyd’s of London disability plan that

is off ered by the Protective Association. Th is plan

is designed to cover the gap caused by a temporary

disability. Our plan provides:

60% of your salary, up to $3,000 per month

24-month Benefi t Period

45-day Elimination Period

Covers anywhere in the world

Optional Lump Sum Benefi t of $250,000 or 5

times your salary, whichever is less

More information is available on our Web site

www.AFSPA.org/Disability or contact us with questions

at 202-833-4910.

Where Do I Go in Case I Need Urgent or Emergency Care?

A part of the FSBP’s new motto of

“Caring for Your Health Worldwide”™

is focusing on bringing health care –

the right kind at the right time – closer

to our members. Th ere are several

types of providers and we make every eff ort to provide

benefi ts to accommodate your choices.

Urgent Care Centers (UCC) and Retail Medical

Clinics (“Convenience Care Clinics”)* are popping up

everywhere. UCCs are becoming a popular alternative

to the hospital ER when your condition is not life

threatening and does not require the resources and

expertise of a true hospital emergency room or trauma

center. Additionally, you usually can avoid the hours of

wait time experienced in the hospital ER.

Th e Convenience Care Clinics are probably a bit newer,

but are gaining in popularity. Th ey are conveniently

located in neighborhood pharmacies, off er convenient

hours and are manned by nurses and/or nurse

practitioners. Th ey provide a convenient alternative to

making a doctor’s appointment, taking time off work,

driving to and from the doctor’s offi ce, etc., when you

just want to have someone check out a rash, to see if

your child has an ear infection, or just pop in to get your

fl u shot. In today’s busy world, one can see why these

Medical Clinics are attracting a wider market.

Th e Foreign Service Benefit Plan provides benefi ts

for accidental injury and also medical emergency in

Section 5(d), “Emergency services/accidents”.

For an accident, the Plan pays 100% of the Plan

allowance for services rendered in Emergency

Rooms (ER) and urgent care facilities. In addition,

if you choose to be treated in a physician’s offi ce,

the Plan pays for the initial offi ce visit at 100%

of the Plan allowance. Th is benefi t includes

services rendered in Convenience Care Clinics.

Th e Convenience Care Clinics in the Plan’s PPO

network include CVS Minute Clinics, Walgreen’s

Take Care Clinics and Th e Little Clinics.

Fall 20117

For medical emergencies

(as distinct from accidental

injuries), the Plan has a special

Urgent Care Benefi t, also found

in Section 5(d). If you go to

a PPO network urgent care

facility or one outside the 50

United States, you pay only

$35 for your treatment. Th is not only saves you

and the Plan the high cost of an ER visit, but you

most likely will be treated more quickly. If your

situation is not life threatening or does not need

immediate medical attention, you should think

about going to an urgent care facility. If you do

not, the Plan’s regular medical emergency benefi ts

apply, but you will have more out-of-pocket

expenses to pay.

Please see the Plan’s Brochure in section

5(d) for details on our Accidental injury and

Medical emergency benefi ts.

Not all medical situations require emergency

care. Below is a chart that will help you decide

on the most appropriate venue to receive care

quickly.

In case of emergency

Remember, ERs are set up to handle extremely serious

medical situations. If you fi nd yourself in need of

emergency care, you should dial 911 or go to the nearest

hospital Emergency Room (ER).

*Depending upon your demographic area, these clinics may be referred to as

Convenience Care Clinics, Convenience Care Centers, Walk-In Clinics, Retail

Medical Clinics and Urgent Care Clinics.

Urgent Care Center (UCC)Retail Medical Clinic

(aka Convenience Care Clinic)

Emergency Room (ER)

What is it UCCs offer quality medical care for illnesses and injuries and are often open until 10 pm and on weekends

Health centers located in pharmacies, grocery stores and other retail stores treat common illnesses and are usually open evenings and weekends

A group of rooms in a hospital created to treat emergency conditions, usually open 24 hours a day, seven days a week

When to go in general

When you can’t get in to see your doctor and you need care for an unexpected illness or injury that does not pose a serious danger to your health

For small problems when you can’t see your family doctor right away

When you experience an injury, sickness or mental illness that happens suddenly and requires immediate care

Examples of when to go

You have a sports injury and it’s after your doctor’s offi ce hours

You need stitches for a non-critical injury

You have a chronic problem, like a sore throat or back pain, that isn’t improving and can’t wait until your doctor is available

Minor sicknesses, like rashes, earaches, sore throats, stomach aches and other problems

Flu shots, vaccinations and other shots

Experience diffi culty breathing

Are bleeding excessively

Suspect a heart attack

Have severe burns or acute stomach pain

Experience unconsciousness

Advantages Save time and money Convenience when you can’t get in to see your doctor for a small problem

An ER is the only place to go for treatment in a true emergency

8Fall 2011

Pre-Diabetes—Are You at Risk?

Pre-diabetes is a condition

in which blood glucose

levels are higher than

normal but not high enough

for a diagnosis of diabetes.

According to the 2011 National Diabetes Fact Sheet,

25.8 million people in the United States (8.3% of the

population) have diabetes and 79 million people are

pre-diabetic. Studies have shown that people with pre-

diabetes develop type 2 diabetes within ten years and are

also at increased risk of developing cardiovascular

disease.

Oft en, early intervention can prevent diabetes and an

A1C test is the best and quickest way to fi nd out if you

are at risk for developing diabetes. Th e A1C test refl ects

a person’s blood sugar levels over the past 2-3 months.

If the A1C number is over the healthy limit, it may be a

warning sign that the person has an increased risk for

developing diabetes and needs to take preventive action.

Th e Foreign Service Benefit Plan (FSBP) wants

you to know if you are at risk for developing diabetes.

Th at is why we are adding a Pre-Diabetic Alert Program

focused on providing education and support for

members who might be at risk for developing diabetes.

For those who may be pre-diabetic, Medco Health

Solutions, the Plan’s Pharmacy Benefi t Manager, will

contact you to off er the opportunity to participate in the

Program and send you a free A1C home test kit. You can

take samples for the A1C test privately and conveniently

at home, following the simple instructions that come

with the kit.

Once you know your A1C number, you can work with

your doctor to develop a health action plan to control

all the leading diabetes risk factors—blood glucose

level, cholesterol, blood pressure, as well as weight

and smoking. Coventry Health Care, Inc., the Plan’s

underwriter, will be available to provide support to

you, too.

Most people can prevent diabetes and its serious

complications if they act early to lower their risk. If

you receive a letter from us, please read it with this in

mind.

The Move to Generic Drugs—Patent Expirations

At the end of November, the

generic version of Lipitor

(atorvastatin) is expected to

become available. Th at’s good

news for people who want lower

cholesterol and lower costs.

Th at will be followed in 2012 by

generic versions of Lexapro, Plavix, Singulair and

Diovan. If you’re taking any of these brand name drugs,

don’t miss an opportunity to cut your prescription costs.

Generic versions of many other brand name drugs

are available already. For example, you can get generic

versions of Zocor, Prilosec, Cozaar, Glucophage and

many other popular brands today. Generic versions

(or equivalents) approved by the U.S. Food and Drug

Administration contain the same active ingredients—

and are the same in safety, strength, performance,

quality and dosage form—as their brand counterparts.

Th e Foreign Service Benefit Plan’s (FSBP)

prescription generic drug benefi ts are aimed at providing

you substantial savings over brand name drugs. You can

obtain a 30-day supply of a prescription generic drug at

retail for only a $10 copay. In 2012 the FSBP is lowering

our mail order copay for a 90-day supply from $15 to

$10. Clearly, there are savings advantages to purchasing

generic drugs when available and your doctor allows it.

And, using mail order allows you to receive 3 times the

amount for the same price you would pay at retail.

In the chart on the next page is a list of popular brand

name drugs that are available now as generics. Members

on the brands listed below could save a considerable

amount of money by switching to a generic drug. If

you are interested in making the switch, we recommend

you contact your doctor to see if he/she will authorize a

generic drug.

Fall 20119

Generic equivalents are available now for the following medications. If you are taking one of these brands, you could

save money with a generic.

BRAND NAME DRUGS

Adderall XR

Ambien

Aricept

Cozaar

Effexor XR

Flomax

Glucophage

Hyzaar

Levaquin

Lovenox

Norvasc

Prevacid

Prilosec

Protonix

Toprol XL

Xalatan

Yaz

Zocor

Zoloft

Additionally, below is a chart of popular brand name

drugs that will be available as generics in the future. Here

again, once the generic equivalents become available, if

you are interested in taking advantage of the savings

available to you, contact your doctor to see if he/she will

authorize the generic drug.

Upcoming Patent Expirations

2011 2012 2013

Caduet

Concerta

Femara

Levaquin

Lipitor

Solodyn

Tazorac

Xalatan

Zyprexa

Actos

Avandia

Avapro

Clarinex-D 12 & 24

Detrol

Diovan & Diovan HCT

Lexapro

Lidoderm

Lunesta

Plavix

Provigil

Seroquel

Singulair

Aciphex

Fosamax Plus D

Cymbalta

Lovaza

Niaspan

Temodar

Xopenex

Th e FSBP off ers a generic copay waiver program

through Medco, as described below:

Start saving now With the FSBP Generics Rx Advantage program, you can call the Medco Pharmacy®—our mail order pharmacy—and pay nothing the fi rst time you fi ll a new generic prescription by mail or get a $25 discount on select brand name drugs that will have generic versions soon. Talk to a Medco Benefi t Specialist today at 1-877-909-GenRx (1-877-909-4367) or visit Medco online at www.medco.com/generics for information about these important savings opportunities through the Medco Pharmacy.

Ordering from the Medco Pharmacy is easy. Your Medco Benefi t Specialist can even contact your doctor to help you get started. The Medco Pharmacy will deliver up to a 90-day supply of your medication with free standard shipping. In addition, you will have 24/7 access to pharmacists who will answer your questions.

Have you recently moved?Are you moving soon?Please don’t forget to give us your new address.

Go to www.AFSPA.org, click the “Change of Address” tab and enter your address changes.

American Foreign Service Protective Association (AFSPA) and the FOREIGN SERVICE BENEFIT PLAN (FSBP)

1716 N Street, NWWashington, DC 20036

Telephone: (202) 833-4910 Fax: (202) 833-4918

10Fall 2011

The FOREIGN SERVICE BENEFIT PLAN Brings You New Special Features and Wellness Coaching

Th e Foreign Service Benefit Plan (FSBP) is

excited about the many features available to members

of the Plan now and that are being made available to

you this fall and in 2012. We have collaborated with

Coventry Health Care (Coventry, the Plan’s underwriter)

and Medco Health Solutions, Inc. (Medco, the Plan’s

Pharmacy Benefi t Manager) to bring you a package

of services and special features designed to make your

health care experience convenient, eff ective and, of

course, healthy.

Available now (FSBP members, please see the FSBP 2011 Open Season Letter for details about these special features)…

Electronic Funds Transfer (EFT)

Th e FSBP provides you the option to receive your

claims payment directly into your U.S. bank account

through EFT. Of course, the biggest benefi t to you

will be the signifi cantly reduced time to receive claim

reimbursements. In addition, this responds to OPMs

call to “go green”.

Electronic Copies of Explanations of Benefi ts (EOBs)

Using the FSBP’s co-branded Web site, My Online

Services, with Coventry Health Care, you can review and

print copies of your EOBs. In doing so, you will know

quickly how benefi ts were applied to a claim you’ve fi led.

Scanned Claim Submission via Secure Internet Transmission

Th e FSBP provides you with a secure method to

submit claims to us via the Internet. Visit our Web site,

www.AFSPA.org/FSBP411. You can attach a scanned

copy of your claim (as a PDF) to an e-mail message

you send to us. We designed this process to eliminate

lengthy mail time. In addition, you may correspond

with us securely via this process.

Available in November for FSBP members—Coventry WellBeing Web site

Your health and well-being are our top priority. Th at is

why the FSBP and Coventry are bringing new features

to our wellness program through the Plan’s co-branded

Web site, My Online Services. Th e enhanced online

wellness experience is easier to navigate, simpler to use

and more personalized to help you get or stay well by

improving your ability to make healthy choices.

In addition to the enhanced health risk assessment

(HRA), a completely confi dential online exercise that

will help you answer questions about your habits and

health history, our new feature off ers online coaching

for everyday challenges like:

Nutrition improvement

Stress management

Cholesterol management

Blood pressure management

Sleep improvement

Depression management

To help you with your program and track your progress,

you have many tools, such as a step tracker, a restaurant

guide for healthy choices, BMI calculator, cook book

and portion size tool. You also have additional resources,

like discount programs, health news and libraries.

Other features include:

Track doctor appointments and important dates

for you and your family

Set up e-mail reminders for appointments

Review articles about kids and teens health

through KidsHealth

Obtain discounts on health and wellness products

Watch for the new program to appear on our co-branded

Web site, My Online Services, in November.

FSBP members, please see the enclosed FSBP 2011 Open Season Letter for details about these special features that are available in January…

FSBP 24-Hour Nurse Advice Line

You have access to a registered nurse, 24 hours a day, 7

days a week to discuss any health concerns by calling

the FSBP 24-Hour Nurse Advice Line. Th e nurse will

provide advice and answer health-related questions and

concerns.

FSBP 24-Hour Translation Line

Th ose of you overseas can take advantage of our 24-

Hour Translation Line to assist you in discussing your

Fall 201111

urgent health-related conditions (such as accidents and

medical emergencies that require immediate attention)

with a foreign health care professional.

Mediterranean Wellness Program

Th e Mediterranean Wellness Program shows you how

healthy cultures eat delicious foods to maintain low

weight, healthy hearts and longer lives.

You can receive up to 100% reimbursement for the

Program through the use of the Plan’s Nutritional

counseling and Weight Management Program, once

you complete at least 80% of the Program (see Section

5(a) of the Plan’s Brochure).

Social Apps—coming to FSBP members soon.

Th ere’s an app for that! You have just returned from

overseas and need a doctor or medication information…

Just a few of the exciting capabilities the FSBP is

planning for you.

Th rough Coventry, the Plan’s underwriter:

When you go to a doctor’s offi ce and have

forgotten your ID Card, you will be able to

display your card on your smart phone and

supply your insurance information to the

doctor.

When you need a PPO Provider quickly, you

will be able to fi nd one on your smart phone

and obtain their specialties, phone numbers

and locations.

Th rough Medco, the Plan’s Pharmacy Benefi t

Manager:

Look up potential lower-cost prescription

options using My Rx Choices and discuss

them with your doctor – even while you’re

still in the doctor’s offi ce.

View your medications and set reminders for

when to take them or notify you when you are

running low.

Th ese apps will enhance your ability to obtain needed

care quickly and with minimal eff ort.

Look for more updates on our Web site soon.

A Continuing Education—Medicare and the FEHB

Th e Protective Association strives to be a resource to

help members understand their coverage. Th e maze of

insurance is extensive and confusing to many. AFSPA

CEO Paula Jakub has spoken to several communities

and shared her knowledge on this perplexing topic.

She opened the 2011 President’s Roundtable series at

DACOR on Medicare and the FEHB.

Excerpt from DACOR’s March 2011 Bulletin

Printed with DACOR’s permission

“Ms. Paula Jakub, RHU, CEO of the American Foreign

Service Protective Association (AFSPA), shared many

insightful and useful tips on navigating the complex

world of Medicare and the Federal Employees Health

Benefi ts Program (FEHB) at the President’s Round Table

on January 11, 2011. Th e diff erent options available

through Medicare and the interrelations with FEHB can

be confusing. However, Ms. Jakub used her expertise to

show how these two resources can be used successfully,

whether one is a long-time retiree using both Medicare

and one of the FEHB plans for years, a baby boomer

about to become eligible for Medicare, or someone

caring for an elderly family member.

First, Ms. Jakub outlined the four parts of Medicare.

Part A is basically hospital insurance that covers

inpatient hospital care and some hospice services.

In most cases, Part A is free to many users.

Part B is medical/surgical insurance, with a

voluntary, monthly premium that changes

based on income. Part B covers general doctor

services and tests, medical equipment (such as

wheelchairs) and preventive screening tests. An

important aspect to understand about Part B is the

Modifi ed Adjusted Gross Income (MAGI), which

is the number used to assess the monthly premium

a Part B enrollee is charged. Th e MAGI number is

calculated when the past two years’ tax statements

are examined; if earnings are above a certain

amount, the monthly premium for Part B goes up

accordingly.

12Fall 2011

Part C of Medicare is a comprehensive

coverage plan, much like a Health Maintenance

Organization (HMO) that gives additional

benefi ts, but at an increased premium. Patients

also have to be enrolled in Part A and B to

participate in a Part C Plan.

Part D of Medicare is a prescription drug coverage

plan that has a monthly premium, which also is

adjusted by one’s MAGI number. However, Ms.

Jakub noted that most Federal Employees would

not need to take Part D because their FEHB

Plan generally is considered to have Creditable

Coverage, meaning the prescription drug benefi ts

are at least as good as the standard Part D Plan.

FEHB and Medicare together generally cover nearly 100

percent of charges according to Ms. Jakub. Anyone who

qualifi es for Part A without paying a premium should

enroll in it because it covers hospital-related charges

and most FEHB Plans will cover the portion Medicare

does not; i.e., inpatient deductible, copays, etc. Part B,

on the other hand, is more of a personal choice and

enrollment should be decided on an individual basis.

Th e increased monthly premiums that come from

higher MAGI numbers may cause some to decide this

portion of Medicare is not worth the cost they have to

pay. However, having both Medicare Part B and the

FEHB Plan again provides almost 100% coverage.

It becomes a question of how much risk in medical

expenses one is willing to take and one’s tolerance for

paperwork in the absence of Medicare Part B. If one

does have Part B of Medicare, Ms. Jakub mentioned

an important caveat to watch out for when choosing

a doctor. Doctors who are “Private Contract (opt-out

providers)” do not work with Medicare and essentially

enter into private contracts with patients. Th is means

that neither the doctor nor the patient can fi le a claim

with Medicare. Medicare will not pay for the services

rendered and patients are responsible for all charges.

Th e FEHB Plans can pay only what they would have paid

if Medicare paid, generally about 20% of the Medicare

allowable charge. For this reason, all members of

Medicare Part B should make sure to ask this question

of their doctor before their fi rst visit: Do you participate

and do you fi le with Medicare or are you a Private

Contract physician?

Regardless of whether Federal annuitants over the age

of 65 and have FEHB choose to take part in Medicare or

not, the FEHB still provides excellent benefi ts. For those

who do not choose to join Medicare, FEHB ensures that

doctors cannot charge these FEHB enrollees any more

than the doctor would have charged someone with

Medicare because of Congressional legislation. Th is

means that retired enrollees of FEHB over the age of 65

without Medicare have no less medical coverage than

they did as a full-time Federal employee.

To end her discussion, Ms. Jakub highlighted and

explained some of the features of the Aff ordable Care

Act (ACA). While there are many aspects of the ACA

scheduled to go into eff ect in upcoming years, as Ms.

Jakub wisely pointed out, the start dates for these portions

of the plan are so far in the future, and Congressional

debate on the issue has already begun, there will likely

be changes to the Act.”

Reminder about the FOREIGN SERVICE BENEFIT PLAN’S Elec-tronic Funds Transfer (EFT) for Claim ReimbursementsThe FOREIGN SERVICE BENEFIT PLAN (FSBP) now offers Electronic Funds Transfer (EFT). Members have been asking for this service for years, and we are pleased to offer it.

Currently, Coventry Health Care is accepting completed Electronic Funds Transfer (EFT)/Direct Deposit Authorization Forms. For more information and/or enrollment instructions, please see the 2011 Open Season FSBP Letter.

Fall 201113

Understanding Your Leave Options

By Jeff rey Mounts, Managing Director for Global

Compensation, Department of State

“How does my leave balance grow?” “Does that count

as ‘sick leave’?” “When does someone use ‘leave without

pay’?” Knowing the answers to these questions and

more will help you to use your leave balances to your

advantage as a Federal employee. Th e following sections

outline the types of leave available to Federal employees

and the rules surrounding accrual and use.

Annual Leave:

Annual leave is used as a paid absence due to vacation, rest

and relaxation, personal business, and/or emergencies.

Annual leave is earned based on the number of years in

service for full time employees. According to 5 U.S.C.

6303, an employee is entitled to annual leave with pay,

which accrues as follows:

Less than three years of service:

Earns four hours per pay period, for a total of 13

days per year.

Greater than three years of service, but less than 15

years of service:

Earns six hours per pay period for a total of 20

days per year.

Aft er 15 years of service:

Eight hours of leave is earned per pay period, for a

total of 26 days per year.

For Department of State employees, as per 3 FAM

3416.1, an employee serving 90 days or more may

request an advance of annual leave. Th e advance cannot

be in excess of the amount that would have been earned

throughout the remainder of the leave year. For more

information regarding advances of leave, contact Payroll

Customer Support at payhelp@state.gov or 1-800-521-

2553.

Sick Leave:

Sick leave may be for absences pertaining to personal

medical needs, care of a family member, adoption-

related purposes, and/or bereavement. Sick leave

is granted by an agency when it is supported by

administratively acceptable evidence. An absence greater

than three days may require a medical certifi cate or

other administratively acceptable evidence, as dictated

by your agency. As stated in 5 U.S.C. 6307, sick leave

accumulation is not limited and is earned at a rate of 4

hours (1/2 day) per pay period for full time employees.

Like annual leave, sick leave can be advanced at the

discretion of the agency. According to 5 CFR 630.402,

the maximum amount of leave that may be advanced

is 240 hours (30 days). Department of State policies

regarding advancement of sick leave may be found in 3

FAM 3428.

Leave Without Pay (LWOP):

LWOP is a temporary non-pay status and absence from

duty that is granted at the discretion of the agency, usually

at the employee’s request. LWOP may be granted even if

there is annual and/or sick leave available. Th is is done

at the discretion of the employing agency. Th e accrual

of annual/sick leave and also coverage under FEHB and

FEGLI is aff ected by LWOP.

If an employee is on LWOP, the number of hours

in a nonpay status may reduce his/her leave

credits. 5 CFR 630.208 states that if the number

of hours spent on LWOP within the leave year

is equal to the number of the employee’s base

pay hours in a pay period, the employing agency

should reduce his/her leave credits by the amount

of leave earned during the pay period. Th erefore,

Upcoming Changes to Our Web SiteWe, along with Coventry Health Care and Medco, will be updating our Web sites. AFSPA’s main purpose for this update is to change all content to HTML 5 format. This will make the layout of our site more user-friendly. We hope that you will visit our site in the next few months to see what changes we have made to enhance your online experience. If you haven’t subscribed to our RSS feed yet, please do so. Simply go to our Home page www.AFSPA.org, click on “What is a RSS?” at the bottom of the page and follow the instructions to subscribe. This is a great way to receive instantaneous news about the Protective Association.

14Fall 2011

no leave is earned for the pay period.

Stated in 5 CFR 890.303(e), FEHB enrollment

continues for no more than 365 days in a non-

pay status. Th e non-pay status may be continuous

or broken by periods of less than 4 consecutive

months in a pay status. For Department of State

employees, per 4 FAH-3 H-545.4:

• FEHB coverage continues for an employee on

LWOP for up to 365 days unless it is canceled

by submitting Form SF-2809. Th e employee

may request cancellation of coverage at

anytime by completion of this form.

• Before expiration of the 365 days, an

employee may complete the reverse side of

Form SF-2810, Federal Employees Health

Form Benefi ts Program-Notice of Change in

Health Benefi ts Enrollment, for conversion to

a private non-group insurance contract.

FEGLI coverage continues for 12 consecutive

months in a non-pay status without cost to the

employee or to the agency, according to 5 CFR

870.508(a). Th e non-pay status may be continuous,

or it may be broken by a return to duty for periods

of less than 4 consecutive months as stated in 5

CFR 870.404(c).

Have more questions about your leave? Contact Payroll

Customer Support at payhelp@state.gov or 1-800-521-

2553.

Finding Help on Payroll Related Matters

Need to know where to turn for more information

regarding Foreign Service pay-related matters? Contact

the Department of State’s Payroll Customer Support

desk Monday through Friday at 1-800-521-2553 from

8:30 AM to 4:30 PM. PCS is also available by e-mail any

time at payhelp@state.gov.

Your Rights to Disability

By Jeff rey Mounts, Managing Director for Global

Compensation, Department of State

Eligibility and requirements for disability vary

depending upon an employee’s retirement system.

Navigating the rules and regulations regarding disability

can be confusing, so the following is a short guide to

understanding your rights regarding disability.

Employees should apply for disability aft er they have

provided their employing agency with complete

documentation of their medical condition and the

agency has exhausted all attempts of retention by

accommodation or reassignment.

Th ere are general eligibility requirements regarding

disability stated in 5 CFR 844.103. Th ey are as follows:

While employed, the employee must have become

disabled due to injury, illness, or disease for useful

and effi cient service in the current position.

Th e employing agency must certify that it is unable

to accommodate the disabling medical condition

in the current position of employment.

Th e disability must be expected to last one year or

more.

Eligibility for disability and the computation of disability

payments diff ers for employees under the Federal

Employees Retirement System (FERS) and the Foreign

Service Pension System (FSPS) versus employees under

the Civil Service Retirement System (CSRS) and the

Foreign Service Retirement and Disability System

(FSRDS). Th e requirements and disability annuity

computations for each group are shown on the next page:

The Protective Association is “Going Green”Last month, we started our initial Going Green initiative by placing a section on our “Change of Address” page where you can provide us with your communication preferences. We encourage you to take a few minutes to do this, if you haven’t already done so. Simply visit our Web site www.AFSPA.org and click on the “Change of Address” tab towards the top of the page.

The offi cial launch of this initiative will be in early 2012.

Fall 201115

HIPAA ComplianceThe FOREIGN SERVICE BENEFIT PLAN (FSBP) is fully compliant with the Health Insurance Portability and Accountability Act (HIPAA). But what does this really mean? The medical information (i.e., PHI-Protected Health Information) that you provide us is kept strictly confi dential and secure in our records.

Many of you correspond with us via e-mail with a question about a recent surgery or doctor’s visit. To ensure that your confi dential medical information isn’t fl oating around somewhere in cyberspace, we “park” our reply containing PHI in AFSPAconnect as a secure message. We notify you when it can be retrieved securely.

Also, you have the capability to send us your claims via our secure Web site. When you click “submit”, your e-mail and any attachments are encrypted and stay encrypted until they are delivered to our server (see separate box entitled “Scan Your Claims and Send Them to Us Securely”).

We take protecting your confi dential medical information seriously. In fact, all of AFSPA is HIPAA compliant.

Scan Your Claims and Send Them to Us SecurelyMany FOREIGN SERVICE BENEFIT PLAN (FSBP) members scan their claims and send them to us via the “Ask AFSPA” tab on our Web site www.AFSPA.org/FSBP411. The process is fast, convenient and ensures that claims are processed more quickly than if sent via ‘snail mail’.

Some of our overseas members may experience diffi culties when sending us their scanned claims if they are using a work computer. This is due to their employer’s security protocols. If you experience this issue, use this alternate link: www.afspa.org/fsbp/AFSPA-2011-04-27.html. Also, many members report immediate success when they send the claims from their home computer.

FERS/FSPS (5 CFR 844.201 and 5 U.S.C. 8452):

Eligible aft er 18 months of creditable federal

civilian service at any age

Must apply for social security disability benefi ts

If under the age of 62 at the time of retirement

and ineligible for immediate voluntary retirement,

60% of high-3 average salary minus 100% of social

security payable is received for the fi rst 12 months.

Aft er the fi rst 12 months 40% of the high-3 salary

average minus 60% of social security payable is

received.

CSRS/FSRDS (5 U.S.C. 8337 and 5 U.S.C. 8339):

Eligible aft er fi ve years of creditable federal civilian

service at any age

If 60 or older at the time of retirement, the

employee is entitled to an earned annuity; however

if under 60 there is a guaranteed minimum that

applies.

Th e guaranteed minimum is the lesser of 40% of

the high-3 average salary or the regular annuity

obtained aft er increasing service by the time

diff erence between retirement and the employee’s

60th birthday.

Additional Assistance under Federal Employees’ Compensation Act (FECA):

Th e Federal Employee’s Compensation Act (5 U.S.C.

8102) provides worker’s compensation paid to an

employee suff ering a disability due to a work related

injury, including occupational disease. 5 U.S.C. 8118

also states:

Continuation of regular pay may be authorized to

an employee, not to exceed 45 calendar days.

An employee may also use annual or sick leave at

the time of the disability.

Compensation under FECA does not begin

until the continuation of regular pay ends and/

or annual/sick leave is exhausted and wage loss

begins.

Have more questions? Contact Payroll Customer

Support at payhelp@state.gov or 1-800-521-2553.

1716 N Street, NW

Washington, DC 20036-2902

American Foreign ServiceProtective AssociationStatement of Financial PositionDecember 31, 2010

ASSETS

Cash & cash equivalents $ 430,517FEHB reimbursement receivable 401,149Accounts receivable & prepaid expenses 668,578Investments, market value 974,982Escrow deposits 120,000Property, plant & equipment, net of depreciation 3,460,616Deferred compensation plan assets 146,019TOTAL ASSETS $ 6,201,861

LIABILITIES & NET ASSETS

Accounts payable & other liabilities $ 896,208Deferred premium revenue 850,899Mortgage payable 1,019,179Deferred compensation plan liability 146,019TOTAL LIABILITIES $ 2,912,305

NET UNRESTRICTED ASSETS $ 3,289,556 TOTAL LIABILITIES & NET ASSETS $ 6,201,861

NOTICE OF

ANNUAL MEETINGThe 2011 AFSPA Annual Meeting

will be held at the Pan American

Health Organization located at

525 23rd Street, NW, Washington,

DC on January 5, 2012 at 12:00 pm

(noon) in Room B. Please join us to

fi nd out about our successful year.