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OMB Approval Number 2900-0648 Estimated Burden Avg 11 minutes Expiration Date 03/31/2019 Foreign Medical Program FMP Claim Cover Sheet PO Box 469061 Denver CO 80246-9061 USA Telephone number 1-303-331-7590 Fax number 1-303-331-7803 Email hac.fmp va.gov Website http //www. Each service s billed charge 3. Date s of service VA FORM MAR 2016 10-7959f-2 Veteran Signature Required Date Required I certify that the above information and attachments are correct and represent actual services dates and...
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The VA Foreign Medical Programor FMP is a health care benefits program for USVeterans who are residing or traveling abroad who have aVA-rated service-connected disability Through the Foreign MedicalProgram VA can pay for a US Veterans service-connecteddisability or any disability associated with and aggravatinga VA-rated service-connected disability VA also providesreimbursement through FMP for emergency care if the treatmentis associated with a service-connected disabilityEnrolling in FMP is simple For example lets say you are aVeteran who decides to permanently relocate to Germanyand you have a VA-rated service-connected disability After establishing a permanent foreign mailing address you canapply for benefits through FMP This means you dont need tophysically move to the new address before enrolling in FMPIf you are already living abroad you can enroll at anytime using your permanent foreign mailing address If youare a service-connected Veteran who is traveling abroad and donot have a permanent foreign mailing address you can stillapply for FMP using your US address Please note thatcertain countries are excluded from FMP VA cannot reimbursetreatment for Veterans who reside in countries where USDepartment of Treasury checks are restricted or where travelis prohibited To enroll in FMP complete andsign VA Form 10-7959f-1 which can be found on ourwebsite and mail it to this address Once we receive the form wewill confirm your service-connected disabilitiesand send you a benefits authorization letter The letterwill explain all the medical disabilities that VA will coverthrough FMP After you receive the benefitsauthorization letter you can make an appointment with a localprovider You can also make follow-up appointments asneeded After you receive care yourprovider should send a claim directly to VA If your providerdoesnt send the claim directly to VA then you will need to paythe provider and then submit a claim to VA for reimbursement The process for submittingclaims is the same whether by you or your provider To submita claim complete VA Form 10-7959f-2 which is on ourwebsite and mail it to this address Please note the following aboutFMP claims - When VA receives the claim wewill review it to make sure all the required documentation ispresent and that the treatment can be paid for by VA We willcontact you if more information is needed Claim amounts are converted toUS dollars according to the foreign currency rate on thedate of service For more detailed informationand to learn more VAs Foreign Medical Program visit ourwebsite or call us at the following phone number