Federal Government Programs (FGP) Overseas Claim Submission

Required Information

*Select Overseas Country required

*Enter Subscriber Email Address:

*Enter Subscriber Date of Birth: / / MM/DD/YYYY

*Enter Subscriber ID: (9-digit number without hyphens or spaces)

Required File Attachments

All claims submitted via this form MUST include a scanned image file of your dentist's payment receipt along with your completed Federal Employees Dental Program claim form. Accepted image file types are pdf, jpg, jpeg, tif and tiff.

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Click Browse to locate your scanned dentist payment receipt image file. Select file to attach.

Click Browse to locate your completed Federal Employees Dental Program claim form. Select file to attach.

Additional Information

Enter any additional related information that may be helpful in processing your claim:

Comments

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