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Foreign Medical Program Benefits and Claims Information

FMP Benefits

Unlike typical health benefit/insurance plans, where the range of benefits is standard among all enrolled beneficiaries/subscribers, FMP benefits are limited to services that are medically necessary to treat a VA-rated, service-connected disability or for a condition that is associated with and held to be aggravating a service-connected disability. Supporting medical documentation is always required.

General Exclusions

  • Services, treatment or supplies received in or from the United States, District of Columbia, Commonwealth of Puerto Rico or the U.S. Territories: Virgin Islands, Guam, American Samoa and the Northern Mariana Islands
  • Services, treatment or prescriptions unrelated to the service-connected disability
  • Late charges on unpaid bills
  • Check-cashing fees
  • Postage and other costs associated with services unrelated to treatment
  • Services as part of a grant, study or research program
  • Services furnished or billed by a provider or facility barred from FMP participation (OCC will notify Veterans prior to barring a provider)
  • Services that are not accepted by the VA or U.S. medical community
  • Services, treatment procedures or supplies for which the Veteran has no legal obligation to pay
  • Treatment, services and supplies that are determined not medically necessary or are submitted from prohibited countries

Health Benefit Exclusions

This list is not all inclusive. FMP does not cover:

  • Any service, procedure, treatment, drug or device that is experimental or investigational
  • Adult day care
  • Assisted living
  • Custodial care
  • Companion services
  • Dental care (unless service-connected)
  • Durable medical equipment with deluxe/luxury features
  • Exercise programs and health club memberships
  • Family planning services and sterilization
  • Nursing homes
  • Non-acute institutional care, such as long-term inpatient psychiatric and nursing home care
  • Nonmedical home care (aid and attendance)
  • Physical therapy not under the supervision of a licensed physician
  • Procedures, services or supplies related to gender transformations 

FMP Claims Information

In order to speed up your claim processing, have your provider submit the claim in English. Claim information submitted in a language other than English will require translation; your claim processing is then delayed.

 FMP has an updated Claim Cover Sheet dated March 2016