You and your eligible dependents may receive reimbursement for non-covered, medically necessary, and unreimbursed medical and dental (that are considered deductible medical expenses by the IRS) under the Family Supplemental Benefit (FSB).
To file an FSB claim, you must submit a Family Supplemental Benefit Claim Form along with your itemized bill or your Explanation of Benefits (EOB) form that relates to the claim and your paid receipt. Your FSB claim must be received by the Fund Office within one year (12 months) of the date the expense is incurred.
Be sure to use a Family Supplemental Benefit Claim Form so that the Fund Office will recognize your claim as being submitted for the FSB.
If you have any questions, please contact Member Services at (708) 579-6600.
These expenses will be reimbursed up to the maximum benefit per family per Plan Year as shown on the Schedule of Benefits for your specific plan.
Eligible FSB expenses include but are not limited to the following:
- Plan allowable amounts over a Plan maximum;
- Certain Plan benefits payable at 50% such as TMJ and orthoptic training benefits;
- Eye exams and prescription eyeglasses or contact lenses;
- Hearing tests and hearing aids;
- Orthodontic expenses in excess of the member’s lifetime orthodontia maximum;
- Dental expenses in excess of the member’s dental benefits maximum benefit;
- Contraceptive devices that are not covered under any other plan benefit;
- Medically necessary genetic testing.
FSB exclusions and limitations:
- Expenses which are not medically necessary;
- Deductibles;
- Copayments (including pharmacy copayments);
- Expenses which are not deductible under Section 213(d) of the Internal Revenue Code;
- Medicines and drugs that do not require a prescription to purchase;
- Smoking cessation programs;
- Exercise programs, health club dues or membership fees;
- Hot tubs or Jacuzzis;
- Cosmetic treatments such as teeth bleaching kits or treatments, cosmetic surgery, facials, etc.;
- Charges that are in excess of reasonable and customary charges;
- Dental and Orthodontia charges in excess of the allowable charge;
- Group insurance premiums for the health plan of a spouse or adult dependent or;
- School expenses, including costs related to special education programs.