You and/or your eligible dependents may receive reimbursement for non-covered, medically necessary, and unreimbursed medical, dental or pharmacy expenses (that are considered deductible medical expenses by the IRS) under the Family Supplemental Benefit (FSB). There are a few exceptions to this rule that are also covered under the FSB:
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. Under the Family Supplemental Benefit there is no deductible and eligible expenses are allowed subject to the Family Supplemental Benefit maximum.
FSB expenses include, but are not limited to the following:
No benefits are payable for the following expenses:
To file a 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.