Family Supplemental Benefit (FSB)

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:

  1. eye exams and prescription eyeglasses or contact lenses;
  2. hearing tests and hearing aids;
  3. orthodontic expenses in excess of the lifetime orthodontia maximum;
  4. routine physical exams for children over the age of two;
  5. dental benefits in excess of the calendar year maximum benefit; and
  6. medically necessary genetic testing.

No benefits are payable for the following expenses:

  1. Expenses which are not medically necessary;
  2. deductibles;
  3. copayments;
  4. medicines and drugs that do not require a prescription to purchase;
  5. weight loss programs;
  6. smoking cessation programs;
  7. exercise programs, health club dues or membership fees;
  8. hot tub or jacuzzi;
  9. cosmetic treatments such as teeth bleaching kits or treatments, cosmetic surgery, facials, etc.;
  10. charges that are in excess of reasonable and customary charges;
  11. dental charges in excess of the Maximum Allowable Fees;
  12. pharmacy copayments;
  13. group insurance premiums for your spouse’s employer’s health plan;
  14. school expenses, including costs related to special education programs for problem children; or
  15. expenses which are not deductible for federal income tax purposes; or
  16. rebates.

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.