Citi Benefits Handbook
Benefits at a Glance
The following table summarizes the vision benefits available to you and your eligible dependents:
In-network benefit
Coverage
Routine eye exam
  • Covered at 100%, including dilation; one exam per 12-month period
Frames and lenses
  • One pair of frames and lenses per 12-month period
  • Standard lenses covered at 100% once every 12-month period
  • Progressive lenses covered at 100% after $20 copay for Premium Tier 1, $30 copay for Premium Tier 2, $45 copay for Premium Tier 3, and $120 copay for Premium Tier 4
  • Frames covered at 100% once every 12-month period, up to the frame allowance below
    • $150 frame allowance; member pays 80% of balance over the $150 plan allowance
  • Up to a 40% discount on additional pairs of glasses
Contact lenses (in lieu of glasses)
  • Covered at 100% up to the contact lens allowance below; one allowance per 12-month period in lieu of eyeglasses
  • $130 allowance for elective conventional or disposable contact lenses; member pays 85% of balance over $130 allowance for conventional contact lenses and 100% over $130 allowance for disposable contact lenses
  • Fit and follow-up covered up to $55 for standard contact lenses and 10% discount for premium contact lenses
  • Discounts on additional conventional contact lens purchases
  • Medically necessary contact lenses covered in full
Laser vision correction (Lasik)
  • 15% off retail price or 5% off promotional price; must use the U.S. Laser Network to receive discount
Out-of-network benefit
Coverage
Routine eye exam
  • Up to $50 once every 12-month period
Frames/lenses
  • Frames: Up to $100
  • Single-vision lenses: up to $50; bifocals up to $60; trifocals up to $90; and lenticular, up to $125
  • Progressive lenses: up to $90
Contact lenses
  • Elective contact lenses: Up to $130
  • Medically necessary contact lenses: Up to $225
  • Fit and follow-up not covered