Citi Benefits Handbook
Out-of-Network Benefits
If you receive services outside the Aetna network, the Plan will provide reimbursements of up to the following amounts:
  • Annual exam: Reimbursable up to $50;
  • Lenses: Reimbursable up to $50 for single vision, up to $60 for bifocal, up to $90 for trifocal, and up to $125 for lenticular
  • Frame only: Reimbursable up to $100; and
  • Contact lenses: Reimbursable up to $130 if elective; and up to $225 if medically necessary.
When you receive services from out-of-network providers, you will need to submit your itemized paid receipts with a Vision Claim Form. You can visit Citi Benefits Online at www.citibenefitsonline.com or www.aetnavision.com to obtain the form.
Mail the completed form and your itemized paid receipts to:
Aetna Vision
Attn: OON Claims
P.O. Box 8504
Mason, OH 45040-7111
Allow at least 14 calendar days for your claims to be processed after receipt. A check and/or explanation of benefits will be mailed within seven calendar days of the date your claim is processed. If you have any questions about your claims, call the Vision Plan at 1 (877) 787-5354.