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 calendar year
Frames and lenses
  • One pair of frames and lenses per calendar year
  • Standard plastic lenses (single vision, bifocal, trifocal and lenticular) covered at 100% once every calendar year
  • Standard progressive lenses covered at 100%.
  • Premium progressive lenses covered at 100% after copay:
    • Tier 1: $20 copay,
    • Tier 2: $30 copay,
    • Tier 3: $45 copay.
    • Tier 4: $120 plan allowance and you will pay the balance
  • Lens enhancements covered at 100% including: UV treatment, tint (solid and gradient), standard plastic scratch coating, standard polycarbonate, standard anti-reflective coating, photogrey glass, oversize lenses, intermediate vision lenses, blended bifocals, and polarized
  • Lens enhancements covered at 100% after a $30 copay: Hi-index lenses, photocromatic / transitions plastic
  • Frame allowance: The Plan pays $150 towards any frame available at the provider location once every 12 months; additional 20% off any 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 calendar year in lieu of eyeglasses
  • The Plan pays $130 towards elective conventional or disposable contact lenses; receive an additional 15% discount off any balance over $130 allowance for conventional contact lenses
  • Fit and follow up: Pay no more than $40 for standard contact lens fitting and receive a 10% discount off the retail price for premium contact lenses
  • 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 calendar year
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