Citi Benefits Handbook
Supplemental medical plans are determined and paid entirely by Aetna. To file a claim for benefits:
Register on the My Aetna Supplemental app or at myaetnasupplemental.com. Click "Report New Claim" and answer the questions needed for filing your claim. If you are a non-Aetna member, you will be prompted to upload a photo of your medical bill.
Claims and Appeal Procedures
On May 4, 2020, the U.S. Departments of Labor and the Treasury (the Agencies) issue guidance that temporarily extends the deadlines in place for certain benefit changes and processes associated with election, notification, payment and claims/appeals in connection with COVID-19, which was deemed a national emergency on March 1, 2020 (the National Emergency). To protect individuals from losing benefits, the Agencies extended deadlines that might have been missed during the National Emergency. The temporary extension of the deadlines was initially set to expire 60 days after the end of the National Emergency. The Agencies have revised their guidance to provide that your extended deadline will end on the earlier of one year from your original deadline or your original time limit after the end of the National Emergency (Agencies' deadline).
If your deadline to file a claim or appeal falls within the National Emergency, you will have up until the Agencies' deadline to submit your claim.
If a benefit is payable, it will be paid no later than 60 days after the date the required written proof is received. All benefits are payable to you. If Aetna needs additional information, you have 45 days from the date of request to send them the additional information. If your claim is denied entirely or in part, this is called an "adverse claim decision." If Aetna makes an adverse claim decision, they will tell you in writing in 30 days. If you disagree, you can ask Aetna to re‐review the adverse claim decision. This is called an appeal.
If you want to appeal, send it to Aetna within 180 calendar days from the time you receive the adverse claim decision. You can appeal by either:
- Calling Aetna at 1 (800) 607-3366
- Sending Aetna a written appeal to the address on the notice of adverse claim decision
When you send a written appeal, be sure to include:
- Your name
- The policyholder's name
- A copy of the adverse claim decision
- Your reasons for making the appeal
- Any other details you would like Aetna to know
Another person may submit an appeal for you, including a provider. That person is called an authorized representative. You need to tell Aetna if you choose to have someone else appeal for you (even if it is your provider). You should fill out an authorized representative form telling Aetna that you are allowing someone to appeal for you. You can get this form online at myaetnasupplemental.com. The form will tell you where to send it.
When Aetna receives your appeal, it will be handled by someone who was not involved in making the adverse claim decision.
Timeframe for deciding your appeal
Aetna will give you an appeal decision within 30 calendar days of receipt of your request for an appeal.
Fees and expenses
Aetna does not pay any fees or expenses incurred by you in pursuing an appeal or complaint.
Receiving Your Benefits
You can receive your benefit as a direct deposit to your checking account or as a check mailed to your home. Log on to your account at myaetnasupplemental.com or the My Aetna Supplemental app or, if you have Aetna medical coverage, aetna.com. Sign up for your preferred method of payment: direct deposit or a check mailed to your home.