phillips 66 health and well-being handbook...a-2 lphillips 66 contacts 2018 phillips 66 contacts...

PHILLIPS 66HEALTH AND WELL-BEING HANDBOOKMedical I Employee Assistance Plan I Dental Vision I Flexible Spending Plan I Disability Life I AD&D I Emergency Responders Retiree Medical I Severance I Other Information

This handbook includes the summary plan descriptions

(“SPD”) for the Phillips 66 health & welfare plans (“plans”),

and provides an overview of certain terms and conditions

of the plans. The SPDs are written in clear, everyday

language designed to help participants understand the

terms of the plans. Every effort has been made to ensure

the accuracy of the information provided in the SPDs.

However, if there is any discrepancy or conflict between

the SPDs and the terms of the plan documents, the plan

documents will control. Phillips 66 reserves the right to

amend, change or terminate the plans at any time without

notice, at its sole discretion. Nothing in the SPDs creates

an employment contract between the company or its

subsidiaries or affiliates and any employee. Represented

employees are eligible to participate in a plan only if

provided for under the terms of an applicable

collective bargaining agreement.

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PHILLIPS 66 TABLE OF CONTENTS

PHILLIPS 66 TOTAL REWARDS HANDBOOKThis handbook contains important information regarding the Phillips 66 Total Rewards program. Participants should keep it on hand and refer to it when they have questions about their Total Rewards.

For more information, participants should contact the Phillips 66 Benefits Center at (800) 965-4421 or (646) 254-3467 between 8 a.m. and 6 p.m. Central time, Monday through Friday, except U.S. company holidays.

TABLE OF CONTENTSContacts ..............................................................................................................................................................A-1

Medical ................................................................................................................................................................B-1

Employee Assistance Plan (EAP) ......................................................................................................................C-1

Dental ..................................................................................................................................................................D-1

Vision ................................................................................................................................................................... E-1

Flexible Spending Plan (FSP) ............................................................................................................................ F-1

DisabilityShort-Term Disability (STD) .................................................................................................................................G-1Long-Term Disability (LTD) ..................................................................................................................................H-1

Life and Occupational Accidental Death (OAD) ................................................................................................ I-1Includes Basic, Supplemental and Dependent Life and OAD

Accidental Death & Dismemberment (AD&D) ..................................................................................................J-1Includes Employee and Dependent AD&D

Emergency Responders Insurance ...................................................................................................................K-1

Retiree Medical .................................................................................................................................................. L-1

Severance ...........................................................................................................................................................M-1

Other Information ...............................................................................................................................................N-1

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PHILLIPS 66 CONTACTS

Phillips 66 Benefits Center ..................................A-2

COBRA administration ..........................................A-2

Medical ...................................................................A-3HDHP option, PPO option, Medicare-eligible

PPO option ..................................................... A-3Kaiser HMO ........................................................ A-5Retiree medical exchanges ............................... A-5Grand Rounds .................................................... A-5Well-Being Incentive Program ........................... A-6

For U.S. Expatriates, Non-Citizen, Non-Resident Aliens and Inpatriates Only .........A-6

Employee Assistance Plan ................................... A-7Resources for Living ............................................A-7

Dental ...................................................................... A-7

Vision .......................................................................A-8

Flexible Spending Plan .........................................A-8

Disability ................................................................A-9Short-Term Disability .......................................... A-9Long-Term Disability ......................................... A-10

Life and OAD .........................................................A-10Includes Basic, Supplemental and

Dependent Life and OAD

Accidental Death & Dismemberment (AD&D) ...................................................................A-12

Includes Employee and Dependent AD&D

Emergency Responders Insurance ....................A-13

Severance .............................................................A-13

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PHILLIPS 66 BENEFITS CENTERFor information on: Contact/address Phone/operating hours

• Eligibility criteria to participate in the plan

• Enrollment, changing coverage

• Dependent verification process

• Changing personal information (including dependent information)

• Qualified Medical Child Support Orders (QMCSOs)

Phillips 66 Benefits Center P.O. Box 64084 The Woodlands, TX 77387-4084

Web:

• Visit hr.phillips66.com to see benefit plan information

• Visit UPoint (go to My HR Tools and click on the UPoint tile) (for active employees only), or at digital.alight.com/phillips66 for personal and benefit plan information and enrollments

(800) 965-4421 or (646) 254-3467

8:00 a.m. to 6:00 p.m. Central time, Monday – Friday, except U.S. company holidays

Note: Make address or phone number changes online through My HR Tools

• Accessing My HR Tools, logon ID, password or Web access code

Email (via Web for employees): connect.sp.phillips66.net/sites/IT/en-us/itservicedesk/Pages/default.aspx

Phillips 66 Global IT Service Desk:

(918) 977-7911 or (855) 886-7910

24 hours/day, 365 days/year

COBRA ADMINISTRATIONFor information on: Contact/address Phone/operating hours

Continuing coverage for:

• Medical

• EAP

• Dental

• Vision

• HCFSA


Web:



(800) 965-4421 or (646) 254-3467


http://hr.phillips66.com

https://connect.sp.phillips66.net/sites/IT/en-us/itservicedesk/Pages/default.aspx




https://mytools.ephillips66.com/app/successfactors/exkj0oovhlgkn9WMI356/sso/saml

http://digital.alight.com/phillips66





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MEDICALHDHP OPTION, PPO OPTION, MEDICARE-ELIGIBLE PPO OPTION

Aetna

For information on: Contact/address Phone/operating hours

Medical, mental health/substance abuse, telemedicine, eyewear, hearing benefits

Contact the appropriate parties identified below for questions about:

• Network providers

• Covered and non-covered expenses

• ID cards

• Claims

Medical benefits — Aetna

HDHP option, PPO option and the Medicare-eligible PPO option

(Uses Aetna Choice POS II Network)

Aetna, Inc. Medical Claims Administrator P.O. Box 981106 El Paso, TX 79998-1106

Web:

• aetnanavigator.com

Mobile App: Aetna Mobile

(855) 267-4184

8:00 a.m. to 6:00 p.m. Central time, Monday – Friday

For solid organ and bone marrow transplants:

• National Medical Excellence Program®

(877) 212-8811


Informed Health® Line/Nurseline (to speak with a registered nurse 24 hours/day)

(800) 556-1555


Teladoc (telemedicine)

Web: teladoc.com/aetna

Mobile App: Teladoc 24/7

(855) 835-2362


Contact Aetna for information on other discount programs (i.e., hearing and vision) that may be available.

http://aetnanavigator.com

http://teladoc.com/aetna



BlueCross BlueShield of Texas (BCBSTX)


Medical, mental health/substance abuse, telemedicine, eyewear, hearing benefits

Contact the appropriate parties identified below for questions about:



• ID cards

• Claims

Medical benefits — BCBSTX


(Uses BlueChoice® PPO option network in Texas; PPO network outside of Texas; member ID necessary in some areas)

BlueCross BlueShield of Texas Medical Claims Administrator P.O. Box 660044 Dallas, TX 75266-0044

Web:

• bcbstx.com

Mobile App: BCBSTX

(855) 594-4233


For solid organ and bone marrow transplants:

• BlueCare Connections

(800) 462-3275

24-hour Nurseline (800) 581-0368

MDLIVE (telemedicine)

Web: MDLIVE.com/bcbstx

Mobile App: MDLIVE: Talk to a Doctor 24/7

(888) 680-8646


Contact BCBSTX for information on other discount programs (i.e., hearing and vision) that may be available.

CVS Caremark


Prescription drug benefits

Prescription drug benefits — Aetna and BCBSTX


CVS Health 1 CVS Drive Woonsocket, RI 02895

Web:

• caremark.com

• CVSspecialty.com

Mobile App: CVS Caremark

CVS Caremark Prescription Services: (888) 208-9634


CVS Specialty Customer Care: (888) 265-7790


http://bcbstx.com

http://MDLIVE.com/bcbstx

http://caremark.com

http://CVSspecialty.com

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KAISER HMO


Kaiser Permanente — CA

Medical benefits — Kaiser HMO

• Medical and prescription benefits

• Claims

• Eyewear discount benefit


• ID cards

Kaiser Permanente — CA

Group #: 101702 (So. Calif.), 666 (No. Calif.)

Web: kaiserpermanente.org

Mobile App: Kaiser Permanente

(800) 464-4000

7:00 a.m. to 7:00 p.m. Pacific time, Monday – Friday

7:00 a.m. to 3:00 p.m. Pacific time, Saturday and Sunday

RETIREE MEDICAL EXCHANGESNote: See pages A-3 – A-6 for contact information for the HDHP option, PPO option and Medicare-eligible PPO option. See page A-6 for contact information for Kaiser HMO.


Health Coverage Resources (For non-Medicare eligible retirees)

Resources to help identify available health insurance options

Web: healthcoverageresources.com/Phillips66/home

(800) 965-4421


Aon Retiree Health Exchange (For Medicare-eligible retirees)

Resources to help identify available health insurance options

Web: retiree.aon.com (844) 335-9044


GRAND ROUNDS


Doctor match and expert opinion

HDHP option, PPO option, Medicare-eligible PPO option and Kaiser HMO

Grand Rounds 360 3rd Street, Suite 425 San Francisco, CA 94107

Web: grandrounds.com/phillips66

Mobile App: Grand Rounds

(844) 339-6732

6:00 a.m. – 6:00 p.m. Pacific time, Monday – Friday

http://kaiserpermanente.org

http://healthcoverageresources.com/Phillips66/home


http://retiree.aon.com

http://grandrounds.com/phillips66



WELL-BEING INCENTIVE PROGRAM


Well-Being Incentive Program

Available to employees who are eligible for medical benefits under the Phillips 66 Medical and Dental Assistance Plan

Virgin Pulse 492 Old Connecticut Path, Suite 601 Framingham, MA 01701

Web: member.virginpulse.com/login.aspx

Mobile App: Virgin Pulse

(Visit the Well-Being program page on hr.phillips66.com for the most up-to-date information)

Virgin Pulse: (888)-671-9395

Wellness Corporate Solutions Health Coaching: (855) 595 2450


FOR U.S. EXPATRIATES, NON-CITIZEN, NON-RESIDENT ALIENS AND INPATRIATES ONLY


Medical and Prescription Drug Benefits, International EAP, Dental and Vision

Medical and prescription drug benefits

• Claim filing

• Coverage questions

Cigna Global Health Benefits Customer Service Center P.O. Box 15050 Wilmington, DE 19850-5050

Web: member.cignaenvoy.com

Within the U.S.: (800) 441-2668

Outside the U.S.: (302) 797-3100

http://member.virginpulse.com/login.aspx


http://member.cignaenvoy.com

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EMPLOYEE ASSISTANCE PLANRESOURCES FOR LIVING


Resources for Living


• Claim filing

Aetna Behavioral Health 151 Farmington Ave. RSAA Hartford, CT 06156

Web: Visit resourcesforliving.com for more information and resources

Username: Phillips66 Password: RFL

(844) 766-7351


DENTALFor information on: Contact/address Phone/operating hours

MetLife

Dental benefits (including the out-of-area dental option)



• Claims

• Predeterminations

MetLife Phillips 66 Dental Claims Administrator P.O. Box 981282 El Paso, TX 79998-1282

Web:

• metlife.com/mybenefits

(855) 837-6381

8:00 a.m. to 11:00 p.m. Eastern time, Monday – Friday

For International Dental Travel Assistance dentist referral: (888) 558-2704 or (312) 356-5970


http://resourcesforliving.com

http://metlife.com/mybenefits



VISIONFor information on: Contact/address Phone/operating hours

VSP

Vision benefits



• Non-network claims

VSP P.O. Box 997105 Sacramento, CA 95899

(800) 877-7195

Web: vsp.com

VSP P.O. Box 385018 Birmingham, AL 35238-5018

Fax claims to (916) 858-4985

(800) 877-7195

5:00 a.m. to 8:00 p.m. Pacific time, Monday – Friday

7:00 a.m. to 8:00 p.m. Pacific time, Saturday

7:00 a.m. to 7:00 p.m. Pacific time, Sunday

Hearing impaired customers may call (800) 428-4833 for assistance

FLEXIBLE SPENDING PLANFor information on: Contact/address Phone/operating hours

HCFSA and DCFSA

HCFSA and DCFSA

• Reimbursement requests (claims)

• Account balance

• Eligible expenses

WageWorks P.O. Box 14053 Lexington, KY 40512

Web: wageworks.com

(877) 924-3967


Fax: (877) 353-9236

Health Savings Account (HSA)

HSA

• Reimbursement requests (claims)

• Account balance

• Eligible expenses

HSA Bank P.O. Box 939 Sheboygan, WI 53082

Web: hsabank.com

(800) 357-6246

24 hours/day, 365 days/year, except U.S. company holidays

http://vsp.com

http://wageworks.com

http://hsabank.com

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DISABILITY SHORT-TERM DISABILITY


• Plan provisions


• Changing personal information

Phillips 66 HR Connections P.O. Box 2400 Bartlesville, OK 74005-2400

Web: hr.phillips66.com

Online for active employees:

• From My HR Tools, click on the UPoint tile

(855) 480-6634 or (918) 977-7905



• Claim denial or reduction Absence Management, HR Operations Phillips 66 Company Adams Building 411 S. Keeler Avenue Bartlesville, OK 74003-6670

HR Connections: (855) 480-6634 or (918) 977-7905


• Employee Health Report

• Return to Work Release

Contact the local designated Phillips 66 Health Services representative, as noted on the back of the Employee Health Report

Web (for Employee Health Report): http://hrcpdocctr.phillips66.com/HR_P66_Comm/HR_Forms/EHR.pdf

HR Connections: (855) 480-6634 or (918) 977-7905



http://hrcpdocctr.phillips66.com/HR_P66_Comm/HR_Forms/EHR.pdf

http://hrcpdocctr.phillips66.com/HR_P66_Comm/HR_Forms/EHR.pdf


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LONG-TERM DISABILITY




• Claim filing



Web:


(800) 965-4421 or (646) 254-3467



• Questions after a claim has been filed or denied

Benefit Management Services Maitland Claim Office The Hartford P.O. Box 14306 Lexington, KY 40512-4306

(800) 549-6514

8:00 a.m. to 8:00 p.m. Eastern time

LIFE AND OADFor information on: Contact/address Phone/operating hours





• Claim filing (except OAD)


• Beneficiary designations


Web:


(800) 965-4421 or (646) 254-3467



Claim filing — OAD Phillips 66 Plan Administrator Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK 74003-6670

(918) 977-6009


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Questions after a claim has been paid or denied (except OAD or travel assistance)

Zurich American Life Insurance Company P.O. Box 1705 Grand Rapids, MI 49501

Email: [email protected]

(800) 206-8826


Fax: (800) 206-3975

Portability and conversion coverage administration (except OAD or travel assistance)

Zurich American Life Insurance Company Attn: Conversion Unit 62024 Collections Drive Chicago, IL 60693-0620


(877) 856-2268


Fax: (877) 856-2269

Travel assistance (part of the basic life insurance option)

• Claim filing


Zurich Travel Assistance 901 King Street West, Suite 300 Toronto, Ontario M5V 3H5

Travel Assistance ID: Phillips 66

Web: zurichtravelassist.com

(800) 263-0261


Accessing My HR Tools (Logon ID, password or Web access code required)


Phillips 66 Global IT Service Desk: (918) 977-7911 or (855) 886-7910 (toll-free)


mailto:myzurichlife%40zurichna.com?subject=

mailto:CLP.Service%40zurichna.com?subject=

http://zurichtravelassist.com




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ACCIDENTAL DEATH & DISMEMBERMENT (AD&D)For information on: Contact/address Phone/operating hours





• Claim filing




Web:


(800) 965-4421 or (646) 254-3467



Questions after a claim has been paid or denied



(800) 206-8826


Fax: (800) 206-3975

Conversion coverage administration

Zurich American Life Insurance Company Attn: Conversion Unit 62024 Collections Drive Chicago, IL 60693-0620


(877) 856 2268


Fax: (877) 856 2269

Accessing My HR Tools (Logon ID, password or Web access code required)


Phillips 66 Global IT Service Desk: (918) 977-7911 or (855) 886-7910 (toll-free)


mailto:myzurichlife%40zurichna.com?subject=

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EMERGENCY RESPONDERS INSURANCEFor information on: Contact/address Phone/operating hours



• Claim filing




Web:

• Visit UPoint (go to My HR Tools and click on the UPoint tile) (for active employees only), or at digital.alight.com/phillips66 for personal and benefit plan information

(800) 965-4421 or (646) 254-3467



Questions after a claim has been paid or denied

Zurich A&H Claims P.O. Box 968041 Schaumburg, IL 60196-8041

(866) 841-4771


Fax: (866) 255-2962

SEVERANCEFor information on: Contact/address Phone/operating hours

Plan provisions Phillips 66 HR Connections P.O. Box 2400 Bartlesville, OK 74005-2400

Web:


(855) 480-6634 or (918) 977-7905


Benefit claims Manager, Total Rewards Phillips 66 Company Total Rewards Department P.O. Box 421959 Houston, TX 77242-1959

(832) 765-1877





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P H I L L I P S 6 6 l M E D I C A L l 2 0 1 8 B - 1

Phillips 66 medical benefit options ....................B-3

Important ERISA information ...............................B-4

Eligibility and enrollment .....................................B-4Eligibility ..............................................................B-4

Employee eligibility ........................................B-4Dependent eligibility .....................................B-5

Enrollment ..........................................................B-6Annual benefits enrollment .......................... B-7

Changing elections midyear ..............................B-8Midyear election changes due to a

qualified change in status event .............B-8Midyear election changes under HIPAA

special enrollment provisions ..................B-9Situations affecting enrollment or

coverage ......................................................B-10If a participant (or the participant’s

dependent) becomes eligible for Medicare .................................................B-10

Leave of absence ........................................B-10Tell the Benefits Center about other

coverage .................................................B-11When coverage ends .......................................B-11

Continuing coverage after leaving the company .................................................B-12

Retiree medical coverage ...........................B-12Continued coverage for surviving

dependents ............................................B-13If the participant’s surviving spouse or

domestic partner is a Phillips 66 employee or retiree ................................B-13

HDHP and PPO options ...................................... B-14How the medical benefit works .......................B-14Medical benefit options ...................................B-16Coverage costs .................................................B-18

Paying for coverage .....................................B-18Annual deductible .......................................B-18Annual out-of-pocket maximum .................B-20Expenses that do not count toward

the deductible and out-of-pocket maximum ................................................B-21

Copays and coinsurance ............................B-22Network vs. non-network providers ................B-22

Ensuring a provider is in the network ........B-23If a network provider is not available .........B-23If care is received from a non-network

provider ...................................................B-24

PHILLIPS 66 MEDICAL

Medical benefit coverage ................................B-24What the HDHP and PPO options pay ........B-24Understanding the non-network

reimbursement rate ...............................B-28Centers of Excellence ......................................B-28Telemedicine ....................................................B-29Other services ..................................................B-29Pre-certification and predetermination of

benefits ........................................................B-29Pre-certification ...........................................B-29Predetermination of benefits......................B-30

Traveling outside of the U.S. ............................B-30Mental health and substance abuse

coverage ......................................................B-31Mental health ..............................................B-31Substance abuse ........................................B-31Mental health and substance abuse

summary chart .......................................B-32Prescription drug coverage ..............................B-32

Generic vs. brand-name drugs ...................B-33Prescription drug summary chart ..............B-34Network pharmacies ...................................B-35Maintenance Choice program ....................B-35Covered prescription drugs and

supplies ...................................................B-36Specialty medications .................................B-36Compound medications ..............................B-37Special programs ........................................B-37Site of Care Specialty Prescription

Program ..................................................B-38Infusion nursing and Site of Care

management for specialty medications ............................................B-39

Accordant health services ..........................B-39Diabetes management ...............................B-40Prescription drugs and supplies that

are not covered ......................................B-40Prescription drug coverage outside

the U.S.....................................................B-41Medicare Part D ..........................................B-41Creditable prescription drug coverage ......B-41

Covered and not covered services and supplies ........................................................B-42Covered services and supplies ..................B-42Services and supplies that are not

covered ...................................................B-54

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PHILLIPS 66 MEDICAL

Health Savings Account (HSA) and Health Care Flexible Spending Account (HCFSA) ....... B-60

Filing claims ........................................................ B-61How to file a claim ............................................B-61If a claim is denied ...........................................B-62

Coordination of benefits (COB) ......................... B-62Determining the primary plan ........................ B-63Coordination with Medicare ........................... B-63

Understanding the Kaiser HMO ........................ B-64How the Kaiser HMO Option works .................B-65

Well-Being Incentive Program .......................... B-67

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Medical and Dental Assistance Plan.” The medical and pharmacy benefit is a component of the plan.

• “Phillips 66” or the “company” refers to Phillips 66 Company and any other subsidiary or affiliated company that has adopted the plan and is a participating employer.

• When describing elections (for example, enrollment, coverage changes), “participant” is defined as an employee, former employee or qualified dependent:

– Who has satisfied the eligibility and participation requirements specified in the medical benefit;

– Who has enrolled in the medical benefit; and

– Whose participation has not terminated under any other applicable provisions of the medical benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the medical benefit under the plan. The Other Information chapter includes important legal information related to the plan.

• Many additional terms used throughout this SPD are defined in the Glossary, which begins on page N-60 of the Other Information chapter. It is important that participants review the Glossary carefully to ensure that they understand the meaning of defined terms used throughout the SPD. Failure to understand the meaning of a defined term could result in a failure to fully understand the plan benefits, requirements, limitations, etc.

• Use of the terms “he” and “his” includes “she” and “her” and is intended to be gender neutral.

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PHILLIPS 66 MEDICAL BENEFIT OPTIONSPhillips 66 offers three comprehensive medical benefit options under the plan. Each of the medical benefit options includes coverage for preventive care, regular checkups and office visits, hospital stays, prescription drugs, mental health and substance abuse, and more.

Medical benefit options

HDHP option*

And

PPO option

For both the HDHP and PPO options, coverage is provided through either Aetna or BlueCross BlueShield of Texas (BCBSTX), based on the primary participant’s home ZIP code. Working with multiple carriers helps to ensure that participants have access to qualified providers in their area.

The HDHP option and the PPO option, in most cases, cover the same services and supplies, as well as share the same provider network.

However, there are important differences between these two options that are detailed in this chapter. Other resources, including myalex.com/p66, can help identify differences in both coverage and costs for these two options.

Kaiser Health Maintenance Organization (Kaiser HMO)

Kaiser HMO is available only to employees in California who live within the Kaiser service area.

• Kaiser HMO information is summarized on page B-64. Participants will receive information to access a separate Evidence of Coverage (EOC) from Kaiser HMO that describes coverage details.

• Some parts of this handbook will still apply to Kaiser HMO participants’ coverage. See Understanding the Kaiser HMO on page B-64 for more information.

* The HDHP option is a qualified high deductible health plan and is the only option for employees who want to contribute to a Phillips 66-affiliated health savings account. See Health Savings Account (HSA) and Health Care Flexible Spending Account (HCFSA) on page B-60, as well as the Flexible Spending Plan chapter, for information.

When selecting a medical benefit option, a participant should consider the total cost for coverage — monthly payroll contributions for coverage plus out-of-pocket costs for medical services and supplies. Use the tools available on UPoint (go to My HR Tools and click on the UPoint tile), access the Interactive Benefits Tool at myalex.com/p66 or check with a personal tax advisor to help identify the best option.

EXPATRIATE, INPATRIATE AND NON-CITIZEN, NON-RESIDENT (NCNR) MEDICAL BENEFIT OPTION

• Medical coverage is available to Inpats, Expats and NCNRs through Cigna Global Health.

• Participants will receive a separate Certificate of Coverage from Cigna Global Health that describes coverage details.

• Participants should refer to the materials provided by Cigna Global Health or go to hr.phillips66.com/Health-Well-Being/Expats-Inpats-NCNRs.aspx for more coverage information.

http://myalex.com/p66


http://hr.phillips66.com/Health-Well-Being/Expats-Inpats-NCNRs.aspx

http://hr.phillips66.com/Health-Well-Being/Expats-Inpats-NCNRs.aspx



PHILLIPS 66 MEDICAL

IMPORTANT ERISA INFORMATIONThis Employee Medical chapter is intended to provide participants with an understanding of the medical benefit provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.

The Other Information chapter contains important legally required information, such as:

• Glossary of defined terms.

• Administrative information.

• COBRA continuation coverage.

• Claim and appeal information.

• Military leave of absence.

• HIPAA privacy rights.

• ERISA information.

ELIGIBILITY AND ENROLLMENTELIGIBILITY

Employee eligibility

An eligible employee is:

• A regular full-time or part-time employee of Phillips 66 scheduled to work an average of at least 20 hours a week, or a recurring seasonal employee of Phillips 66 (as defined in the Glossary, which begins on page N-60 of the Other Information chapter); and

• A U.S. citizen or resident alien employee working within the U.S. (or on a personal, disability, military or family medical leave of absence) who is paid on the direct U.S. dollar payroll. This includes employees rotating abroad.

An individual who is not eligible is:

• An employee in a classification that is not described above. For example, temporary employees, independent contractors and commission agents are not eligible.

• An inpatriate, U.S. expatriate or non-citizen, non-resident alien (NCNR) employee. However, coverage may be available through an international benefit plan option. Additional information is also available from the Benefits Center or on hr.phillips66.com.

• A represented employee whose collective bargaining agreement does not provide for participation in the plan.


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Dependent eligibility

Dependents are enrolled in the plan upon completion of the dependent verification process. The process includes certifying that the person is an eligible dependent and may require providing documents (for example, a birth certificate or a marriage license) that verify this status. The participant is required to provide dependent verification documents required under the plan within 60 days of enrollment and upon request by the plan. Participants should contact the Benefits Center for forms and information.

Refer to the chart below for details on dependent eligibility.

Dependent eligibility* Yes No

The participant’s spouse (including a state-recognized common-law spouse) or domestic partner (as defined in the Glossary, which begins on page N-60 of the Other Information chapter)

X

The participant’s divorced or legally separated spouse, or a domestic partner after the domestic partnership has ended

X

The participant’s biological, legally adopted, placed for adoption or foster child (as defined in the Glossary, which begins on page N-60 of the Other Information chapter) under age 26

X

The participant’s stepchild under age 26, provided:

• The biological parent is the participant’s spouse; and

• The participant and spouse either remain married and live in the same household, or the spouse died while married to the participant

X

The participant’s domestic partner’s biological or legally adopted child under age 26, provided:

• The domestic partnership between the participant and domestic partner is ongoing;

• Over 50% of the child’s support is received from the participant, and the child lives with the participant for the tax year; and

• The child has not been claimed as a dependent on anyone else’s federal tax return for the year of coverage

X

The participant’s child, stepchild, or child of a domestic partner meeting the requirements above who is age 26 or older, provided the child was disabled prior to attaining age 26 and coverage is approved by the plan within the deadline

• Participants should contact the Benefits Center for information

X

The participant’s child, stepchild or child of a domestic partner who does not meet the requirements shown above

X

A grandchild not legally adopted by the participant, or a child placed in the participant’s home under a legal guardianship agreement

X

The child of a surrogate mother who does not otherwise qualify as a dependent X

A child for whom the plan has received a Qualified Medical Child Support Order (QMCSO) X

* Participants enrolled in the HMO option should refer to the Kaiser HMO’s Certificate of Coverage for additional eligibility requirements.


PHILLIPS 66 MEDICAL

An individual is not an eligible dependent if he is:

• On active duty in any military service of any country (excluding weekend duty or summer encampments).

• Not a U.S. citizen, resident alien or resident of Canada or Mexico. (In this event, the participant may be eligible to enroll himself and his dependents in the Phillips 66 Expatriate Medical and Dental Plan. See hr.phillips66.com for details.)

• Already covered under another Phillips 66 medical benefit as an employee, retiree, COBRA participant or dependent.

• In a relationship with the participant that violates local law.

A participant is required to notify the Benefits Center within 30 days if an enrolled dependent is no longer eligible for coverage (for example, following a divorce or a child reaching age 26).

For assistance with questions regarding dependent eligibility, participants should contact the Benefits Center.

INELIGIBLE DEPENDENTS

If a participant enrolls a dependent who does not meet the plan’s requirements, or fails to cancel coverage within 30 days of the date on which the dependent ceases to meet the requirements, the dependent will be considered ineligible for the plan.

• The plan has the right to request reimbursement for amounts paid for an ineligible dependent.

• If cancelling the coverage for the ineligible dependent reduces the participant’s cost for coverage, no amount will be refunded.

• The participant may be subject to disciplinary action, up to and including termination of employment.

• If coverage is rescinded, the plan will provide the participant with written notice at least 30 days prior to the termination of coverage.

ENROLLMENT

LEARN MORE ABOUT BENEFITS

Visit the Benefits Enrollment page on hr.phillips66.com (Resources > Benefits Enrollment).

Visit myalex.com/p66 to use the Interactive Benefits Tool to:

• Learn more about the benefit options.

• Compare the costs of the options to decide which benefits are best for the participant.




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Annual benefits enrollment

Participants can enroll online or over the phone.

Online at UPoint: • Go to My HR Tools and click on the UPoint tile.

• From a computer or mobile device, go to digital.alight.com/phillips66 and enter your UPoint user ID and password.

By telephone: • Call the Benefits Center at (800) 965-4421, 8:00 a.m. to 6:00 p.m. Central time, Monday through Friday.

The following chart summarizes when participants can enroll in medical coverage or change medical coverage elections.

How and when to enroll When coverage begins

When first employed by Phillips 66

Or

When first becoming eligible to participate

To have medical coverage, the participant must enroll within 30 days.

Coverage begins on the date the participant became eligible.

During annual benefits enrollment

The participant may enroll in or change medical coverage elections each year during annual benefits enrollment.

Changes take effect the following January 1.

During the year The participant may change enrollment elections during the year following a qualified change in status event. For most changes, the participant must make the election change within 30 days after the date of the event (90 days if the event is the birth, adoption or placement for adoption of a child).




PHILLIPS 66 MEDICAL

CHANGING ELECTIONS MIDYEAR

Midyear election changes due to a qualified change in status event

For assistance with questions about qualified change in status events, participants should contact the Benefits Center at (800) 965-4421, 8:00 a.m. to 6:00 p.m. Central time, Monday through Friday. It is important that all midyear election changes be made within the applicable timeframe specified below. Untimely midyear changes will not be permitted.

Generally, a participant’s enrollment elections cannot be changed until the next annual benefits enrollment. However, if a qualified change in status event described in this section occurs, the participant may be permitted or required to:

• Enroll in coverage;

• End coverage; or

• Change the dependents covered.

The participant’s new coverage election must be consistent with the qualified change in status event.

To ADD a dependent A participant has:

• 90 days to ADD a newborn, newly placed foster child, or newly adopted or placed for adoption child as a new dependent.

• 30 days to ADD a new dependent (other than a newborn, newly placed foster child, or newly adopted or placed for adoption child).

If the above deadlines are missed, the participant will have to wait until the next annual benefits enrollment to add the dependent to the participant’s coverage. This applies even if the participant already has You + two or more coverage.

To REMOVE an ineligible dependent

A participant has 30 days to REMOVE a dependent who is no longer eligible.

If a participant fails to remove an ineligible dependent and the plan pays any medical claims on behalf of that dependent, the claims will be reprocessed and the participant will be required to reimburse the plan for the amount paid.

To make a change in coverage, the participant can go to My HR Tools and click on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Alternatively, he can call the Benefits Center at (800) 965-4421.



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QUALIFIED CHANGE IN STATUS EVENTS

The following qualified change in status events allow, or require, changes to a participant’s medical elections:

• The participant’s marriage, divorce, legal separation, annulment or change in a domestic partnership.

• The participant’s death or the death of a dependent.

• The addition of a child through birth, adoption or placement for adoption, or the placement of a foster child.

• A qualified medical child support order (QMCSO) that requires the participant to provide medical coverage for a child. (QMCSOs are described on page N-8 of the Other Information chapter.)

• A change in employment status by the participant or the participant’s dependent.

• A change in work schedule by the participant or the participant’s dependent that changes coverage eligibility.

• A change in the status of the participant’s dependent.

• The participant and/or the participant’s eligible dependents become eligible or lose eligibility for Medicare.

• The participant and/or the participant’s dependents become entitled to COBRA.

• The taking of or return from a leave of absence under the Family and Medical Leave Act (FMLA) or USERRA. See USERRA continuation coverage on page N-21 of the Other Information chapter for more information regarding USERRA leaves.

• The participant or the participant’s dependents have a significant change in benefits or costs, such as benefits from another employer.

Midyear election changes under HIPAA special enrollment provisions

For assistance with questions about HIPAA special enrollment, participants should contact the Benefits Center.

HIPAA special enrollment provisions offer the participant and the participant’s dependents other options for qualified status changes if:

• The participant did not enroll earlier because the participant or the participant’s dependent had other medical coverage, and:

– That coverage is lost; or

– An employer stops contributing toward the cost.

• The participant gains a dependent due to marriage, birth, adoption or placement for adoption, or the placement of a foster child.

• The participant or the participant’s dependent becomes eligible for premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP). Note that, in this case, the participant has 60 days instead of 30 days to change coverage.

In certain situations (for example, losing coverage due to non-payment of premiums), special enrollment does not apply.

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PHILLIPS 66 MEDICAL

SITUATIONS AFFECTING ENROLLMENT OR COVERAGE

If a participant (or the participant’s dependent) becomes eligible for Medicare

If the participant is an active employee, Medicare eligibility does not require a change. The participant’s current elections can continue unless the participant or a covered dependent enrolls in Medicare Part D.

However, the participant must inform the Benefits Center and provide a copy of the Medicare card within 30 days if the participant or a covered dependent becomes eligible for Medicare for any reason.

This 30-day notification is important because:

1. Becoming eligible for Medicare allows the participant to change enrollment elections. However, a change must be made within 30 days of becoming eligible for Medicare.

2. If the participant does not inform the Benefits Center of a change in Medicare eligibility and the plan pays more than its share of a medical claim, the participant may be responsible for reimbursing the plan for any overpayment made on behalf of the participant or the participant’s covered dependent.

Once the participant has notified the Benefits Center, the participant, or the participant’s dependent, can choose one of the following three options:

• Continue coverage under the plan. The plan will provide primary coverage and Medicare will provide secondary coverage.

• Enroll in Medicare Part D.

– If the participant enrolls in Medicare Part D, Phillips 66 coverage for the participant and the participant’s enrolled dependents will end.

– If the participant’s dependent enrolls in Medicare Part D, Phillips 66 coverage for that dependent will end.*

• End Phillips 66 coverage (and maintain coverage under Medicare).

– If the participant terminates Phillips 66 coverage, Phillips 66 coverage for the participant and the participant’s dependents will end.

– If the participant’s dependent terminates Phillips 66 coverage, Phillips 66 coverage for that dependent will end.*

If the participant or the participant’s dependent enrolls in Medicare Part D or elects to end Phillips 66 coverage, the Benefits Center must be contacted to cancel medical coverage under the plan for the affected person(s). The participant and the participant’s eligible dependents cannot re-enroll in the plan until the next annual benefits enrollment unless a qualified change in status event occurs.

Note: The participant is responsible for contacting Medicare regarding eligibility, enrollment and penalties that apply to late enrollment in Medicare. See also Creditable prescription drug coverage on page B-41.

Leave of absence

Coverage may continue during an approved leave of absence (excluding a leave of absence-Labor Dispute). During the leave, the participant pays the same cost for coverage that an active employee would pay.

• For most paid leaves, the cost will be deducted from the participant’s paycheck on a before-tax basis.

• For an unpaid leave of absence, or in situations where the participant’s paycheck while on leave is not sufficient to cover the cost, the participant will be billed and will pay the cost on an after-tax basis.

* A dependent’s enrollment in Medicare Part D or termination of Phillips 66 coverage will not affect the participant or any of the participant’s other dependents.

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• When the participant returns to work, the company will resume before-tax paycheck deductions for the cost of coverage, including any Health Savings Account (HSA) contributions necessary to reach the participant’s annual goal amount.

If coverage ends while on a leave, a participant wanting medical coverage will need to re-enroll within 30 days after returning to work. If the participant re-enrolls within 30 days after returning to work, coverage will be effective on the date the participant returned to work. Enrollment information will detail the steps to take.

MILITARY LEAVE OF ABSENCE

Federal law provides certain rights for members of the military. See USERRA continuation coverage on page N-21 of the Other Information chapter for information.

Participants on a leave of absence-Labor Dispute

If a participant is placed on a leave of absence- Labor Dispute, coverage for the participant and the participant’s dependents will end on the last day of the month in which the leave begins. If coverage ends, the participant and dependents have the following options:

• Continue coverage for the participant and/or dependents under COBRA (see COBRA continuation coverage on page N-11 of the Other Information chapter for details).

• If eligible, the participant may elect retiree medical coverage. (Retiree medical coverage is described in the Retiree Medical chapter beginning on page L-1. Additional information is also available from the Benefits Center or on hr.phillips66.com.)

When the participant returns to work:

• Coverage will resume automatically if the leave was 30 days or less.

• The participant must re-enroll if the leave was more than 30 days. If the participant re-enrolls within 30 days after returning to work, coverage will be effective on the date the participant returned to work. Enrollment information will detail the steps to take.

Tell the Benefits Center about other coverage

If a participant or the participant’s dependents become covered under another plan, the participant must notify the Benefits Center immediately. This helps to ensure that the plan does not pay claims for which someone else is responsible. If the plan pays claims for which another plan is responsible, the plan reserves the right to recover amounts it overpaid from the participant.

WHEN COVERAGE ENDS

Note: If coverage is terminated or lowered during the month, no reimbursements for any difference in medical coverage level (You only, You + one, You + two or more) are made for the month.

Coverage for the participant and his dependents ends on the earliest of the following:

• The last day of the month in which the participant’s employment ends.

• The last day of the month in which the participant is no longer eligible under the terms of the plan.

• December 31 immediately following the end of annual benefits enrollment if the participant cancels coverage during annual benefits enrollment. (If the participant cancels coverage for a dependent, coverage ends for that person only.)



PHILLIPS 66 MEDICAL

• The last day of the month in which the participant cancels coverage (except during annual benefits enrollment) or does not pay the required cost of coverage.

• The last day of the month in which the participant goes out on a leave of absence-Labor Dispute.

• The plan termination date, if the plan is terminated.

• The last day of the month in which the participant’s coverage is terminated for any other reason, other than as follows:

– If the participant continued coverage during a leave of absence and he does not return to work as an employee at the end of the leave, coverage will end on the last day of the month in which the earliest of the following events occurs:

º The participant’s leave expires;

º The participant does not pay the required cost for coverage; or

º The participant first notifies the company that he does not intend to return to work.

– If the participant dies:

º Coverage for the participant ends on the date of death.

º Coverage for dependents who were enrolled under the participant’s coverage at the time of his death ends on the last day of the month in which the death occurred.

In addition, coverage for a dependent ends on the earliest of:

• The date that person is no longer an eligible dependent, except:

– Coverage ends on the last day of the month in which the event occurs if the loss of eligibility is due to a divorce, legal separation, annulment or dissolution of a domestic partnership or was due to a dependent child’s reaching the plan’s age limit.

• The date the dependent becomes eligible for coverage as a Phillips 66 employee.

• The date of the dependent’s death.

If a participant or dependent is in the hospital on the day coverage ends, and:

• He is NOT covered by another medical plan, the remainder of the hospital stay will be covered by this plan if:

– The hospitalization began before the participant’s coverage ended; and

– The participant had paid his costs for coverage up to the date coverage ended.

• He IS covered by another medical plan, this plan will pay benefits for the hospital stay through the last day of coverage, and the other plan will be responsible for expenses incurred after that date.

Continuing coverage after leaving the company

When coverage ends, the participant and his dependents may be eligible to continue coverage under COBRA. To elect COBRA, the participant and/or his dependents must enroll within 65 days of the day coverage ends or, if later, within 65 days of the date of the COBRA Enrollment Notice. COBRA cannot be elected if this deadline is missed. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

Retiree medical coverage

The Benefits Center will send an enrollment packet to participants who are eligible for retiree medical coverage. If the participant wants retiree medical coverage, the participant must enroll within 30 days. The enrollment packet will contain details. (Retiree medical coverage is described in the Retiree Medical chapter beginning on page L-1. Additional information is also available from the Benefits Center or on hr.phillips66.com.)


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Continued coverage for surviving dependents

Note: This section does not apply to the children of a domestic partner. A surviving dependent who does not qualify for survivor coverage (or who qualifies but chooses not to enroll in survivor coverage) may be eligible to continue coverage through COBRA. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

In the event of the participant’s death, his eligible dependents may be able to continue medical coverage under the plan.

If the participant is an active employee or on a leave of absence at the time of death, medical coverage for the surviving covered dependents will continue until the last day of the month in which the participant’s death occurs.

At that point, the participant’s dependents may be eligible to continue coverage through COBRA or through the Phillips 66 Retiree Medical Plan. Other considerations include:

• Coverage under the Retiree Medical Plan for the participant’s covered dependents will be the same coverage the participant would have been eligible for as a retiree or long-term disability recipient.

• If the participant’s surviving spouse and/or eligible children were not covered under a medical benefit option under the plan on the date of the participant’s death, they will be notified if they are eligible for Retiree Medical Plan coverage.

• If the participant has a surviving spouse/domestic partner and eligible dependent children, his children (excluding children of the domestic partner) can enroll in a Retiree Medical Plan option even if the surviving spouse/domestic partner does not enroll.

For more information about coverage under the Retiree Medical Plan, participants can:

• See the separate Retiree Medical chapter beginning on page L-1;

• Call the Benefits Center; or

• View the information available on hr.phillips66.com.

If the participant’s surviving spouse or domestic partner is a Phillips 66 employee or retiree

If the participant’s surviving spouse/domestic partner is eligible for coverage as an active employee or retiree:

• He can enroll in medical coverage as an employee/retiree or as a surviving spouse/domestic partner; and then

• Cover any eligible children as dependents under that coverage.



PHILLIPS 66 MEDICAL

HDHP AND PPO OPTIONSHOW THE MEDICAL BENEFIT WORKSThe medical benefit covers medically necessary medical, mental health and substance abuse, and prescription drug services and supplies. Here is a general description of how it works:

• The HDHP and PPO options partner with claims administrators to provide benefits.

– Medical, mental health and substance abuse benefits are administered by Aetna or BlueCross BlueShield of Texas (BCBSTX), depending on the primary participant’s home address. With respect to medical, mental health and substance abuse benefits, claims administrator in this chapter refers to Aetna or BCBSTX, as applicable.

– Prescription drug benefits are administered by CVS Caremark. With respect to prescription drug benefits, claims administrator in this chapter refers to CVS Caremark.

• Using network providers saves both time and money. Network providers have agreed to provide their services at negotiated rates and also to file the claims directly with the claims administrator for those services.

• Non-network reimbursement rates, generally 200% of the Medicare allowable rate (if established) for the geographic area where the service is provided, apply to services and supplies from a non-network provider. Amounts exceeding the non-network reimbursement rate are not covered by the medical benefit, do not count towards the annual deductible or annual out-of-pocket maximum, and may be billed directly to the participant. (See page B-28 for additional information on non-network reimbursement rates.)

• Grand Rounds is available to assist participants in identifying high-quality network providers.

• Preventive medical care received from a network provider is covered at 100%, with no deductible.

• For most non-preventive services, the participant is generally required to meet an annual deductible or pay the required copay before the medical benefit begins paying its share of covered expenses.

• The annual out-of-pocket maximum limits the amount a participant pays for covered expenses. When the participant, or the participant’s enrolled dependent, reaches this maximum amount, the medical benefit generally pays 100% of covered costs for that person for the rest of the calendar year.

• Participants can save money by accessing telemedicine (see page B-29) or Minute Clinic® locations for non-emergency medical services.

• For the HDHP option, generic preventive drugs and insulin are covered at 100%, with no deductible. Brand preventive drugs are covered at 80%, with no deductible.

• For the PPO option, network physician office and urgent care visits are covered at 100%, with no deductible, after a per-visit copay is paid.

• Some inpatient and outpatient services require pre-certification by the claims administrator. If required pre-certifications are not received, benefits will be reduced and may be denied. See Pre-certification on page B-29 for details.

• Participants can request a voluntary predetermination of benefits to learn in advance whether an expense will be covered and how much it will cost. See Predetermination of benefits on page B-30 for details.

Above references include only medically necessary eligible expenses that are covered by the medical benefit. (See Covered and not covered services and supplies beginning on page B-42.) For expenses charged by non-network providers, non-network reimbursement rate limits apply (see page B-28).

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UNDERSTANDING MEDICALLY NECESSARY

Only medically necessary services, procedures and supplies are covered under the medical benefit. Generally, to be medically necessary, the expense must be in accordance with generally accepted standards and:

• Appropriate and required for preventing, evaluating, diagnosing or treating an illness, injury or disease.

• Based on credible scientific evidence published in peer-reviewed literature.

• Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury or disease.

• Not mostly for the convenience of the patient, physician or other health care provider recognized by the medical benefit.

• No more costly than an alternative service or sequence of services generally considered medically equivalent and at least as likely to produce the same results.

Participants should see “medically necessary” in the Glossary, which begins on page N-60 of the Other Information chapter, for more detailed information.


PHILLIPS 66 MEDICAL

MEDICAL BENEFIT OPTIONSThe medical benefit includes three options:

• HDHP option.

• PPO option.

• HMO option. This option is available only to participants living in the Kaiser HMO service area in California. See Understanding the Kaiser HMO on page B-64.

Below is a high-level summary of the HDHP and PPO options. Benefits may be paid differently in some situations, so be sure to read Covered and not covered services and supplies beginning on page B-42 for a more complete picture.

The HDHP option and PPO option pay*...

HDHP option PPO option

Health savings account (HSA)

Employees can contribute to an HSA to pay for eligible medical expenses on a tax-free basis.

Phillips 66 may also contribute to the employee’s Phillips 66-affiliated HSA.

Not available

Annual deductible

The amount the participant pays each calendar year before the medical benefit begins paying its share of covered expenses

Network and/or non-network:

$1,400 for You only coverage

$2,800 for You + one or You + two or more coverage

Network:

$ 600 for You only coverage

$ 1,200 for You + one or You + two or more coverage

Excludes copays and prescription drug costs

Non-network:

$ 1,200 for You only coverage



Annual out-of-pocket maximum

The most the participant pays for his share of covered expenses during the calendar year

Network:

$ 4,500 per individual

$ 9,000 per family

Non-network:


$ 27,000 per family

Network:


$ 9,000 per family

Non-network:


$ 27,000 per family

(continued)* Non-network reimbursement rate limits apply to non-network expenses. See page B-28 for information regarding non-network expenses and reimbursement.

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The HDHP option and PPO option pay*...


Covered services

• Preventive care

• Physician office visits

• Most other covered services

Network: 100%, deductible waived

Non-Network: 100%; deductible waived for up to $1,500 per person per calendar year; 50% thereafter

Network: 80%, after deductible

Non-Network: 50%, after deductible



Network: 100%, deductible waived

Non-Network: 100%; deductible waived for up to $1,000 per person per calendar year; 50% thereafter

Network: 100%, after each per-visit copay ($30 primary care; $60 specialist)




Prescription drugs Provided through CVS Caremark; see the chart on page B-34

Provided through CVS Caremark; see the chart on page B-34

Mental health and substance abuse

Provided through the claims administrator; see the chart on page B-32

Provided through the claims administrator; see the chart on page B-32

* Non-network reimbursement rate limits apply to non-network expenses. See page B-28 for information regarding non-network expenses and reimbursement.

Employees enrolled in the HDHP option may be eligible to contribute to a Phillips 66-affiliated health savings account (HSA).

Employees NOT enrolled in the HDHP option may be eligible to contribute to a health care flexible spending account (HCFSA).

See Health Savings Account (HSA) and Health Care Flexible Spending Account (HCFSA) on page B-60 and the Flexible Spending chapter for information on both types of accounts.


PHILLIPS 66 MEDICAL

COVERAGE COSTS

Paying for coverage

Generally, the participant and the company share the cost of medical coverage under the plan. The participant’s share is paid through before-tax payroll deductions. The cost is based on the option and level of coverage elected (You only, You + one, You + two or more).

To see medical benefit costs, participants should visit UPoint (go to My HR Tools and click on the UPoint tile) or call the Benefits Center at (800) 965-4421.

UNDERSTANDING BEFORE-TAX DEDUCTIONS

Before-tax deductions refers to deductions subtracted from an employee’s pay under the Phillips 66 Flexible Spending Plan before Social Security and Medicare taxes, federal income tax and, usually, state and local income taxes are calculated.

For example:

Assume that a participant pays $250 per month ($3,000 per year) for medical coverage. If the participant is in the 25% federal income tax bracket, the tax savings are as follows:

• Federal income tax savings ($3,000 x 25%) $ 750.00

• Social Security and Medicare tax savings ($3,000 x 7.65%) + $ 229.50

• Total tax savings = $ 979.50

Before-tax deductions will save the participant $979.50 this year. If the participant pays state income taxes, savings could be even higher.

The following sections cover the different factors that affect what the participant will pay under the HDHP option and the PPO option.

Annual deductible

The annual deductible is the amount the participant must pay out-of-pocket for medical services and supplies before the participant’s medical benefit option starts paying benefits. There are some exceptions, however. The participant does not pay a deductible for:

• Network office visits and urgent care under the PPO option (these require a copay, as described on page B-22);

• Network preventive care under the HDHP option and PPO option; and

• Prescription drug costs under the PPO option.

Some expenses do not count toward the annual deductible. See Expenses that do not count toward the deductible and out-of-pocket maximum on page B-21 for details.


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For 2018, the annual deductibles are:


Annual deductible

The amount the participant pays each calendar year before the medical benefit begins paying its share of covered expenses

Network and non-network combined:


$2,800 for You + one or You + two or more coverage

Includes prescription drug costs

Network:

$ 600 for You only coverage



Non-Network:

$ 1,200 for You only coverage



For the annual deductible, it does not matter if services are received from network or non-network providers. All eligible expenses count. For example, Mark has You only coverage under the PPO option and has just met the annual $600 network deductible. When he has another $600 in eligible medical expenses, he will reach the annual $1,200 non-network deductible.

A participant’s annual deductible amount depends on whether the participant has enrolled dependents in his coverage.

If the participant is the only one enrolled in the benefit …

The You only coverage deductibles shown above apply.

If the participant has enrolled additional eligible dependents in his coverage …

The You + one or You + two or more coverage deductibles shown above apply.

The annual deductible can be met by one person or by any combination of enrolled family members. For example:

• If the participant alone reaches the annual $2,800 HDHP option deductible, everybody enrolled in his coverage has also met the annual deductible.

• The annual $2,800 HDHP option deductible could also have been met if the participant’s spouse and child had each incurred $1,400 in covered expenses, or by any other combination of covered expenses that added up to $2,800.


PHILLIPS 66 MEDICAL

ADDING A NEW DEPENDENT MIDYEAR

When a participant enrolls a new dependent in coverage during the year:

• If the participant is enrolled in You only coverage, he will move to You + one coverage, and

– The cost of the participant’s coverage will change.

– The participant now has to meet the higher You + one annual deductible.

– Any expense that had counted toward his original annual deductible now counts toward his new annual deductible.

– Even if he had already met the You only annual deductible, the participant may not have met his new You + one annual deductible. That means the participant and his new dependent have to meet the new, higher annual deductible before the medical benefit begins paying benefits.

• If the participant is enrolled in You + one or You + two or more coverage, the cost of his coverage may change; however, adding a new dependent has no effect on the participant’s annual deductible.


The annual out-of-pocket maximum is generally the most the participant will pay each calendar year before the medical benefit begins paying 100% of eligible expenses. The annual out-of-pocket maximum includes:

• For the HDHP option: Amounts the participant pays toward the deductible, copays, coinsurance and prescription drug costs.

• For the PPO option: Amounts the participant pays toward the deductible, copays, coinsurance and prescription drug costs.

Some expenses do not count toward the annual out-of-pocket maximum. See Expenses that do not count toward the deductible and out-of-pocket maximum on page B-21 for details.

For 2018, the annual out-of-pocket maximums are:



The most the participant pays for his share of covered expenses during the calendar year

Network:


$ 9,000 per family

Non-network:


$ 27,000 per family

Network:


$ 9,000 per family

Non-Network:


$ 27,000 per family

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HOW THE OUT-OF-POCKET MAXIMUM WORKS

Anna has You only coverage under the HDHP option. She had not had any medical expenses this year before she became very ill in February. She is well now, but her network hospital bill was significant — $85,000. Because of the HDHP option network annual out-of-pocket maximum, she paid only $4,500 of that amount.

For the annual out-of-pocket maximums:

• It does not matter if services are received from network or non-network providers. All eligible expenses count. For example, Mark is enrolled in the PPO option and has just met the $4,500 network individual out-of-pocket maximum. He has $9,000 more to go before he reaches the $13,500 individual non-network out-of-pocket maximum.

• The individual out-of-pocket maximum applies to each covered person regardless of whether they are enrolled in You only, You + one or You + two or more coverage.

– Once a covered person has met the applicable (network or non-network) individual out-of-pocket maximum, eligible network or non-network claims for that person will be paid at 100% of eligible expenses for the remainder of the calendar year.

• A family out-of-pocket maximum also applies to participants enrolled in You + one or You + two or more coverage.

– The family out-of-pocket maximum can be met by any combination of two or more covered family members. However, no one family member’s expenses can count for more than their individual out-of-pocket maximum amount.

– Once the applicable (network or non-network) family out-of-pocket maximum has been met, eligible network or non-network claims for all covered family members will be paid at 100% of eligible expenses for the remainder of the calendar year.

Expenses that do not count toward the deductible and out-of-pocket maximum

While most expenses count toward the annual deductible and annual out-of-pocket maximum, the following do not:

• Expenses not covered by the medical benefit.

• Expenses in excess of non-network reimbursement rate limits.

• Pre-certification penalties.

• Preventive medical care expenses covered at 100%.

• Prescription drug expenses for:

– Amounts paid for the retail refill allowance penalty.

– Amounts paid for the brand/generic difference (the difference in cost between a preferred or non-preferred brand drug and the available generic equivalent drug).

– Amounts paid due to prior authorization, preferred drug step therapy, specialty prescription drugs and quantity/dose limit penalties.

See Prescription drug coverage beginning on page B-32 for more information.

• For the PPO option annual deductible only, amounts paid for copays and prescription drugs. (Other than as noted above, those amounts do count toward the annual out-of-pocket maximum.)


PHILLIPS 66 MEDICAL

Copays and coinsurance

A copay is a fixed dollar amount payable each time the participant receives certain services or prescription drugs.

• For expenses to which the copay applies, the medical benefit pays 100% after the participant pays the medical copays shown on pages B-25 – B-27 or the prescription drug copays shown on page B-34.

Coinsurance is the percentage of a covered expense that the participant is responsible for paying. After meeting the annual deductible, the participant generally pays:

• 20% coinsurance for network care.

• 50% coinsurance for non-network care.

Copays and coinsurance do not apply for covered network preventive care. The medical benefit pays 100% of covered network preventive care. See pages B-25 – B-27 for certain limits that apply to care received from non-network providers.

NETWORK VS. NON-NETWORK PROVIDERSIn most cases, the participant saves money and reduces financial risk when services are received from network providers. However, a participant is always free to use non-network providers. Refer to If care is received from a non-network provider on page B-24 for some money-saving tips.

IF A PHYSICIAN IS NOT A NETWORK PROVIDER OR HAS LEFT THE NETWORK:

When a participant sees a non-network provider, eligible services will be paid at the non-network level.

A participant may be eligible for transition of care benefits if the participant:

• Is getting an ongoing course of treatment and the physician’s status as a network provider changes; or

• Is getting an ongoing course of treatment from a non-network provider when coverage begins.

If approved by the claims administrator, transition of care means:

• The participant may be able to finish the current course of treatment with his non-network provider; and

• Claims for the approved treatment and provider will be paid at the network level for the approved transitional period. Note: Such claims will be subject to non-network reimbursement rate limits.

The participant should call the claims administrator prior to continuing to receive ongoing services from a non-network provider.

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Ensuring a provider is in the network

TO FIND A NETWORK PROVIDER FOR MEDICAL SERVICES

Aetna participants:

• Go to aetnanavigator.com, select Find a Doctor, Pharmacy or Facility and select the Aetna Choice® POS II network

• Mobile App: Aetna Mobile

• Call Aetna at (855) 267-4184 (for medical providers)

BCBSTX participants:

• Go to bcbstx.com/phillips66 and select Get medical care

• Mobile App: BCBSTX

• Call BCBSTX at (855) 594-4233 (for medical providers)

Grand Rounds:

• Go to grandrounds.com/phillips66

• Mobile App: Grand Rounds

• Call Grand Rounds at (844) 339-6732

Because network providers may change over time, it is a good idea for the participant to confirm that the provider is still in the network every time an appointment is booked.

This verification step also applies to physician referrals. For example, a participant’s network provider may send lab tests to a non-network lab, or a network hospital may use a non-network specialist. To avoid receiving a lower non-network reimbursement amount, the participant should be sure to specify that all care is to be provided by network providers.

If a participant discovers that a non-network provider has been used, he should contact the claims administrator. Depending on the situation, the claims administrator may pay the claim at the network level.

Non-network emergency room expenses and ambulance services will be paid at the network level in the event of a true medical emergency.

If a network provider is not available

If a network provider is not available, the participant may not have to pay more for a non-network physician. Even though the medical benefit networks are large, there may not be network providers for certain specialties in some areas of the U.S. This is called a network deficiency.

A network deficiency exists if at least two network providers are not available within 50 miles of the participant’s home address. In that event, the medical benefit option may elect to treat a non-network provider as a network provider until a viable network provider becomes available. To confirm whether a network deficiency exists and to ensure care is covered at the network level, the participant should contact the claims administrator and obtain approval before receiving care from a non-network provider.

However, if a network provider is not available because the participant or one of the participant’s dependents lives outside of the network area:

• The participant or dependent will need to travel to a network area for care.

• If care is received instead by a local non-network provider, the participant’s or dependent’s claim will be paid at the non-network level. The only exception is if the nearest network area does not have the network provider needed.

http://aetnanavigator.com

http://bcbstx.com/phillips66

http://grandrounds.com/phillips66


PHILLIPS 66 MEDICAL

If care is received from a non-network provider

Although it is usually in the participant’s best financial interest to seek medical care from a network provider, there may be times when he chooses to visit a non-network provider.

For those situations, here are some actions that might reduce costs. The participant can:

• Contact the claims administrator to see if other medical benefit networks or programs may apply. In some instances, non-network providers have contracted with the claims administrator to charge lower rates to participants. These discounts do not apply in all situations, so the participant should be sure to ask the claims administrator about any restrictions before receiving care.

• Negotiate costs with the provider. The physician may agree to a discount if the participant can show that the physician’s costs are higher than the claims administrator’s estimate of the medical benefit’s non-network reimbursement rate limit (see page B-28) or if the participant pays the entire cost up-front and then submits the claim for reimbursement from the claims administrator. If the participant’s provider will not negotiate and the need is not urgent, the participant has the option of receiving care and, in most cases, saving money by using a network provider.

MEDICAL BENEFIT COVERAGE

What the HDHP and PPO options pay

In the following table, participants should note:

• The HDHP option and PPO option pay the same benefit for most expenses.

• When using a non-network provider, the participant and the plan generally pay more money.

Each option has different annual deductibles, as previously described. Also, limits apply to some benefits, as described in Covered and not covered services and supplies beginning on page B-42.

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The HDHP option and PPO option pay* …


Preventive medical care — no deductible required

• Evidence-based items that have in effect a rating of A and B in the current recommendations of the United States Preventive Services Task Force

• Preventive exams (physicals, well child and gynecological)

• Mammograms

• Prostate specific antigen (PSA)

• Preventive colonoscopies and sigmoidoscopies

• Influenza vaccine and immunizations

• Preventive hearing exams

• Screening and counseling services (obesity, misuse of alcohol and/or drugs and use of tobacco products)

• Family planning services (female contraceptives, comprehensive lactation support)

Network: 100%

Non-network: 100% up to $1,500 per person (for all preventive care combined), then 50%

Network: 100%

Non-network: 100% up to $1,000 per person (for all preventive care combined), then 50%

Non-preventive physician services

Office visits including walk-in clinic


Non-network: 50%, after deductible

Network: 100%, after copay per visit ($30 primary care; $60 specialist)**


Telemedicine Network: 100%, after $10 copay per visit after deductible

Additional fees may apply

Non-network: Not applicable

Network: 100%, after $15 copay per visit

Additional fees may apply


(continued)* Non-network reimbursement rate applies to non-network expenses. See page B-28. ** For the PPO option, the visit copay also covers diagnostic lab and X-rays billed as part of the visit and

the first visit to confirm a pregnancy.


PHILLIPS 66 MEDICAL



Minute Clinic (at various CVS Caremark pharmacies)

Network: 100%, after $10 copay per visit after deductible


Network: 100%, after $15 copay per visit


Maternity care Network: 80%, after deductible




Diagnostic lab and X-rays Network: 80%, after deductible




Outpatient surgery Network: 80%, after deductible




Hospital/urgent care expenses

Hospital room and board and other expenses

Semiprivate room rate





Inpatient physician and surgeon services





Emergency room expenses Network and non-network:

• Emergency use: 80%, after deductible

• Non-emergency use: 50%, after deductible

Network and non-network:

• Emergency use: 80%, after deductible

• Non-emergency use: 50%, after deductible

Ambulance expenses Network and non-network: 80%, after deductible

Network and non-network: 80%, after deductible

(continued)

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Urgent care Network: 100%, after $50 copay per visit after deductible


Network: 100%, after $60 copay per visit**


Alternatives to hospitalization

• Home health care

• Hospice care

• Private duty nursing

• Skilled nursing facility





Other

Spinal manipulation

Maximum 20 visits per calendar year



Network: 100%, after $60 copay per visit**


Durable medical equipment Network: 80%, after deductible




In-vitro fertilization and artificial insemination

$10,000 lifetime maximum





Acupuncture therapy

Only in lieu of anesthesia





Occupational and physical therapy





Prescription drugs See chart on page B-34 See chart on page B-34


See chart on page B-32 See chart on page B-32

* Non-network reimbursement rate applies to non-network expenses. See page B-28.** For the PPO option, the visit copay also covers diagnostic lab and X-rays billed as part of the visit and the first visit to

confirm a pregnancy.


PHILLIPS 66 MEDICAL

Understanding the non-network reimbursement rate

A non-network reimbursement rate applies to services received from non-network providers. Generally, the non-network reimbursement rate is the dollar amount that is the lower of:

• The provider’s charge; or

• Absent a contractual arrangement between the non-network provider and the claims administrator, 200% of the Medicare Allowable Rate (if established) for the geographic area where the service is furnished.

The participant, not the plan, pays any charges that are over the non-network reimbursement rate. For that reason, it is recommended that participants discuss costs with a non-network provider and with the claims administrator before receiving services.

Participants should refer to “non-network reimbursement rate” in the Glossary, which begins on page N-60 of the Other Information chapter, for more detailed information.

CENTERS OF EXCELLENCECenters of Excellence are health care facilities that have demonstrated high levels of quality and efficiency performing certain procedures. Centers of Excellence are as follows:

For Aetna participants

Aetna Institutes of Quality centers cover:

• Bariatric (weight-loss) surgery.

• Cardiac care.

• Knee and hip replacement.

• Spine surgery.

For BCBSTX participants

BCBSTX Blue Distinction Centers Plus (BDC+) cover:

• Bariatric (weight-loss) surgery.

• Cardiac care.

• Knee and hip replacement.

• Maternity care.

• Spine surgery.

• Transplants.

Procedures covered under the Centers of Excellence program are covered at 90% after the deductible. For more information or to find a facility, participants should contact the claims administrator.

The claims administrator’s complex case management program can identify facilities recognized for delivering quality specialized care related to bariatric surgery, cardiac care, transplants, knee and hip replacement, and spine surgery, among others. If such specialized care is not available in the participant’s local geographic area, the medical benefit will reimburse travel and lodging expenses, up to $50 per day per authorized person, up to a maximum of $10,000 per calendar year for care approved and coordinated through the claims administrator’s complex case management program.

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TELEMEDICINETelemedicine provides telephone or video access to board-certified physicians 24 hours a day, seven days a week. While it does not replace a participant’s primary doctor, it can be used as an alternative to urgent care or ER visits for non-emergency medical issues, in addition to behavioral health related consultations.

Telemedicine is provided through the claims administrator.

• For Aetna: Contact Teladoc at (855) 835-2362, teladoc.com/aetna, or download the Teladoc app.

• For BCBSTX: Contact MDLIVE at (888) 680-8646, MDLIVE.com/bcbstx, or download the MDLIVE app.

See the What the HDHP and PPO options pay table beginning on page B-25 and hr.phillips66.com for more information.

OTHER SERVICESParticipants enrolled in medical coverage with Phillips 66 may have access to additional programs and benefits. For example, the claims administrators for the HDHP option and PPO option offer 24-hour nurselines as well as discount programs for eyewear and hearing services. Participants should contact the claims administrator for additional programs, discounts and services that may be available.

In addition, participants may be eligible to participate in other programs to improve health, such as chronic condition management, health coaching, tobacco cessation programs, and maternity programs. Contact the claims administrator for more information.

PRE-CERTIFICATION AND PREDETERMINATION OF BENEFITS

Pre-certification

In certain circumstances, the claims administrator will require advance notice that the participant will be receiving particular services or staying in a hospital, hospice or other facility. When a participant pre-certifies care, the claims administrator will review:

• The need for the services or stay;

• Whether the services or stay will be covered by the medical benefit; and

• The length of time the services or stay will be covered.

If the participant is using a network provider, the provider should call the claims administrator to pre-certify his care.

The participant (or network provider) must call the claims administrator to pre-certify before receiving these services:

• Detailed diagnostic imaging (such as MRI, CT or PET scan) and other radiology services.

• A non-network inpatient hospital stay or a stay beyond the number of days previously pre-certified.

– Call the claims administrator at least 14 days in advance of hospital admission. A pre-certification is valid for 60 days.

– If the participant is hospitalized due to a medical emergency, the claims administrator should be called within 48 hours of admission (72 hours if the admission is on Friday or Saturday) or as soon as reasonably possible.

• Skilled nursing facility care.

• Hospice care.

• Home health care.

• A stay at a rehabilitation facility.

• Private duty nursing.

http://teladoc.com/aetna

http://MDLIVE.com/bcbstx



PHILLIPS 66 MEDICAL

Pre-certification is not required for services received outside of the U.S. A participant also does not have to pre-certify network hospital admissions for childbirth if the stay is expected to be 48 hours or less for a vaginal delivery or 96 hours or less for a cesarean section. However, if the stay will be longer than the 48- or 96-hour timeframes or if a non-network hospital is used, the stay must be pre-certified.

IF PRE-CERTIFICATION IS NOT RECEIVED

If the claims administrator is not contacted for pre-certification before a non-network hospital stay:

• Hospital room and board benefits will be reduced by $200; and

• The medical benefit will not pay for any care that the claims administrator determines is not medically necessary.

Predetermination of benefits

Even if the participant does not need to pre-certify services or a stay in a hospital, hospice or other facility, it is helpful to know in advance that an expense will be covered and how much it will cost. To obtain this information, the participant can get a predetermination of benefits, as follows:

• The provider will submit information to the claims administrator with the proposed procedure codes and costs.

• The claims administrator will review the proposed treatment and let the participant and/or provider know whether the service or stay is covered and the level of coverage.

• If the participant is using a non-network provider, the claims administrator will also tell the participant whether the cost is within the medical benefit’s non-network reimbursement rate limits.

There is no penalty for failing to obtain a predetermination of benefits. However, obtaining one can help ensure the proposed treatment is the right one and may even uncover other treatment options. Pre-certification and predetermination of benefits do not guarantee payment under the medical benefit if the pre-certification or predetermination is based on incomplete or inaccurate facts.

TRAVELING OUTSIDE OF THE U.S.The costs for urgent and emergency care for participants traveling outside of the United States are covered the same as if the participant was in the U.S., provided the participant follows medical benefit guidelines.

A participant who needs medical care when outside of the U.S. should:

• Contact the medical claims administrator and notify them of the need for medical care.

• Submit a claim form to the medical claims administrator for reimbursement.

Remember — emergency services received anywhere in the world are always reimbursed at the network level.

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MENTAL HEALTH AND SUBSTANCE ABUSE COVERAGEThe HDHP and PPO options include coverage for inpatient and outpatient mental health and substance abuse services and treatment.

WHO TO CALL FOR ASSISTANCE

Counselors can be reached 24 hours a day, 365 days a year. In an emergency, do not hesitate to call.

• Resources for Living (EAP), call (844) 766-7351.

• Aetna participants, call (855) 267-4184.

• BCBSTX participants, call (855) 594-4233.

In a substance abuse emergency, the participant can be admitted to any accredited hospital or treatment facility for emergency detoxification. The claims administrator must be notified within two business days of admission.

RESOURCES FOR LIVING

Resources for Living services, administered by Aetna, are confidential, completely voluntary and provided at no cost to eligible Phillips 66 employees and family members.

Resources for Living offers confidential counseling, as well as phone and online assistance for a variety of needs, including:

• Counseling and relationship issues.

• Work/life balance.

• Legal and financial services.

• Identify theft, and more.

See the separate Employee Assistance Plan chapter for more information.

Mental health

Counseling services are available to help with personal and family concerns. Licensed network providers who specialize in mental health issues, such as depression, stress, and anxiety include:

• Psychiatrists;

• Clinical psychologists;

• Social workers (Masters of Social Work);

• Professional counselors;

• Marriage and family therapists; and

• Psychiatric nurses.

A counselor will develop an action plan to resolve the participant’s issues and assist in the process to find appropriate network providers.

Substance abuse

Help is available for substance abuse. The first step in entering a treatment program is to contact the medical claims administrator, who will:

• Evaluate the participant’s needs.

• Design and obtain a treatment plan.

• Provide a referral to network providers and an approved list of several network providers.

Other than for emergency detoxification, treatment must be authorized and supervised by the claims administrator. The medical benefit covers inpatient treatment — including 24-hour residential treatment center care, and day and evening programs — under the medical benefit’s hospital coverage. Extension of an inpatient stay may be considered, if medically necessary, but the extension request must be authorized by the claims administrator prior to the last previously authorized day of care.


PHILLIPS 66 MEDICAL

Mental health and substance abuse summary chart

Here is a summary of the mental health and substance abuse benefits.

• For all services, the participant MUST follow the claims administrator’s notification, pre-certification and/or medical/review requirements in order for the expense to be covered.

• Services received from non-network providers are subject to the non-network reimbursement rate.

• The annual deductible is the same one that applies to other medical expenses under the medical benefit.

Mental health and substance abuse treatment

HDHP option pays* PPO option pays*

If the claims administrator authorizes treatment

AND

A network provider is used

Inpatient: 80%, after deductible

Outpatient: 80%, after deductible


Outpatient: 100%, after $30 copay for each office visit; 80%, after deductible, for other services

If the claims administrator authorizes treatment**

AND

A network provider is NOT used





* If the participant uses a non-network provider, the participant is responsible for paying charges in excess of the non-network reimbursement rate, if applicable. Both inpatient and outpatient treatment are subject to the annual deductible, and apply toward the annual out-of-pocket maximum for the coverage option the participant has selected.

** The non-network provider may also contact the claims administrator to obtain authorization. However, it is the participant’s responsibility to make sure the authorization from the claims administrator has been obtained, except in emergencies. The claims administrator must be notified within two business days of an emergency service.

PRESCRIPTION DRUG COVERAGEThe prescription drug benefit under the HDHP and PPO options is administered by CVS Caremark.

• The participant can get up to a 30-day supply of prescription drugs at a CVS or non-CVS retail pharmacy.

• After obtaining the same prescription three times at a retail pharmacy, all future fills/refills of that prescription must be obtained from the CVS Caremark Maintenance Choice® program. See Retail pharmacy limits on maintenance medications on page B-35.

• For diabetic medications, after obtaining the same prescription two times at a retail pharmacy, all future fills/refills of that diabetic prescription must be obtained from the CVS Maintenance Choice program. See Diabetes Management on page B-35.

• Maintenance Choice® allows the participant to fill a 90-day supply of prescriptions at any CVS/pharmacy or with the CVS Caremark Mail Service Pharmacy for the same low price.

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BEFORE GOING TO THE PHARMACY

As with Phillips 66 medical coverage, the prescription drug program has network and non-network benefits. But instead of the claims administrator’s network, CVS Caremark has its own network of retail pharmacies.

• The participant will pay less if prescriptions are filled at a retail pharmacy participating in the CVS Caremark network.

• The participant must show his prescription drug ID card when having prescriptions filled. If the participant does not show his ID card, even at a network pharmacy, the participant will have to:

– Pay the full price; and

– File a claim with CVS Caremark to receive reimbursement at the non-network level.

• The CVS Caremark mobile app is available to help participants find network pharmacies and to refill/renew mail-order prescriptions.

Generic vs. brand-name drugs

To avoid paying more than necessary for prescription drugs, be sure to understand the types of medications the physician prescribes.

Prescription drugs fall into three categories — generic, preferred brand and non-preferred brand.

• A generic drug is therapeutically equal to and contains the same active ingredients (and in the same dosage form) as the brand-name drug.

• Preferred brand drugs are on the CVS Caremark list of preferred drugs. They are carefully selected brand-name drugs that will provide quality care for patients but usually cost less than other brand-name drugs.

• Non-preferred brand drugs are brand-name drugs that are not on the CVS Caremark list of preferred drugs. Most non-preferred drugs cost more than preferred drugs.

Certain prescription drugs are generally excluded from coverage under the HDHP and PPO options. The list of Preferred Drug List Exclusions is available by contacting CVS Caremark. Participants should contact CVS Caremark for information on covered alternatives and other options that may be available.

Prescriptions will be filled with generic drugs whenever possible, even if the prescription is written for a brand-name drug. A physician can instruct that the prescription is to be dispensed as written (DAW). This means the prescription will be dispensed as written with no substitutions.

The pharmacist may call the participant’s physician if the prescription is unclear, incomplete or to ask if a substitution or change may be made. The pharmacist will not make any changes, except generic substitution when DAW is not instructed by the physician, unless authorized by the physician.

If the participant gets a brand-name drug when an equivalent generic is available, he will pay 100% of the difference in cost even if that cost exceeds the per-prescription maximum amount. In addition, the amount paid in excess of the equivalent generic cost will not apply toward the participant’s annual deductible or annual out-of-pocket maximum.


PHILLIPS 66 MEDICAL

Prescription drug summary chart

Prescription coverage under the HDHP and PPO options is shown below. Participants should note that the annual deductible applies to prescriptions under the HDHP option. That is the same deductible that applies to the participant’s other medical expenses.


Annual deductible

Participant pays 100% of the discounted cost of medications until the annual deductible has been met; thereafter, the coinsurance amounts shown below apply

Not applicable

Retail pharmacy (up to a 30-day supply)

Network pharmacy

• Generic: Participant pays $10 copay after deductible

• Preferred brand: Participant pays 20% ($150 maximum), after deductible

• Non-preferred brand: Participant pays 35%, after deductible

• Generic: Participant pays $10 copay

• Preferred brand: Participant pays 40% ($150 maximum)

• Non-preferred brand: Participant pays 55% ($300 maximum)

Non-network pharmacy

Participant pays 50%, after deductible Participant pays 50%

CVS Caremark Mail-Order or Maintenance Choice program (up to a 90-day supply)

Network pharmacy

• Generic: Participant pays $25 copay after deductible

• Preferred brand: Participant pays 20% ($300 maximum), after deductible

• Non-preferred brand: Participant pays 35%, after deductible

• Generic: Participant pays $25 copay

• Preferred brand: Participant pays 40% ($300 maximum)

• Non-preferred brand: Participant pays 55% ($600 maximum)

Preventive prescription medications* (Those used to help avoid or prevent recurrence of an illness or condition)

Network or non-network pharmacy

• Generic preventive drugs and insulin: Covered at 100%, no deductible

• Branded preventive drugs: Participant pays 20%, no deductible

Participant pays the applicable copay or coinsurance, as shown above

Prescription fluoride (for children under age six)

Network or non-network pharmacy

Covered at 100%, no deductibles, copays or coinsurance

* Participants should contact CVS Caremark for the latest list of preventive prescription medications.

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LOW PRICE GUARANTEE

If the retail pharmacy price for the prescription is less than the participant’s coinsurance or copay, the participant will pay the lower price.

Network pharmacies

At a network pharmacy, the participant will pay only the applicable copay or coinsurance, and there are no claim forms to file. The participant also saves money because the cost will be based on CVS Caremark’s negotiated/discounted rate.

If a participant uses a non-network pharmacy or does not show his ID card at the time the prescription is filled he will pay:

• 100% of the full (not discounted) cost of the medication and will then need to file a claim for reimbursement; and

• The higher 50% non-network coinsurance amount plus anything above CVS Caremark’s negotiated/discounted network rate.

FINDING A NETWORK PHARMACY

Call CVS Caremark at (888) 208-9634 or go to caremark.com or the CVS Caremark mobile app and use their pharmacy locator.

Retail pharmacy limits on maintenance medications

Maintenance medications are generally prescribed for long-term treatment of chronic conditions such as diabetes, high cholesterol or high blood pressure, and limits apply at retail pharmacies.

• After three fills/refills at a retail pharmacy (excluding diabetic medications), the participant must use the CVS Caremark Maintenance Choice program described below. Diabetic medications are limited to two fills/refills at a retail pharmacy.

• It does not matter if the fills/refills are in different calendar years or if the participant gets a new prescription for the same medication. The limit still applies.

• After the participant has reached the limit, he pays 100% of the cost if the prescription is filled at a non-Maintenance Choice retail pharmacy. In addition:

– The per-prescription maximum cost will not apply; and

– The amount payable will not apply to the annual deductible or annual out-of-pocket maximum.

Maintenance Choice program

The Maintenance Choice program:

• Gives participants the flexibility to refill up to a 90-day supply of a maintenance medication via the mail-order pharmacy or at a local CVS/pharmacy at the same cost as mail-order.

• Applies to maintenance medications where greater than an 83-day supply is prescribed.

• Includes free shipping for a normal mail-order delivery. Faster delivery times are available for a fee.

http://caremark.com


PHILLIPS 66 MEDICAL

Submitting mail-order prescriptions

The participant can submit a new prescription to the Maintenance Choice mail-order pharmacy in one of two ways:

• By mail — Complete a mail-order pharmacy program order form and return it, with the physician’s prescription and payment, to the address listed on the form.

• By fax — The participant’s physician can fax the prescription to the mail-order pharmacy. (The physician should call the number on the back of the participant’s ID card for the fax number.) Then, the participant must contact CVS Caremark to pay the coinsurance or copay so the prescription can be processed and mailed.

ORDERING FROM A MAIL-ORDER PHARMACY FOR THE FIRST TIME

For first-time orders, complete a Health, Allergy and Medication questionnaire, available at caremark.com or by calling CVS Caremark at (888) 208-9634.

Ordering refills

Once a participant has a prescription on file with the mail-order pharmacy, refills can be ordered by phone, online, or mobile app. Always order refills at least 14 days before they will be needed — and keep in mind that federal law requires that 75% of the medication be used before a refill can be issued.

• By phone — The participant should have the refill slip with the prescription information ready when calling CVS Caremark at the number on the back of his ID card.

• Online — The participant can log onto the CVS Caremark website listed on the back of his ID card and follow the instructions. The participant must have his member number and the prescription number. The status of a new or refill order can also be checked online.

• Mobile App — From your cell phone or mobile device, go to Phillips 66 HR Connect App (available in the App Store or Google Play), select Apps and launch CVS Caremark.

Mail time may vary from the date the order and payment are received. If the medication is needed sooner, it is a good idea to ask the physician for two prescriptions:

• One for up to a 30-day supply to be filled immediately at a retail pharmacy (this cannot be done for a new prescription that renews the same maintenance medication); and

• One for up to a 90-day supply (plus refills for up to one year) that can be sent to the CVS Caremark mail-order pharmacy program.

Covered prescription drugs and supplies

Whether prescription drugs are obtained from a retail pharmacy or through the mail-order pharmacy program, medications are generally covered if they:

• Require a prescription for dispensing;

• Are approved by the U.S. Food and Drug Administration (FDA);

• Are prescribed by a physician licensed to practice medicine in the U.S. (including Puerto Rico); and

• Are medically necessary and are being used to treat a condition that is covered by the medical benefit.

Specialty medications

This section does not apply to participants who are on Medicare if Medicare pays first. In that event, the participant should obtain specialty prescription drugs from the claims administrator. (See Coordination of benefits (COB) on page B-62 for details on which plan pays first.)

http://caremark.com

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Certain specialty prescription drugs used to treat complex conditions and illnesses are available only from the CVS Caremark specialty pharmacy. Participants should contact CVS Caremark for a list of these medications.

For specialty medications, after one initial fill at a retail pharmacy, additional refills must be obtained through the CVS Caremark mail-order specialty pharmacy.

• Where permitted by state law, the medical benefit participates in the CVS Caremark Specialty Connect program, which allows refills of a specialty medication at a local CVS/pharmacy at the same cost as mail order.

• Where the Specialty Connect program is not permitted under state law (currently Oklahoma, Arkansas and West Virginia), specialty medication refills can be obtained at a local CVS/pharmacy at the copay and coinsurance rates applicable to the CVS Caremark specialty pharmacy.

If specialty medications are bought from any other source, the participant will pay 100% of the cost. The plan will not pay anything, and the amount payable will not apply to the participant’s annual deductible or annual out-of-pocket maximum.

Note: Prescription drugs to treat diabetes are not considered specialty prescription drugs.

Compound medications

A compound medication is covered under the medical benefit only if:

• Preauthorization is received for any compound medication costing more than $300 per prescription.

• A compound medication containing any of the same ingredients has not been covered during the previous 25 days.

Special programs

The medical benefit applies certain standards to some drugs in order to improve participants’ health, safety and cost efficiencies. For these drugs, CVS Caremark might require:

• Prior authorization before dispensing.

• Use of another generic or similar medication (also called preferred drug step therapy).

• Quantity or dose limits.

• Site of Care (see page B-38 for additional information).

Some of the medications managed by these standards include:

• Androgens and anabolic steroids.

• Antidepressant agents (e.g., Abilify).

• Appetite and weight loss agents.

• Antinarcoleptic agents.

• Antiemetic agents.

• CNS stimulants.

• Dermatologicals: Tretinoin topical/brand name minocycline.

• Hypertensive Agents (ARB).

• Hypnotic agents.

• Impotency medications (for more information regarding limitations for drugs prescribed to treat impotency, see Prescription drugs and supplies that are not covered on page B-40).

• Intranasal steroids.

• Long-acting narcotic analgesics.

• Migraine therapy.

• Proton Pump Inhibitors (PPI).


PHILLIPS 66 MEDICAL

In addition, examples of specialty medications managed by these separate standards include (but may not be limited to):

• Cancer therapy.

• Endocrine agents (e.g., Acthar, Ceredase, Cerezyme, Kuvan).

• Gout therapy.

• Growth hormone.

• Hepatitis C treatments.

• Immune globulins.

• Multiple Sclerosis therapy.

• Myeloid and Erythroid stimulants.

• Psoriasis treatment.

• Rheumatological agents.

• Specialty pulmonary agents (Xolair, HAE treatment, Cystic Fibrosis treatment, pulmonary arterial hypertension agents).

If the required authorization, preferred drug step therapy or quantity/dose limits are not followed, any additional costs payable under these provisions will not apply to the annual deductible or annual out-of-pocket maximum.

The participant or his physician should call CVS Caremark if he wants more information regarding these special programs.

Site of Care Specialty Prescription Program

CVS Specialty™, a Designated Dispensing Entity (as defined on page B-39), is the exclusive specialty pharmacy provider for Phillips 66. Select specialty medications will be covered only under the pharmacy benefit through CVS Specialty. As part of this policy, these specialty medications will be excluded from coverage under the medical benefit. Participants should refer to the claims administrator for the most current list of medications that must be dispensed by CVS Specialty.

In general, the medications on this list will not be covered by any pharmacy except for CVS Specialty, regardless of their medical necessity, their approval or if the participant has a prescription from a physician or other provider. In limited circumstances, however, coverage may be allowed through an alternate provider. Those circumstances include:

1. Specialty medications billed by a facility as part of an inpatient hospital stay.*

2. Specialty medications billed as part of an emergency room visit.*

3. Situations where Medicare is the primary carrier.*

4. Circumstances where home care is not clinically appropriate (either due to the participant’s clinical history or due to characteristics of the drug which require special handling) and an alternative infusion site (that is qualified to administer the drug) is not available for coordination of services within a reasonable proximity (i.e., 30 miles or less).**

5. The treating physician has provided written documentation outlining the clinical rationale for the requirement that the participant be treated at the designated facility and confirming that the designated facility is unable to accept drugs dispensed by CVS Specialty. The written documentation will be reviewed and approved by appropriate CVS Specialty clinical personnel before allowing coverage for the requesting provider under the medical benefit.**

Prior authorization may be required regardless of the benefit under which the drug is covered or the identity of the provider administering the drug.

* Prior approval by CVS Specialty is not required. ** Situation will be evaluated by CVS Specialty clinical staff.

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Infusion nursing and Site of Care management for specialty medications

Infusion nursing services for select specialty medications that are administered in the home and/or in an ambulatory infusion center are covered through the pharmacy benefit and are coordinated through and dispensed by CVS Specialty. For infused specialty medications that require administration by a medical professional, a CareTeam nurse will work with providers to assess clinical history and determine clinically-appropriate options (location of the infusion services) for clinician-infused specialty medications. Options may include homecare, ambulatory infusion center or other sites as deemed appropriate. CareTeam nurses will contact all impacted participants to provide assistance and guidance.

Specialty Medications: Specialty medications are defined as certain pharmaceutical and/or biotech or biological drugs (including biosimilars or follow-on biologics) that are used in the management of chronic or genetic disease, including but not limited to, injectables, infused, inhaled or oral medications.

Designated Dispensing Entity: A Designated Dispensing Entity is a pharmacy or other provider that has entered into an agreement with CVS or with an organization contracting on CVS’ behalf, to provide specialty medications for the treatment of specified diseases or conditions. The fact that a pharmacy or other provider is a network provider does not mean that it is a Designated Dispensing Entity. If a participant is directed to a Designated Dispensing Entity and chooses not to obtain a specialty medication from a Designated Dispensing Entity, the participant will be subject to the non-network benefit terms for that specialty medication.

Accordant health services

Accordant provides a care management solution to individuals with rare chronic conditions. Chronic conditions generally include, but may not be limited to, those listed below.

• ALS (Amyotrophic Lateral Sclerosis).

• CIDP (Chronic Inflammatory Demyelinating Polyradiculoneuropath).

• Crohn’s Disease.

• CF (Cystic Fibrosis).

• Dermatomyositis.

• Epilepsy (Seizure Disorders).

• Gaucher’s Disease.

• Hemophilia.

• HIV (Human Immunodeficiency Virus).

• MS (Multiple Sclerosis).

• MG (Myasthenia Gravis).

• PD (Parkinson’s Disease).

• Polymyositis.

• RA (Rheumatoid Arthritis).

• Scleroderma.

• SCD (Sickle Cell Disease).

• SLE or Lupus (Systemic Lupus Erythematosus).

• Ulcerative Colitis.

Participants can expect to receive the following services as a part of this program if eligible:

• Telephonic and/or online outreach and communication (per participant preference).

• Risk assessment and regular follow up.

• Telephonic, mail, and Web-based education.

• Access to specially trained registered nurses 24 hours a day, seven days a week.

• Physician notification and collaboration.

• Proactive management of complex needs in collaboration with health care providers.

• Support for participant-to-physician communication.


PHILLIPS 66 MEDICAL

Diabetes management

The Transform Diabetes Care program with Livongo gives participants tools and support for managing diabetes. The program includes:

• A Livongo connected meter that automatically uploads blood glucose readings for online access. The meter also provides personalized tips based on blood glucose data as well as real-time notifications if readings are too high or low.

• 24/7 support from certified diabetes educators via phone, email, text or mobile app.

• A supply of test strips and lancets shipped at no cost to the participant’s address.

• After two fills/refills of a diabetes maintenance medication at a retail pharmacy, the participant must use the CVS Caremark Maintenance Choice program described on page B-35.

The participant should contact a team member of his dedicated CVS Caremark Diabetes Care Team at (800) 945-4355 for further information or to enroll in the program.

Prescription drugs and supplies that are not covered

This is not a complete list of the prescription drugs and supplies that are not covered by the HDHP and PPO options. As always, check with CVS Caremark to verify whether a medication is covered.

• Allergy serums.

• Biologicals.

• Blood or blood plasma products.

• Charges for the administration or injection of any drug.

• Contraceptive implants, barrier contraceptives and spermicides (contraceptive jellies, creams, foams and devices).

• Drugs labeled “Caution-limited by federal law to investigational use” or experimental drugs, even though a charge is made to the participant.

• Drugs whose sole purpose is to promote or stimulate hair growth (e.g., Rogaine, Propecia) or that are for cosmetic purposes only rather than for treating a medical condition (e.g., Renova, Vaniqa, Tri-Luma, Botox-cosmetic, Avage Solage, Epiquin).

• Fertility agents.

• Homeopathics.

• Medication for which the cost is recoverable under any Workers’ Compensation or occupational disease law or any state or governmental agency.

• Medication furnished by any other drug or medical service for which no charge is made to the participant.

• Medication that is to be taken by, or administered to, the participant, in whole or in part, while the participant is a patient in a licensed hospital, rest home, sanitarium, extended care facility, skilled nursing facility, convalescent hospital, nursing home, rehab facility or similar institution that operates a facility for dispensing pharmaceuticals on its premises or allows to be operated on its premises.

• Mifeprex.

• Non-federal legend drugs.

• Nutritional and dietary supplements.

• Ostomy supplies.

• Over-the-counter drugs and vitamins (those available without a prescription).

• Prescription drugs for which there is an over-the-counter product having the same active ingredient and strength.

• Unless a new prescription is issued, prescriptions refilled in excess of the number of refills specified by the physician, or any refill dispensed after one year from the physician’s original order.

• Therapeutic devices or appliances (humidifiers, etc.).

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Drugs prescribed to treat impotency (excluding Yohimbine) are covered only for males age 18 and over.

• The retail pharmacy benefit is limited to a 30-day supply or eight units per claim, whichever is less.

• The mail-order pharmacy program benefit is limited to a 90-day supply or 24 units per claim, whichever is less.

Lost or stolen prescription drugs will not be replaced. In addition, reimbursement will not be provided for copays or coinsurance if a prescription is lost or stolen.

Prescription drugs cannot be returned to the pharmacy after the prescription has been dispensed. Additionally, participants will not be reimbursed for copays or coinsurance if a prescription drug has been released from the pharmacy.

Prescription drug coverage outside the U.S.

CVS Caremark cannot ship prescription drugs out of the U.S. Even if the participant no longer lives in the U.S., prescriptions must be written by a U.S. physician and can be shipped only to a U.S. address.

If a participant is going to be out of the country for an extended period of time, he must contact CVS Caremark in advance to purchase more than a 30-day (retail) or 90-day (mail-order) supply. A participant may receive up to a year’s supply of drugs (if the prescription is written for up to a year’s supply and the pharmacist agrees to provide a year’s supply) by paying the applicable copay or coinsurance. After obtaining approval, the participant should call CVS Caremark for details.

If a prescription drug is needed for an acute illness or injury while the participant is out of the U.S., the drug should be purchased at a local non-U.S. pharmacy and a non-network/no ID card claim form should be submitted to CVS Caremark.

Medicare Part D

A participant who is eligible for Medicare is also eligible to enroll in a Medicare Part D plan that offers prescription drug coverage.

• If a participant enrolls in Medicare Part D, the participant and his dependents cannot be covered for a medical benefit under the Phillips 66 Medical and Dental Assistance Plan.

• If a participant’s dependent enrolls in Medicare Part D, that dependent cannot be covered for a medical benefit under the Phillips 66 Medical and Dental Assistance Plan.

For either situation above, the participant must contact the Benefits Center and cancel medical coverage under the Phillips 66 Medical and Dental Assistance Plan for the affected person(s). If coverage is canceled, the individual cannot be re-enrolled in medical coverage under the Phillips 66 Medical and Dental Assistance Plan until the next annual benefits enrollment unless the individual experiences a qualified change in status event.

Creditable prescription drug coverage

If the participant does not enroll in Medicare Part D coverage when first eligible, or if the participant does not have creditable prescription drug coverage, his Medicare Part D premiums will permanently be 1% higher than they would otherwise be for each month he is without creditable coverage (drug coverage that is considered to be as good as Medicare Part D coverage).

• The 1% per month penalty is waived if the participant has creditable coverage under an employer group health plan.

• The HDHP and PPO options provide creditable coverage. Therefore, the participant is not required to enroll in a Medicare Part D plan while covered under one of those options.


PHILLIPS 66 MEDICAL

• If the participant loses creditable coverage (for example, by cancelling coverage under the HDHP or PPO option), he must enroll in a Medicare Part D plan within 63 days of the loss of creditable coverage. If he does not enroll, the penalty will apply.

Each year, Phillips 66 is required by law to provide information regarding whether prescription drug coverage under the HDHP and PPO options remains creditable coverage for purposes of Medicare Part D.

For answers to questions about Medicare Part D, participants should contact Medicare at (800) 633-4227 (TTY communications device users should call (877) 486-2048) or go to medicare.gov.

Kaiser HMO participants will be informed by their HMO whether it provides creditable prescription drug coverage.

COVERED AND NOT COVERED SERVICES AND SUPPLIESAt a high level, the medical benefit under the plan covers medically necessary expenses related to non-occupational illness, injury and pregnancy. This section provides more details regarding expenses covered and not covered by the medical benefit.

“Non-occupational illness or injury” is defined in the Glossary, which begins on page N-60 of the Other Information chapter.

Covered services and supplies

The following is a summary of the covered services and supplies under the HDHP option and the PPO option. For questions about an expense, participants should contact the claims administrator.

If not otherwise documented in this chapter, the claims administrator policies, or accepted medical practice as determined by the Phillips 66 Medical Director, will govern the benefits offered and the criteria that must be met in order for benefits to be covered.

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) requires that group health plans providing coverage for mastectomies also provide certain mastectomy-related benefits or services. Since the medical benefit provides medical and surgical benefits for mastectomies, it must also provide coverage for:

• Reconstruction of the breast on which the mastectomy was performed.

• Surgery and reconstruction on the other breast to produce a symmetrical appearance.

• Coverage for prostheses (such as a breast implant).

• Treatment for physical complications at all stages of the mastectomy, including lymphedema.

The same deductibles and coinsurance limitations apply to these procedures as apply to any other illness.

The Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) requires coverage for 48 hours of hospitalization for mothers and their newborn children following a normal vaginal delivery and 96 hours following an uncomplicated cesarean section. Shorter or longer lengths of stay may be approved by the claims administrator at the request of the attending physician.

http://medicare.gov

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The following medical coverage chart of services and supplies is comprehensive, but not all-inclusive. Other specific expenses may be determined to be covered under the plan consistent with other terms of the medical benefit. If not otherwise documented in this chapter, covered services are explained in the carrier’s medical/clinical policy which will govern the benefits offered and the criteria that must be met in order for benefits to be covered under the HDHP option and the PPO option. To verify if particular services or supplies are covered, participants should call the claims administrator.


Acupuncture therapy Acupuncture therapy in lieu of anesthesia.

Allergy testing and treatment

Allergy testing and treatment or other injections, such as hormone injections (includes physician office visit, shot and antigen).

Ambulance services The medical benefit covers emergency transportation via professional ambulance service to transport the participant from the place he was injured or stricken by disease to the nearest hospital that can provide the necessary care. Charges for professional ambulance service also are covered for transportation from:

• One hospital to another hospital in the area and back again when it is documented that the first hospital does not have the required services and/or facilities for treatment.

• Hospital to home, skilled nursing facility or nursing home when the participant cannot be safely or adequately transported any other way (e.g., full body cast, traction, continuous oxygen).

• Home to hospital for medically necessary* inpatient or outpatient treatment when an ambulance is required for safe and adequate transport.

Transportation by airline, railroad or air ambulance is limited to the first trip to and the first transfer from a hospital on account of any single injury, sickness or pregnancy-related condition to the nearest hospital that can provide the necessary emergency care.

* “Medically necessary” is defined in the Glossary, which begins on page N-60 of the Other Information chapter.

Anesthetics and their administration

Anesthetics and their administration (including the services of an anesthesiologist in connection with treatment in a hospital).

Autism spectrum disorder treatment

Autism spectrum disorder treatment (coverage for approved medically necessary treatments for autism spectrum disorder, including applied behavior analysis).

Blood and blood plasma products

Blood and blood plasma products.

Chemotherapy administration and medication

Chemotherapy administration and medication.

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PHILLIPS 66 MEDICAL


Contraception Contraceptive expenses are covered as follows:

• Charges for contraceptive drugs and devices that by law require a physician’s prescription and that have been approved by the U.S. Food and Drug Administration (FDA).

• Related outpatient contraceptive services, such as consultations, exams, procedures and other medical services and supplies, including, but not limited to, tubal ligation and sterilization implants.

NOT covered under the medical portion of the medical benefit are charges for:

• Contraceptive or self-injectable (self-administered) prescription drugs that are covered to any extent under the prescription drug program (see Prescription drug coverage on page B-32).

• Contraceptive services while the participant is confined as an inpatient.

• Oral contraceptives or contraceptive patches.

Dental services The medical benefit covers dental treatment due to accidental injury or diseases (such as jaw tumors or oral cancer) to teeth or jaw. Covered dental expenses include charges for dental work, surgery or orthodontic treatment needed to remove, repair, replace, restore or reposition:

• Natural teeth damaged, lost or removed.

• Other body tissues of the mouth that are diseased, fractured or cut.

At the time of the injury, the teeth must have been:

• Free from decay or in good repair; and

• Firmly attached to the jawbone.

If crowns, dentures, bridgework or in-mouth appliances are installed due to such injury, covered expenses include only charges for:

• The first denture or fixed bridgework to replace the lost teeth.

• The first crown needed to repair each damaged tooth.

• An in-mouth appliance used in the first course of orthodontic treatment after the injury.

The accident causing the injury must occur while the participant is covered under the medical benefit, and expenses must be incurred during the year of the accident or during the following year.

Coordination of benefits with the Employee Dental Plan does not apply to charges resulting from an accidental injury.

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Durable medical equipment

The medical benefit pays for durable medical equipment, providing it is:

• For repeated use and is not a consumable or disposable item;

• Used primarily for a medical purpose;

• Appropriate for use in the home; and

• Prescribed by a physician.

Examples of durable medical equipment include:

• Appliances that replace a lost body organ or part, or help an impaired body organ or part to work.

• Orthotic devices, such as arm, leg, neck and back braces. (Note: Foot orthotic devices are not covered by the medical benefit.)

• Hospital-type beds.

• Equipment needed to increase mobility, such as a wheelchair.

• Respirators or other equipment for the use of oxygen.

• Monitoring devices.

The participant should contact the claims administrator prior to rental or purchase of durable medical equipment. The claims administrator decides whether to cover the purchase or rental of the equipment.

Modifications to the home are not covered, and maintenance and repairs needed due to misuse or abuse are not covered.

Coverage is limited to one item of equipment, for the same or similar purpose, and the accessories needed to operate the item. The participant is responsible for the entire cost of any additional pieces of the same or similar equipment he purchases or rents for personal convenience or mobility.

Emergency room expenses

Treatment provided in a hospital’s emergency room to evaluate and treat a serious medical condition that arises suddenly and, in the judgment of a reasonable person, requires immediate care to avoid:

• Placing the person’s health in serious jeopardy;

• Serious impairment to bodily function;

• Serious dysfunction of a body part or organ; or

• In the case of a pregnant woman, serious jeopardy to the health of the fetus.

Note: Follow-up care after stabilization is not emergency care.

Foot care The medical benefit covers foot care for podiatric surgery (e.g., surgery for bunions and hammertoes). In addition, hygienic foot care may be covered if the participant suffers from systemic diseases and such treatment requires the care of a qualified foot service provider. These diseases include peripheral vascular disease, metabolic or neurological disease (for example, trimming of toenails or calluses for individuals who have diabetes, arteriosclerosis or Rueger’s Disease).

Expenses for foot orthotic devices are not covered by the medical benefit.

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PHILLIPS 66 MEDICAL


Hearing aid device Hearing aid device (up to once every three years).

Home health care Home health care is covered to a maximum of 120 visits.

Home health care is skilled nursing care consisting of services that must be performed by a registered nurse or licensed health care provider and meet all of the following criteria:

• Pursuant to a physician’s orders, the service is so inherently complex that it can be safely and effectively performed only by, or under the supervision of, a licensed nurse to achieve the medically desired result;

• The skilled nursing care must be provided on an intermittent or hourly basis;

• The skilled nursing services cannot be provided to a minor or dependent adult when a family member or caregiver is not present;

• The skilled nursing service(s) must be reasonable and necessary for the treatment of the illness or injury — that is, the services must be consistent with the unique nature and severity of the participant’s illness or injury, particular medical needs and accepted standards of medical and nursing practice, without regard to whether the illness or injury is acute, chronic, terminal or expected to last a long time; and

• The skilled nursing service is not custodial in nature.

Additionally, the care must be performed by a home health care agency, given under a home health care plan and given to the participant in his home or a temporary home.

Prior hospitalization is not required. Home health aide services that directly support the care when provided in conjunction with skilled nursing care are covered and subject to the same visit limitations. Medical social services by a qualified social worker are covered when provided in conjunction with skilled nursing care.

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Hospice care The medical benefit covers hospice care services for a terminally ill patient, as follows:

• Room and board charges by the hospice, if it is not part of a hospital or skilled nursing facility.

• Other medically necessary services and supplies.

• Part-time nursing care by, or under the supervision of, a network registered nurse (R.N.).

• Home health care furnished in the participant’s home by a home health care agency for the following medically necessary services and supplies: – Part-time or intermittent nursing care by, or under the supervision of, a

registered graduate nurse (R.N.); – Part-time or intermittent home health aide services consisting primarily of

patient care; or – Physical therapy and occupational therapy.

• Counseling services by a licensed social worker (or a licensed pastoral counselor if a hospice agency charge) for the patient and the patient’s immediate family.

• Bereavement counseling services by a licensed social worker (or a licensed pastoral counselor) for the patient’s immediate family, provided the services are included in the hospice care charges.

Services must be provided in an inpatient hospice facility or in the participant’s home. Counseling services received by the patient and the patient’s immediate family in connection with a terminal illness will not be considered to have been received due to a mental health disorder.

For purposes of hospice care benefits, the patient’s immediate family is limited to the participant and his eligible dependents who are enrolled in coverage under the medical benefit.

Hospital services (inpatient)

Inpatient hospital charges are covered under the medical benefit as follows:

• Semiprivate room and board in a qualified hospital (if a facility has private rooms only, the billed charge is allowed). Charges in excess of the semiprivate room rate are covered only if the patient is confined in a private room for such conditions as a severe burn or leukemia condition where there is significant danger of infection or for a contagious disease where a private room is required by the hospital or applicable law.

• Necessary hospital services, such as lab tests, X-rays, medication, intensive care, operating room use and general nursing services.

• General and special diets.

• Sundries and supplies.

• Ambulance services.

• Discharge planning.

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Infertility treatment The medical benefit covers infertility treatment consisting of in-vitro fertilization and artificial insemination up to a lifetime maximum of $10,000.

Infertility prescription drugs and injections are not covered.

Lactation support and counseling services

• Comprehensive lactation support and counseling provided to females during pregnancy and in the post-partum period by a certified lactation support provider.

• Rental of a hospital grade electric pump for a newborn child when the newborn child is confined in a hospital.

• Purchase of an electric breast pump (non-hospital grade), if requested within 60 days from the date of the birth of the child. A purchase will be covered once every three years.

• Purchase of a manual breast pump, if requested within 12 months from the date of the birth of the child. A purchase will be covered once every three years.

Medical or surgical treatment of the eyes

Medical or surgical treatment of the eyes.

Mental health/substance abuse

Services are covered as described in Mental health and substance abuse coverage beginning on page B-31.

Nutritional counseling Nutritional counseling that is medically necessary for chronic diseases for which dietary adjustment has a therapeutic role, if the nutritional counseling is:

• Prescribed by a physician; and

• Provided by a licensed health care provider recognized under the medical benefit.

Obesity (bariatric) surgery

Obesity (bariatric) surgery (only if certain medical conditions exist, medical therapies have been used and pre-certification has been obtained).

Outpatient hospital expenses

Outpatient hospital expenses.

Physician office visits Physician office visits.

Physician services Physician services for:

• Medical care and treatment;

• Hospital, office and home visits;

• Surgery; and

• Emergency room services.

Pre-admission testing Pre-admission testing for a hospital stay.

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Pregnancy and maternity care

The medical benefit covers pregnancy, childbirth and related medical conditions for the following covered individuals:

• Covered female employees.

• Covered dependent spouses.

• Covered female dependents of a covered employee enrolled in the medical benefit at the time of delivery.

Pregnancy expenses for a surrogate mother who is not covered under the medical benefit are NOT covered.

For births without complications, the medical benefit provides a minimum 48-hour hospital stay following childbirth (96 hours minimum stay following a cesarean section delivery). Hospital or birth center stays beyond 48 hours (or 96 hours) must be medically necessary.

Payment of expenses for the newborn child will be made for the first 31 days after birth. After that, expenses will be covered only if the child is enrolled in the participant’s medical coverage within 90 days, as shown in Midyear election changes due to a qualified change in status event on page B-8.

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Prescription drugs Prescription drugs are covered as described in Prescription drug coverage beginning on page B-32.

• Certain specialty prescription drugs used to treat complex conditions and illness are available only from the CVS Caremark specialty pharmacy. The participant should contact CVS Caremark for a list of these medications. – If the participant continues to purchase these medications from his physician

or another pharmacy, he will be responsible for their full cost (an amount in addition to his copay).

– When the participant orders a covered specialty medication through the CVS Caremark specialty pharmacy, his out-of-pocket cost will be limited to the applicable (mail-order) copay.

– Prescription drugs to treat diabetes are not considered specialty prescription drugs.

– If the participant is on Medicare and it pays first, he will continue to obtain his specialty prescription drugs from the claims administrator.

• Diabetic supplies, such as blood glucose monitors (excluding continuous blood glucose monitors), insulin syringes and needles, lancets and test strips, are covered if prescribed by a physician but must be submitted only to CVS Caremark. – Continuous blood glucose monitors and insulin pumps must be submitted to

the medical claims administrator. – Prescriptions that are self-injection (self-administered) medication should be

submitted to CVS Caremark. – Prescriptions that are infusion medications (must be administered in an

infusion center, hospital or at home by a licensed health care professional) must be pre-approved by a CVS Caremark Site of Care coordinator and submitted to CVS Caremark. See Site of Care Specialty Prescription Program on page B-38.

Certain prescription drugs are excluded from coverage under the medical benefit. A list of these drugs is available by calling CVS Caremark at (888) 208-9634.

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Preventive care The medical benefit covers the following preventive care services:

• Preventive physical exams/well child care.

• Preventive gynecological exams (includes pap smear and related lab charges).

• Mammograms.

• Prostate specific antigen (PSA).

• Preventive colonoscopies.

• Preventive sigmoidoscopies.

• Influenza vaccine immunizations.

• Preventive hearing exams, which is an audiometric hearing exam performed: – By or at the written direction of a physician certified as an otolaryngologist or

otologist; or – By an audiologist who is legally qualified in audiology or, in the absence of

applicable licensing requirements, holds a certificate of Clinical Competence in Audiology for the American Speech and Hearing Association.

• Evidence-based items that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force.

Private duty nursing Private duty nursing, up to a maximum of 70 visits per calendar year.

Radiologists, anesthesiologists and pathologists

Radiologists, anesthesiologists and pathologists.

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Reconstructive surgery Reconstructive surgery is covered by the medical benefit if performed within 24 months of the original injury, or for a child before age 19, to ameliorate a deformity due to accidental injury, including:

• Cosmetic surgery when it is performed in conjunction with a staged reconstructive surgical procedure to improve or restore bodily function.

• Surgery needed to improve the function of a body part (not a tooth or structure that supports the teeth) or that is malformed as a result of: – A severe birth defect, including cleft lip, cleft palate or webbed fingers or toes. – Disease.

• Surgery performed to treat a disease or injury or to repair an injury. Surgery to repair an injury that occurs while the participant is covered under this medical benefit must be performed in the calendar year of the accident or in the next calendar year.

The medical benefit does not cover surgery to correct a cosmetic disfigurement due to disease, unless:

• The disfigurement causes a functional impairment; or

• The surgical correction of the cosmetic disfigurement due to disease is performed in conjunction with a staged reconstructive surgical procedure to improve or restore bodily function.

Second opinion Second opinion office visits.

Short-term therapy Occupational therapy and physical therapy.

Skilled nursing facility Skilled nursing facility charges are covered by the medical benefit for the following services and supplies, up to 60 days per calendar year:

• Room and board, up to the semiprivate room rate. Private room rate is covered if it is needed due to an infectious illness or to a weak or compromised immune system.

• Use of special treatment rooms.

• Radiological services and lab work.

• Physical, occupational or speech therapy.

• Oxygen and other gas therapy.

• Other medical services and general nursing services usually given by a skilled nursing facility (this does not include charges made for private or special nursing or for physician’s services).

• Medical supplies.

Custodial care is NOT covered.

The need for skilled nursing facility services must be certified in writing by a physician.

The medical benefit does not cover charges for treatment of mental health or substance abuse, senility or mental retardation at a skilled nursing facility.

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Speech therapy Speech therapy, when expected to restore speech to a person who has lost existing speech functions (the ability to express thoughts, speak words and form sentences) as a result of a disease, injury or a congenital defect for which corrective surgery has been performed. Speech therapy may also be covered as part of Applied Behavioral Analysis therapy with an Autism Spectrum Disorder diagnosis.

Spinal manipulation Spinal manipulation performed, prescribed or recommended by a licensed chiropractor, physical therapist or osteopath, up to a maximum of 20 visits per calendar year.

Surgery • Surgery (inpatient or outpatient).

• Assistant surgeon fees are subject to a significant reduction in coverage of the surgeon’s eligible charges.

• Multiple surgery operative session will allow subsequent procedure(s) to the primary procedure at a reduced fee schedule.

Telemedicine 24/7 telephone and video access to board-certified physicians for non-emergency care. See page B-29 or hr.phillips66.com for details.

Temporomandibular Joint (TMJ) disorder

Temporomandibular Joint (TMJ) disorder (diagnosis only; appliances, restoration and procedures for TMJ are not covered).

Transgender Reassignment

Includes charges in connection with medically necessary Transgender Reassignment surgery or services which have been approved through a precertification from the medical carrier.

Transplants (organ and soft tissue)

Organ and soft tissue transplants are covered under the medical benefit.

Travel Assistance If a transplant or other specialized care cannot be provided within the patient’s local geographic area, travel and lodging expenses are covered at 100%, up to $50 per day per authorized person, up to a maximum of $10,000 per calendar year. To be eligible to receive the travel and lodging benefit, care must be coordinated through the claims administrator’s complex case management program.

Urgent care Services that are medically necessary and immediately required because of a sudden illness, injury or condition that:

• Is severe enough to require prompt medical attention to avoid serious deterioration of the participant’s health;

• Includes a condition which would subject the participant to severe pain that could not be adequately managed without urgent care or treatment;

• Does not require the level of care provided in the emergency room of a hospital; and

• Requires immediate outpatient medical care that cannot be postponed until the participant’s physician becomes reasonably available.

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PHILLIPS 66 MEDICAL


Voluntary sterilization The following voluntary sterilization services are covered under the medical benefit:

• Routine uncomplicated vasectomy on an outpatient basis.

• Routine uncomplicated laparoscopic tubal ligation on an outpatient basis.

• Tubal ligation in an inpatient setting for women who are confined for a delivery.

Reversal of sterilization is not covered.

X-rays and laboratory examinations

X-rays and laboratory examinations, including complex imaging (covered for diagnostic and treatment purposes or in connection with preventive care).

Walk-in clinic Walk-in clinic for non-emergency care.

Services and supplies that are not covered

The medical benefit covers many services and supplies; however, there are some exceptions to coverage. The following list of exceptions, exclusions and exemptions does not include everything that is not covered. Occupational illnesses and injuries* are not covered under the medical benefit. To verify whether something is covered, participants should contact the claims administrator before incurring the expense.

* See the Glossary, which begins on page N-60 of the Other Information chapter, for the definition of “occupational illnesses and injuries.”


Cosmetic or plastic surgery

Cosmetic surgery, reconstructive surgery, plastic surgery or other services and supplies that improve, alter or enhance appearance — except when defined as medically necessary and as described in the Reconstructive surgery row of the Covered services and supplies table that begins on page B-43.

Dental • Appliances, restoration and procedures used in the treatment of jaw or cranial pain known as temporomandibular joint dysfunction (TMJ), myofascial pain dysfunction or craniomandibular pain syndrome.

• Dental prosthetic appliances or fittings (except as a result of accidental injury to physical organs or parts sustained while coverage is in effect).

• Dental services (except in the case of accidental injury to natural teeth, for a dentist’s charges for consultation and X-rays done at the request of a physician).

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Expenses payable by others

• Expenses the participant is not required to pay due to discounts or other considerations given by the provider.

• Services and supplies furnished, paid for or for which benefits are provided or required due to past or current service in any government’s armed forces.

• Services and supplies furnished, paid for or for which benefits are provided or required under any law of a government. This does not include a plan established by a government for its own employees or their dependents or Medicaid.

• Services for confinement in a U.S. government or agency hospital. However, the reasonable cost incurred by the U.S. or one of its agencies for inpatient medical care and treatment given by a hospital of the uniformed services, Veterans Administration Facility or Military Treatment Facility may be covered. If the cost for the care would normally have been a covered expense under this medical benefit, it will be covered for: – An employee who is retired from the uniformed services. – A family member of a person who is active in or retired from the uniformed

services. – A family member of a deceased member of the uniformed services.

Any benefits paid under this provision will be paid to the U.S. government or appropriate agency and not to the participant.

• Services in connection with any injury or sickness that is sustained: – While doing anything that is or should be covered under the provisions of any

Workers’ Compensation or similar law for which benefits are payable under that law or provision; or

– As an employee of an employer other than Phillips 66 or its participating affiliates.

• Services incurred by persons who are not covered under the HDHP or PPO option.

• Services performed before coverage under the HDHP or PPO option begins or after coverage ends.

• Services the participant would not be required to pay if there were no coverage. This includes charges for services provided by a member of the participant’s immediate family — his spouse/domestic partner, son, daughter, domestic partner’s children, father, mother, brother and sister.

Foot care Foot orthotic devices, even if the participant’s physician provides a written prescription. Participants should contact the claims administrator for medical conditions and devices that may be covered.

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PHILLIPS 66 MEDICAL


Hospices, hospitals, home care and institutions

• Education, training, and room and board in an institution that is primarily a school or other institution for training, a place of rest, a place for the aged or a nursing home.

• Halfway house expenses.

• Home health care services or supplies that are: – For transportation. – Not part of the home health care plan. – Performed by a person who usually lives with the participant or is a member of

his or his spouse’s/domestic partner’s family.

• Hospice care services provided by a licensed pastoral counselor to a member of his congregation. These are services in the course of duties to which he is called as a pastor or minister.

• Hospice care services provided by volunteers or individuals who do not regularly charge for their services, or for unlicensed hospice care.

• Hospital expenses for private room accommodations in excess of the hospital’s regular daily rate for a semiprivate room (if a facility has private rooms only, the billed charge is allowed).

• Hospital expenses for private room accommodations for which benefits provided under Medicare are limited to the cost of a semiprivate room.

Infertility Except as specifically described in Covered services and supplies, any services, treatments, procedures or supplies designed to enhance fertility or the likelihood of conception.

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Investigational or experimental services and supplies

Services or supplies that are determined by the claims administrator to be investigational and/or experimental because they do not meet generally accepted standards of medical practice in the U.S. This includes any related confinement, treatment, services or supplies. The medical claims administrator’s medical policy provides more specific information on what services and treatments are covered.

Some investigational and/or experimental drugs, devices, treatments or procedures are covered if all of the following conditions are met:

• Standard therapies have not been effective or are inappropriate;

• The claims administrator determines, based on medical and scientific evidence, that the participant would likely benefit from the treatment; and

• The participant is enrolled in a clinical trial that meets these criteria: – The drug, device, treatment or procedure to be investigated has been granted

investigational new drug (IND) or Group C/treatment IND status; – The clinical trial has passed independent scientific scrutiny and has been

approved by an Institutional Review Board that will oversee the investigation; – The clinical trial is sponsored by the National Cancer Institute (NCI) or similar

national organization (such as the Food & Drug Administration or the Department of Defense) and conforms to the NCI standards;

– The clinical trial is not a single institution or investigator study unless the clinical trial is performed at an NCI-designated cancer center; and

– The participant is treated in accordance with protocol.

Miscellaneous exclusions

• Care furnished mainly to provide a surrounding free from exposure that can worsen the person’s disease or injury.

• Charges for a service or supply furnished by a network provider in excess of the negotiated charge.

• Charges for a service or supply furnished by a non-network provider in excess of the non-network reimbursement rate charge.

• Charges submitted for services by an unlicensed hospital, physician or other provider or not within the scope of a provider’s license.

• Education, special education or job training, whether or not given in a facility that also provides medical or psychiatric treatment.

• Performance, athletic performance or lifestyle enhancement drugs or supplies, except to the extent coverage for such drugs or supplies is specifically provided as described in the Prescription drug coverage section beginning on page B-32.

• Regular food products, such as food thickeners, baby food or other regular grocery products.

• Travel expenses, unless prior approval is obtained through the claims administrator or the travel qualifies as a covered ambulance service.

• Whirlpools or spas.

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PHILLIPS 66 MEDICAL


Not medically necessary or reasonable

• Care, treatment, services or supplies that are not prescribed, recommended and approved by the participant’s attending physician or dentist.

• Diagnostic procedures that are unlikely to provide the participant’s physician with additional information when used repeatedly.

• Expenses that exceed non-network reimbursement rate limits as determined by the claims administrator.

• Procedures that would be unnecessary when performed in combination with other procedures.

• Services and supplies that are not medically necessary as determined by the claims administrator for the diagnosis, care or treatment of the disease or injury involved. This applies even if they are prescribed, recommended or approved by the participant’s attending physician or dentist.

Pregnancy or sexual function

• Infertility drugs and injections.

• Reversal of a sterilization procedure.

• Surrogate mother’s pregnancy expenses.

Procedures and treatments

• Acupuncture therapy, except when performed by a physician as a form of anesthesia for a surgery covered under the medical benefit.

• Bioenergetics therapy.

• Carbon dioxide therapy.

• Custodial care, as determined by the claims administrator.

• Marriage, family, child, career, social adjustment, pastoral or financial counseling when the service is not provided by a legally qualified physician, licensed psychologist or social worker or when the treatment is not related to a covered Diagnostic and Statistical Manual of Mental Disorders diagnosis.

• Megavitamin therapy.

• Psychodrama.

• Primal therapy.

• Rolfing.

• Speech therapy, except when expected to restore speech to a person who has lost existing speech functions (the ability to express thoughts, speak words and form sentences) as a result of a disease, injury or a congenital defect for which corrective surgery has been performed.

• Vision perception training.

Providers in training • Expenses for treatment of covered health care providers who specialize in the behavioral health field and who receive treatment as part of their training in that field.

• Services of a resident physician or intern rendered in that capacity.

Self-inflicted injuries Self-inflicted injuries.

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Strength and performance

Services, devices and supplies to enhance strength, physical condition, endurance or physical performance.

Vision Vision care expenses, including:

• Eyeglasses to correct impaired vision or fittings.

• Radial keratotomy to correct nearsightedness (myopia).

• Surgery to correct refractive errors.

Refer to the Employee Vision chapter for information on the vision program. In addition, the claims administrator may provide a discount program.

Weight loss • Fees for weight loss clinics or programs — except charges for specific services by approved physicians and psychiatrists, which are covered if certain medical conditions exist, medical therapies have been used and pre-certification is received.

• Food supplements, such as those prescribed or provided as part of a weight loss or weight gain program.


PHILLIPS 66 MEDICAL

HEALTH SAVINGS ACCOUNT (HSA) AND HEALTH CARE FLEXIBLE SPENDING ACCOUNT (HCFSA)The HDHP option is a high-deductible health plan, as that term is defined in the Internal Revenue Code. Eligible employees enrolled in the HDHP with HSA option can contribute on a before-tax basis to a Phillips 66-affiliated health savings account (HSA). In addition, Phillips 66 may contribute to the Phillips 66-affiliated HSA on behalf of employees enrolling in the HDHP with HSA option.

Eligible employees not enrolled in the HDHP with HSA option can contribute on a before-tax basis to the Phillips 66 Health Care Flexible Spending Account (HCFSA). See the Flexible Spending Plan chapter for details regarding HSAs and HCFSAs.

An HSA is a savings account that the participant can use to put aside tax-free dollars to pay certain medical expenses. It works much like an HCFSA under the Phillips 66 Flexible Spending Plan, but there are some key differences between these two accounts, as shown below.

HSA* HCFSA*

Enrollment restrictions Must be enrolled in the HDHP option.

Cannot be enrolled in the HDHP option.

Amounts not spent during the year

Unused funds are available for use in future years.

Funds not used for services incurred within the calendar year are forfeited.

Non-medical expenses Funds spent on non-medical expenses are taxable and may be subject to a 20% penalty.**

Funds can only be used for IRS-approved medical expenses.

Portability The HSA belongs to the participant. Participation generally ends when the participant leaves Phillips 66.

* See the Flexible Spending Plan chapter for details.** Penalties do not apply if the participant uses his HSA to pay non-medical expenses after attaining the age required for

Medicare eligibility.

ELIGIBLE EXPENSES

The IRS determines what constitutes an eligible expense under an HSA. They are typically the same types of expenses that are eligible under an HCFSA. For more information, see Publication 502 at irs.gov.

Tax rules are complex. Factors such as Medicare eligibility can affect a participant’s eligibility to contribute to an HSA. The participant is encouraged to consult with a tax or financial advisor.

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FILING CLAIMS

A participant enrolled in the HDHP option or the PPO option must file any medical or prescription drug claims within one year following the date the service is provided or medication is received. Claims received after the deadline are not eligible for payment under the plan. Information regarding the HMO claim-filing process can be obtained from the Kaiser HMO.

A participant who goes to a network provider and incurs a covered expense is generally not required to file a claim — the provider will file a claim on behalf of the participant. The participant can pay the deductible, coinsurance or copay at the time of the service or get billed by the network provider and pay later.

If a participant goes to a non-network provider or to a physician or hospital outside the U.S., payment for services must be made in full and a claim for reimbursement filed with the plan. Also, a participant may be required to file a claim if prescription drugs are purchased at a non-network pharmacy or the participant does not show his ID card at a network pharmacy.

HOW TO FILE A CLAIM• File medical claims (including mental health and

substance abuse claims) with the appropriate medical claims administrator.

• File prescription drug claims with the prescription drug claims administrator.

To file a non-network claim, submit the following to the claims administrator:

• A completed claim form; and

• Itemized bills with the date of service, description of service provided, diagnosis, name of the provider and charges incurred.

WHERE TO SUBMIT PRESCRIPTION DRUG CLAIMS

Most covered prescriptions should be submitted through CVS Caremark — but some diabetic supplies and infused medicines* should be submitted to the medical claims administrator.

• Diabetic supplies prescribed by a physician, like blood glucose monitors, insulin syringes and insulin needles, lancets and test strips, should be submitted to CVS Caremark.

• Continuous blood glucose monitors and insulin pumps should be submitted to the medical claims administrator.

• Self-injection (self-administered) prescription medications should be submitted to CVS Caremark.

• Prescriptions that are infusions (administered in an infusion center, hospital or at home by a licensed health care professional) should be submitted to the medical claims administrator unless subject to the CVS Caremark Site of Care Specialty Prescription Program.

* Applies to infused medication received in an inpatient setting or allowed as an exception due to medical necessity.

Participants can request claim forms from the claims administrators by phone or from their websites, or download claim forms from hr.phillips66.com. Claims should be returned to the appropriate claims administrator at the address listed in the Contacts chapter beginning on page A-1.

In the case of a pre-service claim or urgent claim, the participant should call the appropriate claims administrator. The claim will be considered filed on the date of the call.



PHILLIPS 66 MEDICAL

FILING CLAIMS WITH KAISER HMO

Typically, Kaiser HMO participants are not responsible for filing claims unless a covered expense is incurred through a provider who is not part of the Kaiser HMO network (for example, when the participant has a medical emergency and is outside his network area). Participants should contact Kaiser HMO for information regarding Kaiser HMO claims.

IF A CLAIM IS DENIEDThe participant has specific rights and responsibilities for appealing a denied claim. See the Claims and appeals procedures section on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.

COORDINATION OF BENEFITS (COB)When a participant or his dependents are also covered by other group health plans or Medicare, the plan uses coordination of benefits provisions (COB) to determine how much of each medical expense is paid by this plan and how much is paid by the other plan(s). COB does not apply to prescription drug benefits.

The general rule is that the benefits otherwise payable under this plan for all expenses processed during a single processed claim transaction will be reduced by the total benefits payable under all other plans for the same expenses.

Here is how COB works:

• Rules are applied to determine which plan pays first (the primary plan), which pays second (the secondary plan) and, if applicable, which pays third (the tertiary plan).

• The primary plan pays for coverage under its own terms and does not take into account what any other plan may pay.

• Then, the secondary and tertiary plans pay their share, if applicable.

• The total benefits payable from all plans cannot be more than the total covered expense.

Note: The plan does not coordinate with no-fault insurance.

REMEMBER

The participant must tell the claims administrator if he or his dependents have other coverage. That way, the plan will not pay for coverage that may be paid by another plan. If the participant does not tell the claims administrator about the other coverage and a claim is overpaid, he will be required to reimburse the plan for the overpaid amount.

This plan uses maintenance of benefits, which is a form of COB. Under maintenance of benefits, if the participant’s Phillips 66 coverage is the secondary plan and another plan is primary, it is possible that the Phillips 66 plan will not pay any benefits at all. This will happen if the primary plan’s benefits are equal to or better than this plan. The plan limits benefits so that the total of all reimbursements will not exceed what this plan would have paid. The participant is required to tell the claims administrator when he or a covered dependent has other coverage.

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DETERMINING THE PRIMARY PLANThe order in which benefits are paid is determined as follows when an individual has coverage under two or more plans:

• A plan that does not have a coordination of benefits provision is the primary plan and determines its benefits first.

• A plan that covers the individual as an employee is primary; the plan covering the individual as a dependent is secondary.

• If the participant is covered by this plan and his spouse/domestic partner is covered under another plan, special rules apply to dependent children covered under both plans:

– In the case of domestic partnerships, the plan of the natural parent is primary.

– In the case of married parents who are not divorced or separated, the plan of the parent whose birthday (the month and day, not the year) falls earlier in the calendar year is primary. If both parents have the same birthday, the plan that has covered a parent longer is primary.

• When parents are separated or divorced, or have terminated their domestic partnership and are living apart, and the dependent children are covered under more than one plan, the following rules apply unless there is a court order to the contrary:

– The plan of the parent with custody of (or court-ordered financial responsibility for) the dependent child is primary.

– The plan of (1) the spouse of the parent with custody or (2) domestic partner of the natural parent with custody of the dependent child is secondary.

– The plan of the parent or domestic partner without custody (or court-ordered financial responsibility) pays last.

• The plan covering an individual as an employee (or as an employee’s dependent) who is neither laid-off nor retired is primary. The plan covering the individual as a laid-off or retired employee (or that individual’s dependent) is secondary.

• If the participant has COBRA continuation coverage, the COBRA coverage will be secondary to a plan that covers him as an employee (or as an employee’s dependent). (COBRA continuation coverage is described beginning on page N-11 of the Other Information chapter.)

• If none of the above rules apply, the plan that has covered the individual longer is primary, and the plan that has covered the individual for less time is secondary.

COORDINATION WITH MEDICAREThe plan will coordinate benefits with Medicare, and the reason the participant is eligible for Medicare will determine how COB works. The participant will be eligible for Medicare:

• On the first day of the month in which he reaches age 65 — or the first day of the previous month if his birthdate is the first of the month — regardless of whether he is retired or still working;

• After he has been receiving Social Security disability benefits for two years; or

• When he is diagnosed with end-stage renal disease.

The participant must notify the Benefits Center if he or his covered dependent becomes eligible for Medicare prior to age 65.


PHILLIPS 66 MEDICAL

If the participant or a covered dependent becomes entitled to Medicare (even if the Medicare-eligible individual does not enroll), Medicare is assumed to be the primary plan except in the following circumstances:

• Medicare is secondary for the participant and his dependents age 65 and over who are covered under this plan as a result of the participant’s status as an active employee with the company.

• Medicare is secondary for the participant and his dependents under age 65 who are entitled to Medicare on the basis of disability and who are covered under this plan as a result of the participant’s status as an active employee with the company.

• Medicare is secondary for up to 30 months for the participant and his dependents under age 65 who are entitled to Medicare solely on the basis of end-stage renal disease and who are covered under this plan as a result of the participant’s status as an active employee with the company. After 30 months, Medicare becomes primary and the plan will pay secondary for charges that are eligible for Medicare Part A coverage, even if the individual has not accepted enrollment in Medicare Part A. However, the HDHP option or the PPO option will pay as primary for charges that are eligible for Medicare Part B coverage if the individual has elected not to enroll in Medicare Part B.

The above provisions apply regardless of Medicare enrollment. When Medicare is, or would otherwise be, the primary plan, the plan assumes all covered expenses are eligible for Medicare, whether or not the participant or a covered dependent is actually enrolled in Medicare, and does not pay charges for expenses that qualify for Medicare Part A or B payment.

UNDERSTANDING THE KAISER HMO

Before enrolling in the Kaiser HMO, the participant should read the Kaiser HMO’s Evidence of Coverage (EOC) to learn about the benefits provided by the HMO. Within the EOC, the participant can find a detailed schedule of benefits which offers an in-depth description of the benefits, coverage and any applicable rules to the Kaiser HMO.

In addition:

• The benefits and services provided to Kaiser HMO participants.

• How to obtain services.

• Emergency services and urgent care.

• Whether coverage is available for family members who live outside the Kaiser HMO service area.

• Exclusions, limitations, coordination of benefits and reductions.

• Post-service claims and appeals.

• Legal notices such as Newborns’ and Mothers’ Health Protection Act (Newborn Act), Women’s Health and Cancer Rights Act (WHCRA) and Michelle’s Law.

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HOW THE KAISER HMO OPTION WORKS

Participants should contact the Kaiser HMO for information on the specific benefits provided by that plan.

Typically, with the Kaiser HMO:

• The participant must receive all medical care from the HMO’s network of providers in order to receive benefits.

• The participant must select a primary care physician (PCP) from the HMO’s network for himself and for each covered family member when enrolling.

• The PCP acts as the primary physician, provides treatment for most conditions, provides specialist referrals when necessary and arranges for hospitalization when appropriate.

• The participant must consult with the PCP first, each time care is needed, in order for the care to be covered by the HMO.

• Most services are covered at 100%, after a deductible and/or a copay.

• The Kaiser HMO offered under the plan includes its own separate mental health/substance abuse benefits and prescription drug benefits.

• If the participant elects the Kaiser HMO, the Kaiser HMO will provide a separate Evidence of Coverage (EOC) that describes coverage and benefits.


PHILLIPS 66 MEDICAL

Below is a high-level summary of the Kaiser HMO. This benefit chart provides summary information only. It does not fully describe Kaiser HMO benefit coverage. For details on benefit coverage, participants should refer to their Kaiser Foundation Health Plan, Inc. (Health Plan) Evidence of Coverage. The Health Plan Evidence of Coverage is the binding document between the Health Plan and its members.

Kaiser HMO

Annual deductible None



$3,000 for You + 1 or You + 2 or more coverage

Covered services

Preventive care Covered at 100%

Physician office visits Covered at 100%, after each per-visit copay ($25 primary care; $25 specialist)

Urgent care visit $25 copay per visit

Emergency room visit $150 copay per visit

Inpatient hospital $250 per admission

Most other covered services Copay may be applicable; see Evidence of Coverage for details

Prescription drugs

Retail (30-day supply)

• Generic: $10 copay

• Brand name: $25 copay

• Specialty: $25 copay

Mail order (100-day supply)

• Generic: $20 copay

• Brand name: $50 copay

• Specialty: Not applicable

Mental health/substance abuse

Mental health • Inpatient psychiatric hospitalization: $250 per admission

• Individual outpatient: $25 copay per visit

• Group outpatient: $12 copay per visit

Substance abuse • Inpatient detoxification: $250 copay per admission

• Individual outpatient: $25 copay per visit

• Group outpatient: $5 copay per visit

As a condition of coverage, a Health Plan physician must determine that any requested services and items are medically necessary to prevent, diagnose, or treat a medical condition. Generally, requested services and items must be provided, prescribed, authorized, or directed by a Health Plan provider. Except as otherwise noted in the Health Plan Evidence of Coverage, the participant must receive the requested services and items from a Health Plan-designated provider inside the Health Plan Service Area in which he is enrolled.

For details on the benefit and claims review and adjudication procedures, participants should refer to the Kaiser HMO Evidence of Coverage which can be requested through Kaiser Permanente or on hr.phillips66.com.


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Many portions of this chapter — and portions of the separate Other Information chapter — apply to HMO participants. The Kaiser HMO Evidence of Coverage (EOC), the Employee Medical chapter and the Other Information chapter, when combined, constitute the participant’s Summary Plan Description. Specific portions of the handbook that apply to both the Kaiser HMO and all other participants are as follows:

• From this Employee Medical chapter:

– The Eligibility and enrollment section (pages B-4 – B-13), which describes who is eligible, how to enroll or change coverage, costs for coverage and when coverage begins and ends.

• From the Other Information chapter, which begins on page N-1:

– Administrative information

– If the plan changes or ends

– ERISA rights

– COBRA continuation coverage

– USERRA continuation coverage

– Claims and appeals procedures

– HIPAA privacy rules

– ERISA plan information

• The Glossary, which begins on page N-60.

• The Contacts chapter, which begins on page A-1.

WELL-BEING INCENTIVE PROGRAMThe Well-Being Incentive Program is a voluntary wellness program available to employees who are eligible for medical benefits under the Phillips 66 Medical and Dental Assistance Plan. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease. If a participant chooses to take part in the Well-Being Incentive Program, he may be asked to complete voluntary activities to obtain the associated incentive credit.

Participants are not required to participate in the Well-Being Incentive Program, the biometric screening, undergo any other medical examinations or other related activities that may be a part of the Well-Being Incentive Program. For the most up-to-date information on the Well-Being Incentive Program, visit the Well-Being page at hr.phillips66.com.


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P H I L L I P S 6 6 l E M P L O Y E E A S S I S T A N C E P L A N l 2 0 1 8 C - 1

PHILLIPS 66 EMPLOYEE ASSISTANCE PLAN

Benefits summary ..................................................C-2

Important ERISA information ...............................C-3

Eligibility and enrollment .....................................C-3Eligibility .............................................................. C-3

Employee eligibility ........................................ C-3Dependent eligibility .....................................C-4

Enrollment .......................................................... C-5Leave of absence ............................................... C-5

Participants on a leave of absence-Labor Dispute ...................................................... C-5

When coverage ends .........................................C-6Continuing coverage after leaving the

company ...................................................C-6

How the plan works ...............................................C-6Services under the plan ..................................... C-7Resources for Living providers ..........................C-8Services ..............................................................C-8

Short-term, professional counseling services .....................................................C-8

Online information .........................................C-8

How to file a claim .................................................C-8

This SPD is a description of the Phillips 66 Employee Assistance Plan, which is separate and distinct from the Workplace EAP program provided by Phillips 66. For assistance with the Workplace EAP program, call HR Connections at (855) 480-6634 and ask for the Workplace EAP Coordinator in your area.

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Employee Assistance Plan,” which is an employee assistance program (“EAP”) commonly referred to as “Resources for Living.”


• “Participant” is defined as an employee, former employee or qualified dependent:

– Who has satisfied the eligibility and participation requirements specified in the plan; and

– Whose participation has not terminated under any other applicable provisions of the plan.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS SUMMARYThe plan provides confidential, short-term counseling and referral services, as well as work/life resources, to help participants and their families.

Does the participant need to enroll?

No. Eligible employees and dependents are automatically enrolled.

Who pays? The company pays the costs for covered services.

What services are covered? The plan covers five telephonic, televideo or face-to-face counseling sessions per person, per problem, including but not limited to:

• Adoption

• Alcohol/substance abuse

• Balancing work and family

• Child and adult care, including special needs situations

• Emergency dependent care

• Marital or family concerns

• Moving and relocation

• Pet care

• Stress management

Are there additional services?

The plan also offers:

• A range of online self-assessment and interactive tools;

• 24-hour access to self-help information and educational materials; and

• Webinars, articles and feature stories, which are updated frequently.

How is privacy protected? The plan does not share personal information with the company, unless the participant specifically instructs the EAP to do so.

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IMPORTANT ERISA INFORMATIONThis Employee Assistance Plan chapter is intended to provide an understanding of the short-term counseling and referral services, as well as the work/life resources, available under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.













• A U.S. citizen or resident alien employee working within or outside the U.S. (or on a personal, disability, military or family medical leave of absence) who is paid on the direct U.S. dollar payroll. This includes employees rotating abroad.










The following chart provides details regarding dependent eligibility.

Dependent eligibility Yes No


X


X


X




X





X



X


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• Not a U.S. citizen, resident alien or resident of Canada or Mexico.


A participant is required to notify the Benefits Center within 30 days if a dependent is no longer an eligible dependent (for example, following a divorce or a child reaching age 26).


ENROLLMENTThe participant is automatically enrolled at no cost on the date he becomes eligible. For most participants, that is their first day of work at Phillips 66.

LEAVE OF ABSENCECoverage continues during an approved leave of absence (excluding a leave of absence-Labor Dispute).




If a participant is placed on a leave of absence- Labor Dispute, coverage for the participant and the participant’s dependents will end on the last day of the month in which the leave begins. If coverage ends, the participant may continue coverage for himself and/or his dependents under COBRA (see COBRA continuation coverage on page N-11 of the Other Information chapter for details).



WHEN COVERAGE ENDSCoverage for the participant and his dependents ends on the earliest of the following:



• If the participant dies:

– Coverage for the participant ends on the date of death.

– Coverage for dependents ends on the last day of the month in which the death occurred.










HOW THE PLAN WORKSThe plan provides confidential short-term counseling and referral services, as well as work/life resources, designed to help the participant and/or his eligible dependents resolve issues and problems quickly. Services are provided through Aetna’s Resources for Living, the plan’s claims administrator.

Participants can contact Resources for Living 24 hours/day, 365 days/year by phone or through its website:

• Phone: (844) 766-7351

• Website: Resources for Living — resourcesforliving.comUsername: Phillips66 Password: RFL

When the participant calls Resources for Living:

• The participant will speak with a specially trained counselor who will assist in getting the help the participant needs.

• Depending on the participant’s situation, the counselor may suggest additional resources to help the participant reach his goals.

• If the counselor believes the participant needs specialized or longer-term counseling, the participant may be referred to another resource in the community or within another Phillips 66 benefit.

If the participant does not call and receive pre-authorization for services, benefits under the plan will not be paid.


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SERVICES UNDER THE PLANResources for Living counselors can help with a wide range of needs. Here are some examples:

Health and well-being • Alcohol/substance abuse

• Anxiety and stress

• Chronic pain

• Coping with illness

• General health

• Grief and loss

• Mental health

• Nutrition and weight management

• Sleep disorders

Family • Birth or adoption

• Blended families

• Caring for an adult

• Communication

• Family and marital problems

• Learning disorders

• Marriage or divorce

• Parent-school interaction

• Parenting/grandparenting

Work/life resources • Academic and educational

• Adoption

• Balancing work and family

• Care, resource and referrals for children with special needs

• Child, adult or elder care, including emergency care

• Convenience services (household services, travel, sports and recreation, etc.)

• Pet care

• Post-natal care

• Wellness and fitness resources

Legal/financial services & identity theft

• Domestic/family law, civil, property, estate planning, immigration (employment law excluded)

• Telephonic consultations with attorneys and financial planners

Work • Career development or transition

• Changing jobs

• Living and working abroad

• Managing change

• Time management



RESOURCES FOR LIVING PROVIDERSResources for Living is staffed by a network of highly qualified professionals who have experience providing counseling services and work/life resources.

When appropriate, Resources for Living will arrange for counseling through one of Resources for Living’s EAP affiliate providers. These providers must possess at least a Master’s level degree and may include:

• Licensed clinical social workers (LCSW);

• Licensed professional counselors (LPC, LMHC);

• Licensed marriage and family therapists (LMFT);

• Licensed clinical psychologists (PhD, PsyD); and

• Worklife Consultants.*

* All Worklife Consultants hold a Bachelor’s degree among other professional licenses within their specialty practice or have related degrees and/or related experience in social services roles.

SERVICES

Short-term, professional counseling services

The plan provides five telephonic, televideo or face-to-face counseling sessions per person, per problem, per year. If additional resources are deemed necessary:

• The counselor may refer the person to other appropriate resources.

• The plan does not pay for those additional resources, but they may be covered by the participant’s medical plan. Participants should check with their medical plan for details.

Online information

The plan also offers 24-hour access to self-help information available through the website:

Website: Resources for Living (resourcesforliving.com)

Username: Phillips66Password: RFL

Participants can access a library of online educational materials on a wide variety of mental health topics — including information on:

• Child care.

• Elder care.

• Stress and relationship issues.

In addition, the site offers a range of self-assessment tools and interactive trainings, as well as articles, webinars and feature stories, which are updated frequently.

HOW TO FILE A CLAIMIf a participant believes that he or an eligible dependent was denied benefits, he has specific rights and responsibilities for appealing the denial. See Claims and appeals procedures on page N-48 of the Other Information chapter for information regarding how to file an appeal with the appeals administrator if a claim is denied.


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Benefits summary ..................................................D-2

Important ERISA information ...............................D-3

Eligibility and enrollment .....................................D-3Eligibility ..............................................................D-3

Employee eligibility ........................................D-3Dependent eligibility .....................................D-4

Enrollment ..........................................................D-5Annual benefits enrollment ..........................D-6

Changing elections midyear ..............................D-7Midyear election changes due to a

qualified change in status event .............D-7Midyear election changes under HIPAA

special enrollment provisions ..................D-8Situations affecting enrollment or coverage ....D-9

Leave of absence ..........................................D-9Tell the Benefits Center about other

coverage ...................................................D-9When coverage ends .......................................D-10

Continuing coverage after leaving the company .................................................D-11

Continued coverage for surviving dependents ............................................D-11

If the participant’s surviving spouse or domestic partner is a Phillips 66 employee ................................................D-11

Understanding the dental benefit .................... D-12Dental benefit summary chart ........................D-12Coverage costs .................................................D-13

Paying for coverage .....................................D-13Annual deductible .......................................D-14Coinsurance .................................................D-14Understanding the non-network

reimbursement rate ...............................D-14Alternate benefit ..........................................D-15

Benefit maximums ...........................................D-15Network vs. non-network providers ................D-15

Ensuring a provider is in the network ........D-16Predetermination of benefits ..........................D-16Traveling outside the U.S. ................................D-16Covered and not covered services and

supplies ........................................................D-16Covered services and supplies ..................D-16Services and supplies that are not

covered ...................................................D-18

PHILLIPS 66 DENTAL

Filing claims ........................................................ D-20How to file a claim ............................................D-20If a claim is denied ...........................................D-20

Coordination of benefits (COB) ......................... D-20Determining the primary plan .........................D-21

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Medical and Dental Assistance Plan.” The dental benefit is a component of the plan.



– Who has satisfied the eligibility and participation requirements specified in the dental benefit;

– Who has enrolled in the dental benefit; and

– Whose participation has not terminated under any other applicable provisions of the dental benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the dental benefit under the plan. The Other Information chapter includes important legal information related to the plan.



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PHILLIPS 66 DENTAL

BENEFITS SUMMARYThe dental benefit provides coverage for regular dental checkups, preventive care and other services to promote dental health. The dental benefit partners with a claims administrator to provide benefits. The claims administrator in this chapter refers to MetLife.

The dental benefit is summarized below. Benefits may be paid differently in some situations, so participants should read the Covered and not covered services and supplies section beginning on page D-16 for details. It is important to review the entire SPD to obtain an understanding of the dental benefit.

Dental benefitOut-of-area** dental benefitNetwork Non-network*

Annual deductible $50 individual; $100 family

$150 individual; $300 family


Annual maximum benefit

$2,000 per person $2,000 per person

The plan pays*

Diagnostic and preventive services, such as oral exams, cleanings, and fluoride treatments

100%, deductible waived 80%, deductible waived 100%, deductible waived; covered up to plan limits

Basic services, such as fillings, endodontic and periodontic treatments

80%, after deductible 50% after deductible 80%, after deductible; covered up to plan limits

Major services, such as crowns and implants

50%, after deductible 50%, after deductible 50%, after deductible; covered up to plan limits

Orthodontia services Lifetime maximum benefit of $2,000 per person

50%; deductible waived 50%; deductible waived 50%; deductible waived

* Non-network reimbursement rate limits apply to non-network expenses.** The out-of-area dental option is available to those without access to at least two network dentists within 10 miles of their

home ZIP code.

EXPATRIATE OR INPATRIATE DENTAL PLAN PARTICIPANTS

Participants enrolled in an expatriate or inpatriate dental plan should refer to the materials provided by the carrier or go to hr.phillips66.com for more coverage information.


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IMPORTANT ERISA INFORMATIONThis Dental chapter is intended to provide participants with an understanding of the dental benefit provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.




















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• Not a U.S. citizen, resident alien or resident of Canada or Mexico. (In this event, the participant may be eligible to enroll himself and his dependents in the Phillips 66 Expatriate Medical and Dental Plan; see hr.phillips66.com for details.)

• Already covered under another Phillips 66 dental benefit as an employee, COBRA participant or dependent.










ENROLLMENT










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The following chart summarizes when participants can enroll in dental coverage or change dental coverage elections.



OR


To have dental coverage, the participant must enroll within 30 days.



The participant may enroll in or change dental coverage elections each year during annual benefits enrollment.





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If a participant fails to remove an ineligible dependent and the plan pays any dental claims on behalf of that dependent, the claims will be reprocessed and the participant will be required to reimburse the plan for the amount paid.





PHILLIPS 66 DENTAL


The following qualified change in status events allow, or require, changes to a participant’s dental elections:




• A qualified medical child support order (QMCSO) that requires the participant to provide dental coverage for a child. (QMCSOs are described on page N-8 of the Other Information chapter.)







• An address change mid-year may move a participant into or out of the out-of-area dental option, depending on the participant’s home ZIP code and will be effective on the address change date.




• The participant did not enroll earlier because the participant or the participant’s dependent had other dental coverage, and:






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Leave of absence




• When the participant returns to work, the company will resume before-tax paycheck deductions for the cost of coverage.

If coverage ends while on a leave, a participant wanting dental coverage will need to re-enroll within 30 days after returning to work. If the participant re-enrolls within 30 days after returning to work, coverage will be effective on the date the participant returned to work. Enrollment information will detail the steps to take.










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PHILLIPS 66 DENTAL

WHEN COVERAGE ENDS

Note: If coverage is terminated or lowered during the month, no reimbursements for any difference in dental coverage level (You only, You + one, You + two or more) are made for the month.





















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WHEN COVERAGE ENDS DURING TREATMENT

The participant’s benefits may be extended for certain treatment in progress if:

• A tooth was prepared for crowns, bridges, inlays or onlays, and the final impression was taken while he was covered under the plan;

• The final impression for full or partial dentures was taken while he was covered under the plan; or

• A tooth was opened into the pulp chamber for root canal therapy while he was covered under the plan.

The above services for the participant or his dependents would have to be completed within 90 days after coverage ended, without taking into account the extension.




In the event of the participant’s death, his eligible dependents may be able to continue coverage through COBRA. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

If the participant is an active employee or on a leave of absence at the time of death, dental coverage for the surviving covered dependents will continue until the last day of the month in which the participant’s death occurs.

If the participant’s surviving spouse or domestic partner is a Phillips 66 employee

If the participant’s surviving spouse/domestic partner is eligible for coverage as an active employee:

• He can enroll in dental coverage as an employee or as a surviving spouse/domestic partner; and then

• Choose to cover any eligible children as dependents under that coverage.


PHILLIPS 66 DENTAL

UNDERSTANDING THE DENTAL BENEFITDENTAL BENEFIT SUMMARY CHARTThe chart below outlines the benefits provided under the dental benefit. Limits apply to some benefits, so participants should read the Covered and not covered services and supplies section beginning on page D-16. For care received from non-network providers (unless the participant is enrolled in the out-of-area dental option), the dental benefit does not cover charges in excess of the “non-network reimbursement rate” (as defined in the Glossary, which begins on page N-60 of the Other Information chapter).

Dental planOut-of-area** dental planNetwork Non-network*




Annual maximum benefit $2,000 per person $2,000 per person

Diagnostic and preventive services***

• Oral exams

• Bitewing/full mouth X-rays

• Cleaning and scaling

• Prophylaxis treatments

• Fluoride treatments

• Space maintainers (for missing primary teeth)

• Sealants

Plan pays 100%, deductible waived


Plan pays 100%, deductible waived; covered up to plan limits

Basic services***

• Fillings (amalgam, composite, synthetic porcelain and plastic restorations)

• Endodontic treatment

• Periodontic treatment (including surgery)

• Re-linings and re-basings of existing removable dentures

• Repair or re-cementing of existing crowns, inlays, onlays, dentures or bridgework

• Oral surgery (extractions and related surgical procedures)

Plan pays 80%, after deductible


Plan pays 80%, after deductible; covered up to plan limits

(continued)

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Dental planOut-of-area** dental planNetwork Non-network*

Major services***

• Bridges and dentures

• Crowns, inlays, onlays, jackets and cast restoration benefits

• Implant services (repair, maintenance and removal)



Plan pays 50%, after deductible; covered up to plan limits

Orthodontia services***

• Orthodontia (for the participant and his/her eligible dependents)



Plan pays 50%, deductible waived; covered up to plan limits

• Lifetime maximum orthodontia benefit**** $2,000 per person $2,000 per person

* Non-network reimbursement rate limits apply to non-network expenses.** The out-of-area dental option is available to those without access to at least two network dentists within 10 miles of

their home ZIP code.*** See Covered services and supplies beginning on page D-16 for explanations of services and any limitations on

coverage.**** This maximum is separate from the annual maximum benefit.

COVERAGE COSTS

Paying for coverage

Generally, the participant and the company share the cost of dental coverage under the plan. The participant’s share is paid through before-tax payroll deductions. The cost is based on the level of coverage elected (You only, You + one, You + two or more).

To see dental benefit costs, participants should visit UPoint (go to My HR Tools and click on the UPoint tile) or call the Benefits Center at (800) 965-4421.

The following sections cover the different factors that affect what the participant will pay under the dental benefit.



PHILLIPS 66 DENTAL

Annual deductible

This is the amount the participant must pay out-of-pocket for dental services before the dental benefit begins paying benefits. For 2018, the annual deductibles are as follows:

Dental planOut-of-area dental planNetwork Non-network




Eligible expenses applied to the network deductible are also applied to the non-network deductible (and vice versa) regardless of whether they were incurred with network or non-network providers.

While most dental expenses are eligible expenses that apply toward the annual deductible, the following do not:

• Diagnostic and preventive services received from a network provider.

• Expenses not covered by the dental benefit.

• Expenses in excess of non-network reimbursement rate limits.

• Orthodontic services.

Coinsurance

This is the percentage of a covered expense that the participant is responsible for paying. Coinsurance applies after the participant has met the annual deductible.

Understanding the non-network reimbursement rate

A non-network reimbursement rate applies to services received from non-network providers, including services received under the out-of-area dental option. Generally, the non-network reimbursement rate is the dollar amount that is the lower of:


• The most common charge for the same service among providers in the same geographic area.

The participant, not the plan, pays any charges that are over the non-network reimbursement rate. For that reason, it is always recommended that the participant discusses costs with his provider and reviews the plan before receiving non-network services.

See “Non-network reimbursement rate” in the Glossary, which begins on page N-60 of the Other Information chapter, for more detailed information.

• Non-network services are paid at the 70th percentile, determined by the service provider’s geographic area.

• The out-of-area dental option mirrors the network dental benefit and is subject to the same limits. Services are paid at the 90th percentile, determined by the service provider’s geographic area.

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Alternate benefit

If the claims administrator determines that a service could have been done in a less costly manner, the benefits paid will be based upon the less costly service if that service:

• Would produce a professionally acceptable result under generally accepted dental standards; and

• Would qualify as a covered service.

Examples of when both methods are professionally acceptable, but the less costly service is being used to determine the dental benefit include:

• A filling instead of an inlay for treating tooth decay or breakdown.

• A partial denture instead of fixed bridgework for replacing multiple missing teeth in an arch.

When the benefit paid is based on the less costly service, the dentist may charge the participant the difference between the service that was performed and the less costly service, even if the service is performed by a network provider.

BENEFIT MAXIMUMSThe annual maximum benefit is the maximum amount the dental benefit will pay each calendar year for each person’s covered dental expenses. It applies to non-orthodontia benefits.

The lifetime maximum benefit for orthodontia is the maximum amount the dental benefit will pay for each person’s orthodontia expenses. This lifetime maximum is separate from the annual maximum benefit described above.

NETWORK VS. NON-NETWORK PROVIDERSIn most cases, the participant saves money when he receives services from network providers because:

• For diagnostic, preventive and basic services, the dental benefit pays a higher share of the cost when the services are received from a network provider; and

• Network providers have agreed to charge a contracted rate that is usually lower than the non-network rate.

There may be times when a participant chooses to visit a non-network provider. For those situations, the participant can ask his dentist to get a predetermination of benefits to see how much the dental benefit will pay for the proposed services.

Suzanne loses a filling while traveling on vacation. A local network dentist cannot see her until the following day, so she gets an appointment with a non-network dentist who can see her later that afternoon.

Although Suzanne gets her filling replaced quickly, she had to pay 50% of the cost, rather than the 20% she would have had to pay if she had seen a network dentist. Additionally, the non-network dentist’s charges were $40 above the dental non-network reimbursement rate, and Suzanne was responsible for paying 100% of that $40.


PHILLIPS 66 DENTAL

Ensuring a provider is in the network

TO FIND A NETWORK PROVIDER

• Go to metlife.com/mybenefits.

• Call MetLife at (855) 837-6381.

• Download the MetLife app via the HR Mobile Connect app.

Because network providers may change over time, it is recommended that the participant confirms that the provider is still in the MetLife Preferred Dentist Program (PDP) network each time an appointment is made.

The participant can also contact the claims administrator by phone or online as shown above to find network providers in his area.

PREDETERMINATION OF BENEFITSA voluntary predetermination of benefits is available to let participants know in advance whether an expense will be covered, and how much it will cost. Predetermination of benefits procedures are as follows:

• The participant’s dentist fills out the predetermination request and sends it to MetLife for review.

• MetLife reviews the request and lets the participant and his dentist know:

– Whether the treatment is covered by the dental benefit;

– An estimate of the cost; and

– Whether the cost is within the dental benefit’s non-network reimbursement rate.

There is no penalty for failing to obtain a predetermination of benefits. However, obtaining one can help make sure the proposed treatment is the right one and may even uncover other treatment options.

TRAVELING OUTSIDE THE U.S.A toothache or other dental issue can happen at any time, so the dental benefit provides coverage for participants traveling outside the U.S.

The costs for covered services received from a licensed dentist will be covered by the dental benefit as a non-network expense, provided the participant follows dental benefit guidelines.

If the participant or a family member needs dental care when outside the U.S., the patient should:

• Pay for the services.

• If possible, have the bill translated into English.

• Submit a claim form, in the currency of the country in which the licensed dentist is located, to the claims administrator for reimbursement.

OBTAINING A REFERRAL TO A LOCAL DENTIST

Under the International Dental Travel Assistance program, a participant can get a referral to a local dentist in over 200 countries. The program provides referrals to dentists who have Western dental training, local accreditation and appropriate technology. See the Contacts chapter for contact information.

COVERED AND NOT COVERED SERVICES AND SUPPLIES


Here is a summary of the dental benefit’s covered services and supplies. For questions about an expense, participants should contact the claims administrator.

http://www.metlife.com/mybenefits

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Preventive and diagnostic services

Preventive and diagnostic services include the following procedures that help a dentist evaluate a participant’s dental health and prevent the deterioration of teeth and gums:

• Oral exams — including preventive cleanings, non-periodontal scaling of teeth and bitewing X-rays at the time of the oral exam (may or may not be part of a routine cleaning) — up to the following limits:

– Exams and cleaning — three per calendar year, regardless of time between each visit; and

– Bitewing X-rays — two per calendar year, regardless of time between each visit, for covered children under age 19 and once every calendar year for adults.

• Full-mouth X-rays* — limited to one set every 60 months.

• Periapical X-rays* (images of the entire tooth from crown to root tip) and other medically necessary X-rays.*

• Prophylaxis treatment for three exams per calendar year, regardless of time between each treatment.

• Topical fluoride treatment for covered children under age 19 — limited to one treatment per calendar year.

• Space maintainers for covered children under age 19 to prevent teeth from drifting after the loss of primary teeth.

• Sealants for covered children under age 19 — limited to one application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar.

• Emergency treatment for dental pain — limited to minor procedures.

* The dental benefit will cover the cost of the X-ray or the cost of full-mouth X-rays, whichever is less.

Basic restoration services

Basic restoration services include the following procedures necessary to restore the teeth:

• Simple extractions.

• Fillings — amalgam, synthetic porcelain, plastic and resin composites.

• Prefabricated stainless steel or resin crowns — limited to once per tooth every 7 calendar years.

• Crown, denture and bridgework repair.

• Adjustment of dentures — no earlier than six months after installation.

• Relining/rebasing of existing removable dentures — no earlier than six months after installation and limited to once every 36 months.

• Tissue conditioning — limited to once every 36 months.

• Pin retention in addition to restoration — limited to once per tooth every 7 calendar years.

• Occlusal adjustment — limited to once every 12 months for complete and limited adjustments.

• Oral surgery — surgical removal of visible and impacted teeth.

• Periodontics — treatment of diseases of the gums and tissues of the mouth, including surgery — up to the following limits:

– Periodontal scaling and root planning — once per quadrant every 24 months; and

– Periodontal maintenance — four times per year, combined with cleanings.

• Endodontics:

– Treatment of dental pulp — final restorations limited to once per tooth per 24 months.

– Root canal therapy — limited to once per tooth every 24 months.

• Consultations (diagnostic service provided by a dentist or physician other than practitioner providing the treatment) — limited to once per 12 months.


PHILLIPS 66 DENTAL

• General anesthesia when medically necessary in connection with covered dental services — limited to a maximum of two hours.

Major restoration services

Major restoration services include the following restoration and prosthodontic procedures:

• Initial installation of crowns, inlays or onlays to restore diseased teeth — limited to once in seven calendar years.

• Replacement of an existing crown, inlay or onlay — limited to once in seven calendar years and cannot be made serviceable.

• Initial installation of full or partial dentures and fixed bridgework to replace natural teeth — limited to once in seven calendar years.

• Replacement of an existing temporary full denture — provided it cannot be made serviceable and the permanent denture is installed within 12 months after the temporary denture was installed.

• Replacement of an existing denture or bridge — limited to once in seven calendar years and cannot be made serviceable.

• Implant services (supported connecting bar) — limited to once in seven calendar years and cannot be made serviceable.

• Implant repair and maintenance — limited to once every 12 months.

• Implant/abutment supported removable denture — limited to once in seven calendar years.

Orthodontia treatment

Orthodontia treatment for children and adults includes:

• Diagnostic procedures, including oral exams and X-rays; and

• Treatment, including appliances (for example, braces and retainers).

The patient’s orthodontist should file a claim with the claims administrator detailing the full treatment plan (e.g., banding date, total fees and planned length of treatment):

• Benefits are payable at 50% of the applicable reimbursement rate.

• 20% of the total charge is considered for payment to the provider at the time the appliance is placed.

• The balance of the total charge is prorated over the estimated months of treatment.

• Benefits for the months of treatment will be paid automatically, provided:

– The patient is still eligible for coverage;

– Active treatment is still being rendered; and

– The lifetime maximum benefit for orthodontia treatment has not been paid.


The dental benefit covers many dental services and supplies; however, there are some exceptions to coverage. To verify whether something is covered, participants should contact the claims administrator before incurring the expense.

Some exclusions include:

• Charges for oral hygiene instruction.

• Dietary or nutritional counseling.

• Oral/facial images (including intra- and extra-oral images).

• Caries susceptibility tests.

• Tobacco counseling for the control of oral disease.

• Canal preparation and fitting of pre-formed dowels or posts.

• Unspecified maxillofacial prostheses.

• Provisional pontics or retainer crowns.

• Occlusal orthotic devices.

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• Appliance removal by other than the dentist who placed appliance, including removal of archbars.

• Orthodontic treatment that is not billed as part of the contract fee.

• Replacement of lost or broken retainers.

• Fixed and removable appliances for correction of harmful habits.

• Non-intravenous conscious sedation.

• Behavior management.

• Fabrication of athletic mouthguards.

• Enamel microabrasion.

• Odontoplasty, one or two teeth — including removal of enamel projections.

• Dental treatment due to an accidental injury or disease (such as jaw tumors or oral cancer) to teeth or the jaw (may be covered instead by a medical option under the Phillips 66 Medical and Dental Assistance Plan if the participant has elected that coverage and is covered when the accidental injury occurs).

• Diagnosis and treatment of temporomandibular joint dysfunction (TMJ).

• Prescription drugs.

• Restoration of a tooth for reason of attrition or discoloration (rather than for decay or injury).

• Services and supplies that are partially or wholly cosmetic in nature, including teeth whitening.

• Dentist’s charges for education and training.

• Services and supplies covered by any Workers’ Compensation law.

• Treatment of conditions resulting from acts of war.

• Services and supplies provided or required under a government law (except for Medicaid or a plan for a government’s own employees).

• Services and supplies provided or required in connection with past or present service in the armed forces of a government.

• Services and supplies that are not medically necessary for treatment.

• Services and supplies not prescribed, recommended and approved by the participant’s or his/her dependent’s attending physician or dentist.

• Services provided by a physician or dentist in residency or internship, or charges made by a denturist or free-standing denture lab service.

• Treatment other than by a physician, dentist or dental hygienist — except when performed by a duly qualified technician under the direction of a dentist or physician.

• Services and supplies that the claims administrator determines to be investigational or experimental.

• Charges the participant is not legally obligated to pay.

• Services that are otherwise free to you.

• Missed appointments.

The above list of non-covered expenses is not all-inclusive. Other specific expenses may be determined not to be covered consistent with other terms of the dental benefit.


PHILLIPS 66 DENTAL

FILING CLAIMS

A participant must file any dental claims by December 31 of the year following the date he received the service or medication. For example, claims incurred in 2018 must be filed by December 31, 2019. Claims received after the deadline are not eligible for payment under the dental benefit.

As long as the participant goes to a network provider, and the expense incurred is a covered expense, he does not have to file a claim — the provider will file the claim with the claims administrator.

However, if the participant, including participants in the out-of-area dental option, goes to a non-network provider or receives dental care outside the U.S., he may have to pay for dental care at the time of service and file a claim for reimbursement.

HOW TO FILE A CLAIMTo file a claim, submit the following to the claims administrator:

• A completed claim form; and

• An itemized bill with the date of service, description of service provided, diagnosis, name of the provider and charges incurred.

The participant can download a claim form from hr.phillips66.com or from the MetLife website at metlife.com/mybenefits (under Tools and Resources). The participant’s dentist must complete part of the form.

In the case of a pre-service claim or urgent care claim, the participant should call the claims administrator. The claim will be considered filed on the date of that call.

See the Claims and appeals procedures section on page N-48 of the Other Information chapter for more information regarding how to file claims.

IF A CLAIM IS DENIEDThe participant has specific rights and responsibilities for appealing a denied claim. See the Claims and appeals procedures section on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.

COORDINATION OF BENEFITS (COB)When a participant or his dependents are also covered by other group health plans, the plan uses coordination of benefits provisions (COB) to determine how much of each dental expense is paid by this plan and how much is paid by the other plan(s).

Here is how COB works:

• Rules are applied to determine which plan pays first (the primary plan), which pays second (the secondary plan) and, if applicable, which pays third (the tertiary plan).

• The primary plan pays for coverage under its own terms and does not take into account what any other plan may pay.

• Then, the secondary and tertiary plans pay their share, if applicable.

• The total benefits payable from all plans cannot be more than the total covered expense.

REMEMBER

The participant must tell the claims administrator if he or his dependents have other coverage. That way, the plan will not pay for coverage that may be paid by another plan. If the participant does not tell the claims administrator about the other coverage and a claim is overpaid, he will be required to reimburse the plan for the overpaid amount.


http://www.metlife.com/mybenefits

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This plan uses standard coordination of benefits, which is a form of COB and is a cooperative claim payment between two or more insurance carriers. If the participant’s dental coverage under the plan is the secondary plan and another plan is primary, this plan will pay the difference between what the primary carrier paid and the allowable fee. That means that the participant may receive 100% reimbursement of benefit, but not more than that.

DETERMINING THE PRIMARY PLANThe order in which benefits are paid is determined as follows when an individual has coverage under two or more plans:

• A plan that does not have a coordination of benefits provision is the primary plan and determines its benefits first.

• A plan that covers the individual as an employee is primary; the plan covering the individual as a dependent is secondary.

• If the participant is covered by this plan and his spouse/domestic partner is covered under another plan, special rules apply to dependent children covered under both plans:

– In the case of domestic partnerships, the plan of the natural parent is primary.

– In the case of married parents who are not divorced or separated, the plan of the parent whose birthday (the month and day, not the year) falls earlier in the calendar year is primary. If both parents have the same birthday, the plan that has covered a parent longer is primary.

• When parents are separated or divorced, or have terminated their domestic partnership and are living apart, and the dependent children are covered under more than one plan, the following rules apply unless there is a court order to the contrary:

– The plan of the parent with custody of (or court-ordered financial responsibility for) the dependent child is primary.

– The plan of (1) the spouse of the parent with custody or (2) domestic partner of the natural parent with custody of the dependent child is secondary.

– The plan of the parent or domestic partner without custody (or court-ordered financial responsibility) pays last.

• The plan covering an individual as an employee (or as an employee’s dependent) who is neither laid-off nor retired is primary. The plan covering the individual as a laid-off or retired employee (or that individual’s dependent) is secondary.

• If the participant has COBRA continuation coverage, the COBRA coverage will be secondary to a plan that covers him as an employee (or as an employee’s dependent). (COBRA continuation coverage is described beginning on page N-11 of the Other Information chapter.)

• If none of the above rules apply, the plan that has covered the individual longer is primary, and the plan that has covered the individual for less time is secondary.

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PHILLIPS 66 VISION

Vision benefit options ........................................... E-2

Important ERISA information ............................... E-2

Eligibility and enrollment ..................................... E-2Eligibility ...............................................................E-2

Employee eligibility .........................................E-2Dependent eligibility ..................................... E-3

Enrollment .......................................................... E-4Annual benefits enrollment .......................... E-4

Changing elections midyear .............................. E-6Situations affecting enrollment or coverage .....E-7

Leave of absence ...........................................E-7Tell the Benefits Center about other

coverage ................................................... E-8When coverage ends ......................................... E-8

Continuing coverage after leaving the company ................................................... E-9

Continued coverage for surviving dependents .............................................. E-9

If the participant’s surviving spouse or domestic partner is a Phillips 66 employee .................................................. E-9

Understanding the vision benefit ......................E-10Vision benefit summary chart ......................... E-10Coverage costs ................................................. E-12

Paying for coverage ..................................... E-12Participant costs .............................................. E-12Network vs. non-network providers ................ E-12How the vision benefit works........................... E-12Covered and not covered services and

supplies ........................................................ E-13Covered services and supplies .................. E-13Services and supplies that are not

covered ................................................... E-15

Filing claims .........................................................E-16How to file a claim ............................................ E-16If a claim is denied ........................................... E-16

Coordination of Benefits (COB) ..........................E-16Determine the primary and secondary plan....E-17

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Medical and Dental Assistance Plan.” The vision benefit is a component of the plan.



– Who has satisfied the eligibility and participation requirements specified in the vision benefit;

– Who has enrolled in the vision benefit (or has been automatically covered under the Basic option); and

– Whose participation has not terminated under any other applicable provisions of the vision benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the vision benefit under the plan. The Other Information chapter includes important legal information related to the plan.



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PHILLIPS 66 VISION

VISION BENEFIT OPTIONSThe Phillips 66 vision benefit provides two levels of eye care benefits:

• Through the company-provided Basic option, the employee and his family are eligible for routine eye exams at no cost and discounts on other services received from VSP network providers. Participants and their eligible dependents are automatically enrolled in this option.

• Participants enrolling in the Comprehensive option, and their enrolled dependents, are eligible for additional benefits including allowances for prescription eyeglasses (lenses and frames) or contact lenses and discounts on certain other services received from VSP network providers.

Both the Basic and Comprehensive options provide additional coverage for diabetic-related vision problems.

A participant may obtain services from any provider; however, he can save time and money by obtaining services from a VSP network provider.

See the Vision benefit summary chart on page E-10 for an overview of the Basic and Comprehensive options.

It is important to review the entire SPD to obtain an understanding of the vision benefit.

IMPORTANT ERISA INFORMATIONThis Employee Vision chapter is intended to provide participants with an understanding of the vision benefit provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.



















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Dependents are enrolled in the Comprehensive option upon completion of the dependent verification process. The process includes certifying that the person is an eligible dependent and may require providing documents (for example, a birth certificate or a marriage license) that verify this status. The participant is required to provide dependent verification documents required under the plan within 60 days of enrollment and upon request by the plan. Participants should contact the Benefits Center for forms and information.




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• Already covered under another Phillips 66 vision benefit as an employee, COBRA participant or dependent.










ENROLLMENT







Enrollment actions depend on the vision option selected.

• The participant is not required to enroll in the Basic option.

– He and his eligible dependents are automatically enrolled at no cost to the participant on the first day he becomes eligible. For most employees, that is their first day of work at Phillips 66.

– The participant must be actively at work* on that day. If he calls in sick or otherwise misses work, coverage for the participant and his dependents will not begin until the first day he is actively at work.

• The participant is required to enroll in the Comprehensive option if he wants that coverage. Note: If he enrolls in the Comprehensive option, he and his dependents will no longer be enrolled in the Basic option. The participant’s election will determine the coverage for the participant and his dependents.

* “Actively at work” is defined in the Glossary, which begins on page N-60 of the Other Information chapter.



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For the Comprehensive option, participants can enroll online or over the phone.




The following chart summarizes when participants can enroll in vision coverage or change vision coverage elections.



OR


To have coverage under the Comprehensive option, the participant must enroll within 30 days.



The participant may enroll in the Comprehensive option or change coverage elections each year during annual benefits enrollment.






PHILLIPS 66 VISION




• Enroll in coverage under the Comprehensive option;










If a participant fails to remove an ineligible dependent and the plan pays any vision claims on behalf of that dependent, the claims will be reprocessed and the participant will be required to reimburse the plan for the amount paid.




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The following qualified change in status events allow, or require, changes to a participant’s vision elections:




• A qualified medical child support order (QMCSO) that requires the participant to provide vision coverage for a child. (QMCSOs are described on page N-8 of the Other Information chapter.)








Leave of absence




• When the participant returns to work, the company will resume before-tax paycheck deductions for the cost of coverage.

If coverage ends while on a leave, a participant wanting coverage will need to re-enroll within 30 days after returning to work. If the participant re-enrolls within 30 days after returning to work, coverage will be effective on the date the participant returned to work. Enrollment information will detail the steps to take.




PHILLIPS 66 VISION








WHEN COVERAGE ENDS

Note: If coverage is terminated or lowered during the month, no reimbursements for any difference in vision coverage level (You only, You + one, You + two or more) are made for the month.








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In the event of the participant’s death, his eligible dependents may be able to continue coverage through COBRA. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

If the participant’s surviving spouse or domestic partner is a Phillips 66 employee

If the participant’s surviving spouse/domestic partner is eligible for coverage as an active employee:

• He can enroll in vision coverage as an employee or as a surviving spouse/domestic partner; and then

• Choose to cover any eligible children as dependents under that coverage.

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PHILLIPS 66 VISION

UNDERSTANDING THE VISION BENEFITVISION BENEFIT SUMMARY CHARTThe chart below outlines the vision benefit options provided under the plan. Coverage varies between VSP network providers and VSP non-network providers. Limits apply to some benefits, so participants should read Covered and not covered services and supplies beginning on page E-13.

Vision Benefit

Network Non-network

Basic optionCoverage is automatic; the company pays for this

Vision exam One exam every calendar year

Basic option pays 100% Basic option reimburses up to $45

Other discounts The participant may receive discounts on certain services received from VSP network providers

Ask the VSP provider for details Not covered

Diabetic Eyecare Plus (DEP) Program(Additional services related to Type 1 or Type 2 diabetes)

DEP eye exam Basic option pays 100%, after $20 copay

Basic option reimburses up to $100

Special ophthalmological services

Ask VSP provider for details Basic option reimburses up to $120

Comprehensive optionThe participant can choose to buy additional coverage for himself/herself and his/her family

Vision exam One exam every calendar year

Comprehensive option pays 100% Comprehensive option reimburses up to $45

Prescription eyeglasses (Lenses and frames; in lieu of contact lenses; covered once per calendar year)

Lenses

• Single vision

• Lined bifocal

• Lined trifocal

• Lenticular

• Polycarbonate

Comprehensive option pays 100%

Polycarbonate lenses covered to age 19

Comprehensive option reimburses up to:

• $ 30 (single vision)

• $ 50 (lined bifocal)

• $ 65 (lined trifocal)

• $ 100 (lenticular)

• Not covered

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Vision Benefit

Network Non-network

Progressive lenses, scratch resistant coating, tints

Participant receives VSP Preferred Pricing

Reimburses up to $50 (progressive)

Frames Comprehensive option pays 100%, up to $200; 20% discount thereafter

Comprehensive option reimburses up to $100

Contact lenses (In lieu of prescription eyeglasses; covered once per calendar year)

Medically necessary lenses* Comprehensive option pays 100% Comprehensive option reimburses up to $210

Elective lenses Comprehensive option pays 100%, up to $180


Laser vision correction

Laser vision surgery Not covered; however, discounts may be available from contracted facilities; ask VSP provider for details

Not covered

Diabetic Eyecare Plus (DEP) Program(Additional services for vision problems related to Type 1 or Type 2 diabetes)

DEP eye exam Comprehensive option pays 100% Comprehensive option reimburses up to $100

Special ophthalmological services

Comprehensive option pays 100%; ask VSP provider for details


Low vision benefit (For severe visual problems that are not correctable with regular lenses)

Supplemental testing Evaluation, diagnosis and prescription of visual aids

Comprehensive option pays 100% Comprehensive option reimburses up to $125

Supplemental aids Comprehensive option pays 75% Comprehensive option reimburses 75% of VSP’s allowed amount

Maximum benefit Per every two calendar years

$1,000 per person, including up to two supplemental tests

* Contact lenses are medically necessary if the participant is physically unable to wear glasses, as determined by the plan.


PHILLIPS 66 VISION

COVERAGE COSTS

Paying for coverage

The company pays the entire cost of the Basic option.

For the Comprehensive option, the participant pays the entire cost of coverage through before-tax payroll deductions. The cost is based on the level of coverage elected (You only, You + one, You + two or more).

To see vision benefit costs, participants should visit UPoint (go to My HR Tools and click on the UPoint tile) or call the Benefits Center at (800) 965-4421.

PARTICIPANT COSTSThe participant is responsible for all costs not covered by the plan.

• If a VSP network provider is utilized, participant costs generally include the percentage of a covered expense that the participant is responsible for paying (the coinsurance) as well as any amounts over plan limits.

• If a VSP non-network provider is utilized, participant costs include everything in excess of the plan’s reimbursement limits. The participant must pay his provider for the supply or service and then file a claim with VSP for reimbursement.

NETWORK VS. NON-NETWORK PROVIDERSA participant may obtain services from any optometrist, optician, ophthalmologist or other licensed and qualified vision care provider. However, he can save money by receiving services from a vision care provider who is a VSP network provider because:

• The plan pays a higher share of the cost when the services are received from VSP network providers;

• VSP network providers have agreed to charge a contracted rate that is usually lower than the non-network rate; and

• The participant is eligible for discounted rates on certain eye care services and products when he uses VSP network providers.

FINDING A VSP NETWORK PROVIDER

The VSP network includes thousands of certified optometrists, ophthalmologists and other vision providers located throughout the country. To find a provider, call VSP at (800) 877-7195, go to vsp.com for a list of area providers or download the VSP app via the HR Mobile Connect app.

HOW THE VISION BENEFIT WORKSWhen a participant or his covered dependents need vision services:

• He should identify himself as a VSP member when making an appointment with his eye care provider. The provider will contact the plan to verify eligibility for benefits and receive authorization for services.

• If a VSP network provider is utilized and authorization is received, the plan pays the provider directly for all covered services and eyewear. If the expenses are more than the limits shown on pages E-10 – E-11, the participant pays the provider for those expenses at the time of his appointment.

• If a VSP non-network provider is utilized or authorization is NOT received, the participant pays his provider for services and eyewear at the time they are received, and then files a claim for reimbursement from the plan. See Filing claims on page E-16.

ID CARD NOT REQUIRED

VSP does not issue ID cards. However, it is important for the participant to tell the doctor that he is a VSP member so the provider can contact the plan to verify benefits.

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COVERED AND NOT COVERED SERVICES AND SUPPLIES


The following chart of covered services and supplies is comprehensive, but not all-inclusive. Other specific expenses may be determined to be covered consistent with other terms of the vision benefit. To verify if particular services or supplies are covered, call VSP.


Eye examinations The Basic option pays a benefit for one complete vision exam each calendar year. The exam includes a comprehensive examination of visual functions and a prescription of corrective eyewear where indicated.

Eye examinations, prescription eyeglasses (lenses and frames) or contact lenses

The Comprehensive option pays a benefit for one complete vision exam, as well as one pair of prescription eyeglasses (lenses and frames) or contact lenses per calendar year.

For prescription eyeglasses, this benefit includes professional services for:

• Prescribing and ordering the proper lenses.

• Helping the participant choose frames.

• Verifying the accuracy of the finished lenses.

• Proper fitting and adjustment of frames.

• Subsequent adjustments to frames to maintain comfort and efficiency.

• Progress or follow-up work as necessary.

Prescription eyeglasses (lenses and frames) are covered in lieu of contact lenses.

In lieu of the lenses and frames benefit described above, the Comprehensive option pays a benefit for medically necessary or elective contact lenses once per calendar year. Contact lenses are medically necessary if the participant is physically unable to wear glasses, as determined by the plan.

(continued)


PHILLIPS 66 VISION


Diabetic Eyecare Plus Program (DEP Plus)

If the participant is covered under a group medical plan, such as the medical benefit under the Phillips 66 Medical and Dental Assistance Plan, DEP Plus benefits are payable after the participant’s medical plan has paid its share of the cost.

Both the Basic option and the Comprehensive option include the DEP Plus program. DEP provides additional benefits if the participant or a dependent have been diagnosed with Type 1 or Type 2 diabetes and have specific ophthalmological conditions such as:

• Diabetic retinopathy.

• Diabetic macular edema.

• Rubeosis.

Examples of symptoms that may lead to the participant seeking treatment under DEP Plus include:

• Blurry vision.

• Transient loss of vision.

• Trouble focusing.

• Floating spots.

DEP Plus covers an additional eye exam per calendar year and other services. Participants should contact VSP for the current list of covered services.

DEP Plus does not cover:

• Frames, lenses, contact lenses or any other ophthalmic materials.

• Orthoptics or vision training and any associated supplemental testing.

• Surgery of any type, or any pre- or post-operative services.

• Treatment for any pathological conditions.

• An eye exam required as a condition of employment.

• Insulin or any medications or supplies of any type.

• Local, state and/or federal taxes, except where VSP is required by law to pay.

• Services and/or materials not specifically listed as a covered expense by the plan.

Low vision benefit The Comprehensive option’s low vision benefit covers professional services and supplies for severe visual problems that cannot be corrected with regular lenses. Examples of covered services include:

• Supplemental testing.

• Supplemental Care aids.

Participants should contact VSP for additional information about this program.

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Some brands of frames may not be available for plan benefits, or may be subject to additional limitations. Find information about which brands are available from the VSP doctor by calling VSP at (800) 877-7195.

The following list of exclusions and limitations does not include everything that is not covered under the vision benefit. If the participant is not sure about whether something is covered, he should contact VSP before incurring the expense.

Services and supplies that are NOT covered

Patient options • Certain lens coatings, including: – Anti-reflective. – Color. – Mirror. – Scratch resistance.

• Certain types of lenses, including: – Blended. – Cosmetic. – Laminated. – Oversize. – Polycarbonate over age 19 or from VSP non-network providers. – Photochromic or tinted, except Pink #1 and #2. – Progressive multifocal. – UV (ultraviolet) protected.

• Optional cosmetic processes.

Other exclusions • Corrective vision treatment of an experimental nature, as determined by VSP.

• Costs for services or materials above plan benefit allowances or low vision care limits.

• Medical or surgical treatment of the eyes. This may be covered under the Phillips 66 Medical and Dental Assistance Plan. Check with the applicable medical benefit claims administrator for details.

• Orthoptics or vision training and associated testing.

• Plano lenses (less than a ± .50 diopter power).

• Replacement of lenses and frames furnished under this policy which are lost or broken, except at the normal intervals when services are otherwise available.

• Services and/or materials not indicated in this chapter as covered expenses under the plan.

• Two pairs of glasses instead of bifocals.

• Under the Basic option, any expense other than the annual eye exam described in this chapter.


PHILLIPS 66 VISION

FILING CLAIMS

A participant must file any vision claims within twelve months of the date of service. Claims received after the deadline are not eligible for payment under the plan.

If the participant receives authorized benefits from a VSP network provider, he is not required to file a claim form. However, he must submit a claim if he sees a non-network provider or does not receive authorization from the plan.

HOW TO FILE A CLAIMWhen the participant sees a non-network provider or does not receive authorization from the plan, he must pay for services and eyewear at the time of the appointment and then submit the following to VSP within twelve months of service:

• An itemized receipt.

• A completed Member Reimbursement Form. Access reimbursement forms and instructions online at vsp.com or download them from hr.phillips66.com.

VSP will reimburse the participant for any covered expenses, up to the plan limits.

Some non-network providers may submit the participant’s claim to VSP. Check with them before receiving services.

See the Claims and appeals procedures section on page N-48 of the Other Information chapter for more information regarding how to file claims.

IF A CLAIM IS DENIEDThe participant has specific rights and responsibilities for appealing a denied claim. See Claims and appeals procedures on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.

COORDINATION OF BENEFITS (COB)When a participant or his dependents are also covered by other group health plans (whether through another carrier or another VSP plan), the plan uses coordination of benefits provisions (COB) to determine how much of each vision expense is paid by this plan and how much is paid by the other plan(s).

REMEMBER

The participant must tell VSP if he or his dependents have other coverage. That way, the plan will not pay for coverage that may be paid by another plan. If the participant does not tell VSP about the other coverage and a claim is overpaid, the participant will be required to reimburse the plan for the overpaid amount.

http://www.vsp.com


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DETERMINE THE PRIMARY AND SECONDARY PLANWhen a covered person has duplicate coverage and wants to coordinate benefits, VSP must determine the order of assignment.

• The plan that covers the person as an employee is primary.

• The plan that covers the person as a dependent is secondary.

If the covered person is a dependent child and is covered under both parents’ plans, the parent whose birth date falls first in the calendar year has the primary plan. If the parents are separated or divorced, the parent with custody is primary, or the parent decreed by the court to be responsible is primary.

• The primary plan must pay or provide its benefits as if the secondary plan or plans do not exist.

• If a VSP plan is the secondary plan, the covered person will receive allowances (exam, lenses, and frames) that will be used to pay up to, but not more than the billed amount.

Only services used on the primary benefit may be used for coordinating like services on the secondary benefit. Secondary allowances are applied first to the same service or product of the primary plan.

FOR EXPENSES PROVIDED UNDER THE DIABETIC EYECARE PLUS PROGRAM (DEP PLUS)

The vision benefit coordinates its benefit payments with any benefits a participant may receive from a group medical plan, such as a medical benefit paid under the Phillips 66 Medical and Dental Assistance Plan. Here is how it works:

• The participant submits a claim for the expense to his medical plan. His medical plan is primary and pays its share of the cost first.

• This plan then pays its share of any remaining costs.

• The total benefits payable from both plans cannot be more than the total covered expense.

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PHILLIPS 66 FLEXIBLE SPENDING PLAN

Benefits summary .................................................. F-2

Important ERISA information ............................... F-2

Eligibility and enrollment ..................................... F-3Eligibility .............................................................. F-3Enrollment .......................................................... F-3

Annual benefits enrollment .......................... F-4Changing elections midyear .............................. F-5

Midyear election changes due to a qualified change in status event ............. F-5

Midyear election changes under HIPAA special enrollment provisions .................. F-6

Situations affecting enrollment or elections .... F-6Leave of absence .......................................... F-6

When coverage ends ..........................................F-7HCFSAs and DCFSAs: When coverage

ends .......................................................... F-8

How the plan works ............................................... F-8Coverage costs ................................................... F-9Contribution amounts ........................................ F-9Separate accounts ........................................... F-10Eligible dependents ......................................... F-10How the HCFSA and DCFSA help reduce

taxes ............................................................. F-11

Using the HCFSA..................................................F-12Eligible and ineligible HCFSA expenses .......... F-12

Eligible HCFSA expenses ............................ F-12Ineligible HCFSA expenses ......................... F-12

Reimbursements from the HCFSA .................. F-13How expenses are reimbursed ................... F-14If a claim is denied ...................................... F-15

Using the DCFSA..................................................F-15Eligible and ineligible DCFSA expenses .......... F-15

Eligible DCFSA expenses ............................ F-15Ineligible DCFSA expenses ......................... F-16

Reimbursements from the DCFSA .................. F-16How expenses are reimbursed ....................F-17If a claim is denied .......................................F-17

Health savings accounts ....................................F-18HSA eligibility .................................................... F-18Setting up an HSA ............................................ F-18HSA annual maximum contribution ................ F-19Other HSA facts to keep in mind ..................... F-19

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Flexible Spending Plan.”


• When describing elections (for example, HCFSA or DCFSA contributions), “participant” is defined as an employee or former employee:

– Who has satisfied the eligibility and participation requirements specified in the Flexible Spending Plan;

– Who has elected to pay premiums under the Phillips 66 Medical and Dental Assistance Plan (“MDAP”) on a before-tax basis or make before-tax HSA contributions;

– Who has elected to contribute to an HCFSA or DCFSA; and

– Whose participation has not terminated under any other applicable provisions of the Flexible Spending Plan.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS SUMMARYHere are the different ways the participant can save through the plan. It is important to review the entire SPD to obtain an understanding of the Flexible Spending Plan.

Health Care Flexible Spending Account (HCFSA)

Allows the participant to use before-tax dollars to pay eligible health care expenses.

Note: Participants enrolled in the HDHP with HSA option cannot participate in the HCFSA.

Dependent Care Flexible Spending Account (DCFSA)

Allows the participant to use before-tax dollars to pay eligible dependent care expenses so he and his spouse (if married) can work.

Before-Tax Premium Feature

Provides active employees with a cafeteria plan mechanism through which health care premiums are paid on a before-tax basis for the following benefits:

• Medical.

• Dental.

• Vision.

• Expatriate medical and dental.

When enrolling in any of the above benefits, the participant agrees to pay his share of the cost of the benefit through automatic before-tax payroll deductions.

Before-Tax Health Savings Account (HSA) Feature

Enables participants enrolled in the HDHP with HSA option under MDAP to make contributions to an HSA, and receive company contributions to an HSA, on a before-tax basis.

IMPORTANT ERISA INFORMATIONThis Flexible Spending Plan chapter is intended to provide participants with an understanding of the plan’s HCFSA, DCFSA, before-tax premium and before-tax HSA benefits. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.









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ELIGIBILITY AND ENROLLMENT

The eligibility and enrollment information generally applies to the HCFSA and the DCFSA. The participant authorizes before-tax contributions to the before-tax premium feature when he enrolls in MDAP and authorizes before-tax contributions to the before-tax HSA feature when he elects the HDHP with HSA option under MDAP.

ELIGIBILITYAn eligible employee is:

• A regular full-time or part-time employee of Phillips 66 scheduled to work an average of at least 20 hours a week; and



• An employee in a classification that is not described above. For example, temporary employees, intermittent and recurring seasonal employees, independent contractors and commission agents are not eligible.

• An inpatriate or non-citizen, non-resident alien (NCNR) employee.


In addition, an individual cannot contribute to the HCFSA if he is enrolled in the HDHP with HSA option.

ENROLLMENT



Visit myalex.com/p66 to use the Interactive Benefits Tool to learn about plan options.

A participant must enroll in the HCFSA and/or DCFSA every year if he wants to contribute to those accounts for that year. The participant’s election does not carry forward from year to year. Participants can enroll when first eligible for the plan or during each year’s annual benefits enrollment.

Federal law requires that the participant forfeits any HCFSA or DCFSA contributions that have not been spent on eligible expenses incurred by the end of the plan year (December 31). The participant should make sure to estimate his annual eligible expenses very carefully before choosing how much to contribute.

It is a good idea to ask a tax advisor for advice before deciding to contribute to the HCFSA or DCFSA.










Participants may enroll in the HCFSA and/or DCFSA, before-tax premium feature and before-tax HSA feature or change elections as shown below, following the instructions shown in their enrollment materials. The Benefits Center can assist with questions.


When first employed by Phillips 66*

OR

When first becoming eligible to participate*

To contribute to the HCFSA, DCFSA, before-tax premium feature and before-tax HSA feature** the participant must enroll within 30 days.



The participant may enroll in or change his contributions each year during annual benefits enrollment.


During the year The participant may change his HCFSA and DCFSA contributions during the year following a qualified change in status event. For most changes, the participant must make the election change within 30 days* after the date of the event.

The qualified change in status event rules also apply to the before-tax premium feature, but do not apply to the before-tax HSA feature. Participants are permitted to prospectively change the amount contributed to their HSA at any time before November 30 of the calendar year.

* HCFSAandDCFSAcontributionscannotbestartedorchangedafterNovember30.**Enrollmentinthebefore-taxpremiumfeatureisautomaticwhentheparticipantenrollsinMDAP.Enrollmentinthe

before-taxHSAfeatureisautomaticwhentheparticipantenrollsintheHDHPwithHSAoptionunderMDAP.



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Generally, a participant’s enrollment elections cannot be changed until the next annual benefits enrollment. However, if a qualified change in status event described in this section occurs, the participant may be permitted to enroll in or change the amount he contributes to the HCFSA and/or DCFSA, as long as the change is consistent with the qualified change in status event. Enrollment in or changes to a participant’s elections under MDAP will impact the participant’s participation in the before-tax premium feature under the plan.

The participant has 30 days following a qualified change in status event to make changes to his HCFSA and DCFSA contributions and/or his MDAP elections. If the participant misses this deadline, he will have to wait until the next annual benefits enrollment and the change will not take effect until January 1 of the following year. Note: The participant cannot start or change contributions to an HCFSA or DCFSA after November 30 of each calendar year.

To make changes, go to UPoint (go to My HR Tools and click on the UPoint tile). No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Or, call the Benefits Center at (800) 965-4421.


The following qualified change in status events allow a participant to enroll in or make changes to the before-tax premium feature, HCFSA or DCFSA elections:




• A qualified medical child support order (QMCSO) that requires the participant to provide medical, dental or vision coverage for a child. (QMCSOs are described on page N-8 of the Other Information chapter.)







• The participant or the participant’s dependents have a significant change in benefits or costs, such as day care costs or benefits from another employer.











SITUATIONS AFFECTING ENROLLMENT OR ELECTIONS

Leave of absence

The participant’s HCFSA and DCFSA contributions may continue during an approved leave of absence (excluding a leave of absence-Labor Dispute).

If the participant is on … His contributions will be made as follows …

A paid leave of absence For most paid leaves, the participant’s contributions will be deducted from his paycheck on a before-tax basis for the rest of the calendar year.

If the leave extends into the next calendar year, the participant can make new elections for that year during annual benefits enrollment.

An unpaid leave of absence If the participant is not receiving a paycheck from the company, he will be billed and will pay the cost on an after-tax basis for the rest of the calendar year. Note: This does not apply to the DCFSA. The participant’s DCFSA contributions will end if he is on an unpaid, non-military leave of absence.

When the participant returns to work, the company will resume deducting contributions from his paycheck on a before-tax basis, excluding DCFSA contributions. The participant should contact the Benefits Center if he would like to make up any missed HCFSA contributions on a before-tax basis.

If the participant’s contributions ended while on leave, he must re-enroll to contribute to the HCFSA or DCFSA. The participant must do this within 30 days after his return to work.



For the Flexible Spending Plan, HIPAA special enrollment applies to medical plan premium payments only. For assistance with questions about HIPAA special enrollment, participants should contact the Benefits Center.

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If a participant is placed on a leave of absence-Labor Dispute, Flexible Spending Plan participation ends on the last day of the month in which the leave begins.

If that happens and the participant has a balance in his HCFSA or DCFSA, see HCFSAs and DCFSAs: When coverage ends on page F-8 for important information.



• The participant must re-enroll if the leave was more than 30 days and he wants to contribute to the HCFSA, DCFSA or HSA. Participation in the before-tax premium feature will automatically begin if the participant enrolls in MDAP within 30 days after returning to work. The participant’s coverage will be effective on the date of his enrollment. Enrollment information will detail the steps to take.

WHEN COVERAGE ENDSCoverage ends on the earliest of the following:



• For HCFSA and DCFSA contributions, December 31 immediately following the end of annual benefits enrollment if the participant did not re-enroll during annual benefits enrollment.



• The date of the participant’s death.









HCFSAs and DCFSAs: When coverage ends

If the participant’s coverage ends before the end of the calendar year, HCFSA and DCFSA contributions stop with his last paycheck.

• The participant (or his estate, in the event of death) has up to June 30 of the following calendar year to submit claims for any eligible expenses incurred up until the date coverage ended.

• Participants are not permitted to claim reimbursement for any expenses incurred after coverage ends. In addition, the participant will forfeit any amounts left in his account after being reimbursed for all eligible expenses for which timely claims have been submitted.

• To avoid this forfeiture, the participant can elect to make after-tax contributions to his HCFSA until the end of the calendar year. This allows the participant to be reimbursed for eligible expenses incurred through the end of the calendar year (rather than through the date coverage would otherwise have ended).

– These after-tax contributions are made through COBRA continuation coverage.

– If the participant wants COBRA continuation coverage, he must enroll within 65 days of the day coverage ends. If this deadline is missed, he cannot enroll. See COBRA continuation coverage beginning on page N-11 of the Other Information chapter for details.

Note: COBRA continuation coverage is not available for the DCFSA.

HOW THE PLAN WORKSWith the HCFSA and DCFSA:

• The participant indicates how much, if any, he wants to contribute to each account for the calendar year. This amount is deducted in equal installments from his pay on a before-tax basis.

• As the participant incurs eligible expenses during the year, he can receive tax-free reimbursement from his account. There are several ways to pay for expenses or get reimbursed. See Reimbursements from the HCFSA on page F-13 and Reimbursements from the DCFSA on page F-16 for more information.

• Expenses must be incurred in the same calendar year in which the contribution was made, and only expenses incurred while participating in the plan are eligible for reimbursement.

• All requests for reimbursement of expenses incurred during the calendar year must be filed by June 30 of the following calendar year. Due to IRS regulations, any money remaining in the participant’s account(s) after that deadline is forfeited.

TRACKING ACCOUNT ACTIVITY

The participant’s pay statements list HCFSA, DCFSA and HSA contributions during each pay period.

The participant may also review account details on the claims administrator’s website.

With the before-tax premium feature and HSA:

• Participation in the before-tax premium feature will begin automatically if the participant enrolls in MDAP. The participant’s benefit elections in MDAP determine the amount of his before-tax contributions under the plan.

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• Enrollment in the HDHP with HSA option under MDAP will enable the participant to elect to make before-tax contributions to the HSA. A participant’s enrollment in the HDHP with HSA option under MDAP will result in an automatic company contribution to his HSA, with the amount of the company contribution being based on the level of coverage elected.

COVERAGE COSTSIf the participant elects to contribute to an HCFSA or DCFSA, he pays the entire contribution amount through before-tax payroll deductions. The company does not contribute to these accounts. The company contributes to a participant’s HSA in accordance with the provisions of MDAP. See the Employee Medical chapter for details.

CONTRIBUTION AMOUNTSEach year, the participant chooses how much to contribute to his HCFSA, DCFSA and HSA.

Contribution limits

HCFSA • The minimum annual contribution is $120.

• The maximum* annual contribution is $2,500.

DCFSA • The minimum annual contribution is $120.

• The maximum** annual contribution is: – If single: $5,000 or the participant’s earned income, whichever is less. – If married, filing a joint income tax return: $5,000 or the earned income of the lower-paid

spouse, whichever is less. – If married, filing separate income tax returns: $2,500 or the earned income of the

lower-paid spouse, whichever is less. – If married and his spouse is either a full-time student or disabled: $250 per month for

one dependent or $500 per month for two or more dependents***

HSA The maximum annual participant contribution is:

• $3,450 for You only coverage.

• $6,900 for You + one or You + two or more coverage.

• Additional $1,000 for participants age 55 and over and not enrolled in Medicare.

The company contributes:

• $500 for You only coverage.

• $750 for You + one coverage.

• $1,000 for You + two or more coverage.

* The participant may have different limits if his spouse is also an eligible Phillips 66 employee or also contributes to an HCFSA. The participant should contact the Benefits Center for details.

** The maximum contribution may be reduced in some cases (for example, if the participant’s spouse also contributes to a DCFSA). The participant should contact the Benefits Center for details.

*** To calculate the annual limit, the monthly amount is multiplied by the number of months the participant’s spouse is a full-time student or disabled.

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SEPARATE ACCOUNTSThe HCFSA and the DCFSA are separate. That means:

• The participant’s HCFSA contributions can be used only for eligible health care expenses (see page F-12 for a list of eligible expenses).

• The participant’s DCFSA contributions can be used only for eligible dependent care expenses (see page F-15 for a list of eligible expenses).

• The participant cannot transfer funds between the two accounts.

ELIGIBLE DEPENDENTSThe HCFSA and DCFSA allow participants to use before-tax dollars to pay certain eligible health care and dependent care expenses for eligible dependents.

IRS regulations define dependents differently for the two types of spending accounts, so it is important to understand who is — and who is not — a dependent under each type of account. If the plan reimburses the participant for expenses claimed for an ineligible dependent, the participant is required to pay that money back to the plan. In addition, the participant’s coverage may be canceled.

The participant should consult with a tax advisor for questions regarding whether an individual qualifies as a dependent or see IRS Publication 503.

Eligible dependents for the HCFSA

• Anybody who would qualify as an eligible dependent of an active employee under MDAP.

• Note: For HCFSA purposes, the participant’s dependents do not have to be enrolled in any of those plans. They just need to meet the plan’s eligibility requirement.

Eligible dependents for the DCFSA

The participant can use his DCFSA to pay dependent care expenses for any of the following people who spend at least eight hours a day in the participant’s home:

• The participant’s disabled spouse, if he is not physically or mentally able to care for himself and lives with the participant for more than 50% of the current calendar year.

• The participant’s biological, legally adopted or placed for adoption child under age 13 who is claimed as a dependent on the participant’s federal income tax return.*

• Any person* age 13 or older whom the participant claims as a dependent on his federal income tax return, as long as: – The individual is not physically or mentally

able to care for himself; – The individual lives with the participant for

more than 50% of the current calendar year; and

– The participant provides more than 50% of the individual’s financial support for the current calendar year.

* In the case of divorced or separated parents, a dependent child is considered to meet these requirements if the parent is the custodial parent and all other requirements to claim the child as a dependent on his tax return are met.

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HOW THE HCFSA AND DCFSA HELP REDUCE TAXESThe following example shows how paying health care and dependent care expenses with before-tax dollars can make a difference in disposable income.

Bill is married and has two children, both under age 13. He is enrolled in the PPO medical option and the Dental option. He estimates that his family will have $2,500 in health care expenses that are not covered under MDAP and another $4,800 in dependent care expenses this year. Here is how much Bill could save by paying those expenses with before-tax dollars through the HCFSA and DCFSA.

When Bill pays eligible health and dependent care expenses with ...

Before-tax dollars After-tax dollars

Bill’s adjusted gross income $ 50,000 $ 50,000

Before-tax contributions to HCFSA and DCFSA

– 2,500 (HCFSA)

– 4,800 (DCFSA)

– 0 (HCFSA)

– 0 (DCFSA)

Taxable income = $ 42,700 = $ 50,000

Taxes* (assumes 15% federal, 7.65% FICA)

– 9,672 – 11,325

Remaining income = $ 33,028 = $ 38,675

After-tax costs for:

• Health care

• Dependent care

– 0

– 0

– 2,500

– 4,800

Disposable income = $ 33,028 = $ 31,375

Tax savings from using HCFSA and DCFSA

$ 1,653 N/A

* These examples do not consider itemized deductions, personal exemptions, state taxes or the Child and Dependent Care Credit.

A WORD ABOUT SOCIAL SECURITY TAXES …

Because before-tax contributions to the plan reduce the participant’s income for Social Security purposes, his Social Security benefits could also be slightly reduced at retirement. For most people, this should not make much difference to future Social Security benefits. However, the participant should contact the nearest Social Security office or ask a tax or financial advisor for advice if concerned.



USING THE HCFSAThe participant can use the HCFSA for reimbursement of medical, dental, prescription drug, vision and hearing expenses that the IRS considers qualified for the participant and his dependents and for some other over-the-counter items, such as diabetic supplies.

See page F-14 for information regarding the HCFSA health care card and HCFSA manual reimbursement.

ELIGIBLE AND INELIGIBLE HCFSA EXPENSESGenerally, eligible expenses include any item that would qualify as a medical deduction on the participant’s federal income tax return, as long as the expense is incurred while contributing to the HCFSA.

In order to qualify, the expenses cannot be:

• Paid by any other plan.

• Paid through a health savings account (HSA).

• Claimed as a deduction on the participant’s income tax return.

Eligible HCFSA expenses

The following are examples of out-of-pocket expenses that are reimbursable through the HCFSA:

• Eligible medical, dental, vision and hearing expenses not reimbursed by other plans. This includes annual deductibles and copayments.

• Acupuncture performed by a licensed practitioner.

• Braille books and magazines.

• Charges above reasonable and customary limits.

• Diabetic supplies.

• Drugs and weight loss programs, if a doctor documents they are medically necessary due to obesity or other medical conditions.

• Eyewear (including glasses, contact lenses and contact lens solution).

• Hearing aids and fitting.

• Hospice care.

• Nursing services.

• Orthodontic services. Note: Special rules apply to these expenses. The participant should contact the claims administrator for details.

• Over-the-counter medications, when accompanied by a prescription from a doctor.

• Prescription drugs.

• Prosthetic and orthopedic devices.

• Purchase or rental of durable medical equipment (such as wheelchairs, crutches, etc.).

• Smoking cessation (if medically necessary and the services/supplies are provided by or prescribed by a doctor).

• Special schooling for physical or learning impairments.

• Travel expenses required to receive medical care.

• Treatment of alcohol or drug dependency.

• Vision correction surgery or procedures.

• Vitamin and mineral supplements prescribed for treatment of an illness.

Ineligible HCFSA expenses

The following are examples of expenses that are not reimbursable through the HCFSA:

• Babysitting.

• Costs for health care coverage — including the participant’s premium costs for medical, dental or vision coverage under a Phillips 66 plan.

• Custodial care.

• Exercise equipment.

• Expenses claimed as a deduction on the participant’s federal tax return.

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• Expenses reimbursed through another policy, plan or program.

• Funeral and burial expenses.

• Health care services received before the participant enrolled in the HCFSA or after participation ends.

• Health club dues.

• Maternity clothes.

• Most cosmetic surgery, and drugs used for cosmetic purposes.

• Non-prescription (over-the-counter) medications when not prescribed by a doctor.

• Premiums for life or accident insurance.

• Social activities, such as dance lessons (even if recommended by a doctor).

• Special dietary food or drink.

• Weight loss programs that are not considered medically necessary.

For questions about whether an expense is eligible, refer to IRS Publication 502 or the participant should contact the claims administrator.

IRS PUBLICATION 502

Internal Revenue Service (IRS) rules control which expenses can be reimbursed under the HCFSA and which cannot. For more detailed information, refer to IRS Publication 502, “Medical and Dental Expenses,” available at irs.gov.

REIMBURSEMENTS FROM THE HCFSA

The participant’s claims for reimbursement must be received no later than June 30 of the year after the year in which the expense was incurred. For example, a claim dated March 2018 must be received by the claims administrator (not just sent) no later than June 30, 2019. Claims received after the June 30 deadline will not be paid.

A claim will be reimbursed ONLY if the expense was incurred in the same calendar year in which the contribution to the HCFSA was made.

A participant can file a claim for reimbursement for each expense when incurred, or save receipts and send them in batches or all at once. Note:

• Each claim must be for at least $5.

• HCFSA claims are paid daily.

• A participant can have claims paid by check or deposited directly into his bank account. (Participants can enroll in, change or cancel HCFSA direct deposits online at any time on the claims administrator’s website.)

• HCFSA claims are paid up to the full amount of the participant’s annual contribution election, even if that entire amount has not yet been deducted from his pay.

FOR EXAMPLE …

During annual benefits enrollment, Samantha elected to contribute $1,200 to her HCFSA. She had some large medical bills in March, and her share of the cost was $1,000.

Even though Samantha had contributed $300 to her account as of March, she paid the entire $1,000 expense from her HCFSA.

http://irs.gov



How expenses are reimbursed

There are three reimbursement options:

• HCFSA debit card: The participant uses a specially issued health care card to pay eligible HCFSA expenses at the time the expense is incurred.

• Manual reimbursement: The participant submits a claim form to be reimbursed for out-of-pocket costs.

• Pay the provider: The participant can request direct, online payments to his provider.

How the HCFSA health care card works

Participants receive a health care card to use for paying eligible HCFSA expenses after enrolling in the HCFSA. After activating the card and accepting the terms and conditions, the participant swipes the card at checkout and chooses “credit” (even though it is not a credit card). The amount will be paid directly to the provider until the participant’s account is exhausted.

In most instances, as long as the merchant has an IRS-approved inventory system, items or services that are eligible HCFSA expenses will be verified automatically when the participant uses the card, without the participant submitting any paperwork. However, he should keep receipts until the claim is processed because the claims administrator sometimes needs to verify the expense. The participant should keep receipts for any potential auditing purpose.

Note: The card may be turned off if the participant does not provide proof, such as a receipt or an invoice, when requested for transactions that cannot be verified electronically. In addition, the participant will have to pay the plan back for any unsubstantiated expenses.

There are two options for submitting required verification.

• Complete the receipt upload, which is available when the participant logs into his account online at the claims administrator’s website or the claims administrator’s mobile app.

• Download the card use verification form and submit it to the claims administrator by fax or mail.

How manual reimbursement works

If the participant does not use the HCFSA health care card — or has claims for services that cannot be processed through that option — he will need to file a claim manually. The claim form is available at hr.phillips66.com (Resources > Forms), on the claims administrator’s website or by calling the claims administrator.

Follow the claim form’s instructions to submit the claim online, by mail or by fax. It will be considered filed on the date it is received, not on the date it is sent.

The claim must include some proof that the participant paid the expense — such as a receipt or an Explanation of Benefits (EOB). The participant should keep copies of everything sent in case there are questions.

The participant’s HCFSA claim should include all the information below:

• The name of the person or facility performing the services.

• The name of the person who received the services or for whom the items were purchased. For retail store purchases, this may be excluded.

• The date of the services.

• The type of services received.

• The amount of the expense.

Claims for eligible over-the-counter drugs must include a receipt with the prescription number or the name of the drug and a copy of the prescription recognized under applicable state law.


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How to pay the provider

The participant can request that payment be made from his HCFSA and sent directly to the provider online. On the claims administrator’s website, the participant can request a one-time payment or schedule recurring monthly payments for regular needs such as orthodontics.

If a claim is denied

Participants have specific rights and responsibilities for appealing denied claims. See Claims and appeals procedures on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.

USING THE DCFSAThe participant can use the DCFSA to obtain reimbursement for the cost of certain types of dependent care provided for his dependents.

If the participant is married, he can use the DCFSA to pay dependent care expenses only if his spouse:

• Works full-time or part-time;

• Is a full-time student for at least five months of the year; or

• Is disabled and unable to care for his dependent children.

ELIGIBLE AND INELIGIBLE DCFSA EXPENSESFor purposes of the DCFSA, eligible expenses generally include any item that would qualify for the Child and Dependent Care Credit on the participant’s federal income tax return, as long as he incurs the expense while contributing to the DCFSA.

Eligible DCFSA expenses

Here are some examples of out-of-pocket expenses reimbursed through the DCFSA:

• A licensed day care center or nursery school that provides services to at least six people who do not live there and that receives a fee for its services.

• A caretaker or companion who works in or out of the participant’s home during working hours and provides the participant with a Social Security number for tax purposes.

• Family day care or adult day care centers.

• Expenses for before- and after-school day care.

• Dependent care expenses for children or an elderly dependent — including preparing meals, housecleaning and help with dressing.

• Transportation to or from the dependent day care location, if provided by the day care provider.

• Day camp, provided the participant’s dependent does not stay at the camp overnight.



Ineligible DCFSA expenses

Expenses that the participant cannot pay out of his DCFSA include, but are not limited to:

• Expenses that are not recognized as legitimate deductions under IRS guidance.

• Dependent care that lets the participant participate in leisure activities.

• Payments to one of the participant’s dependents or to someone in his immediate family.

• Care outside of the participant’s home — unless his eligible dependent spends at least eight hours per day in his home.

• Food or school expenses, including kindergarten.

• Transportation to or from the dependent day care location, unless provided by the day care provider.

• Care provided in full-time residential institutions — such as nursing homes or homes for the mentally disabled.

• Care that allows the participant or his spouse to attend school part-time or to attend educational programs, meetings or seminars.

• Dependent care expenses incurred during times the participant was absent from work, except for absences shorter than the period he is committed to paying the dependent care provider (daily, weekly or monthly).

• Overnight camp of any kind.

• Expenses the participant plans to take as a Child and Dependent Care Credit on his federal income tax return.

• Dependent health care expenses.

For questions about whether an expense is eligible, refer to IRS Publication 503 or the participant should contact the claims administrator.

IRS PUBLICATION 503

Internal Revenue Service (IRS) rules control which expenses can be reimbursed under the DCFSA and which cannot. For more detailed information, refer to IRS Publication 503, “Child and Dependent Care Expenses,” available at irs.gov.

REIMBURSEMENTS FROM THE DCFSA

Claims for reimbursement must be received no later than June 30 of the year after the year in which the expense was incurred. For example, a claim dated March 2018 must be received by the claims administrator (not just sent) no later than June 30, 2019. Claims received after the June 30 deadline will not be paid.

A claim will be reimbursed ONLY if the expense was incurred in the same calendar year in which the contribution to the DCFSA was made.

A participant can file a claim for reimbursement for each expense when incurred, or save receipts and send them in batches or all at once. A few things to note:

• Each claim must be for at least $5.

• DCFSA claims are paid daily.

• A participant can have claims paid by check or deposited directly into his bank account. (Participants can enroll in, change or cancel DCFSA direct deposits online at any time on the claims administrator’s website.)

• A participant can request that payment be made from his DCFSA and sent directly to the provider online. (Request a one-time payment or schedule recurring monthly payments on the claims administrator’s website.)

http://irs.gov

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• Unlike the HCFSA, the participant can be repaid for expenses only up to the amount deposited into his DCFSA as of the date the claim is received. For example, if the participant has $150 in his DCFSA and submits a claim for $350:

– $150 will be reimbursed as soon as possible.

– The balance will be reimbursed as additional contributions are withheld from the participant’s pay and deposited into his DCFSA.

How expenses are reimbursed

There are two reimbursement options:

• Manual reimbursement: The participant submits a claim form to be reimbursed for his out-of-pocket costs.

• Pay the provider: The participant can request direct, online payments to the provider.

How manual reimbursement works

The claim form is available at hr.phillips66.com (Resources > Forms), on the claims administrator’s website or mobile app, or by calling the claims administrator.

Follow the claim form’s instructions to submit the claim online, by mail or by fax. It will be considered filed on the date it is received, not on the date it is sent.

The claim must include some proof that the participant paid the expense — such as a receipt or canceled check. The participant should keep copies of everything sent in case there are questions.

The participant’s DCFSA claim should include all the information below:

• The name of the person or facility providing the service.

• The name of the dependent receiving the services, and his relationship to the participant.

• The type of service provided.

• The date(s) of the service.

• The amount of the expense.

How to pay the provider

The participant can request that payment be made from his DCFSA and sent directly to the provider online. On the claims administrator’s website, the participant can request a one-time payment or schedule recurring monthly payments for regular needs such as eligible day care expenses.

If a claim is denied

Participants have specific rights and responsibilities for appealing denied claims. See Claims and appeals procedures on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.




HEALTH SAVINGS ACCOUNTSHSA ELIGIBILITYTo be eligible to contribute to the HSA under the plan, the participant:

• Must be enrolled in the HDHP with HSA option under MDAP;

• Cannot be covered by any other non-high deductible medical plan (for example, as a dependent under a spouse’s plan);

• Cannot be covered by Medicare; and

• Cannot be claimed as a dependent on anyone else’s federal income tax return.

PAYING A DEPENDENT’S MEDICAL EXPENSES

A participant is generally permitted to pay a dependent’s medical expenses if:

• The participant can claim the individual as a dependent on his federal income tax return; and

• The participant’s HSA was established before the dependent incurred the medical expenses.

SETTING UP AN HSAA participant who enrolls in the HDHP with HSA option under MDAP will automatically have an HSA established and be permitted to contribute to the HSA by making before-tax payroll contributions.

• The HSA is not sponsored or administered by Phillips 66. The HSA is administered by HSA Bank.

• The participant elects how much to contribute and can change the election at any time (changes are generally effective the first of the following month).

– Before-tax HSA contributions cannot be started or changed after November 30 of each calendar year.

• The company may contribute to the participant’s HSA established under the plan. See the Contribution Amounts section on page F-9 for information regarding company contributions.

– Enrollments in the HDHP option with HSA that are effective on or after December 1 of each year are not eligible for a company HSA contribution in that calendar year.

• As long as a participant is enrolled in the HDHP option with HSA under MDAP, his HSA elections will continue each year unless changed by the participant.

A participant is encouraged to consult with a tax or financial advisor before enrolling in or paying expenses from an HSA.

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HSA ANNUAL MAXIMUM CONTRIBUTIONSee the Contribution Amounts section on page F-9 for information regarding the minimum and maximum contribution amounts under the plan. Note that the maximums are per household. If the participant’s spouse also contributes to an HSA, the maximum amount the participant can contribute is reduced by the amount of the spouse’s contribution.

OTHER HSA FACTS TO KEEP IN MIND• If the participant stops participating in a high

deductible health plan, such as the HDHP option under MDAP, the participant can prospectively revoke his HSA election.

– The participant can use the funds remaining in the HSA for eligible medical expenses, but cannot make any new contributions to the HSA.

• The participant is the account holder and is responsible for reporting HSA contributions and distributions to the IRS.

• When an HSA is used to pay eligible expenses, the amounts are not subject to taxation. Generally, the same types of expenses that are eligible expenses under the HCFSA are considered eligible expenses under the HSA. For more information, see Publication 502 at irs.gov.

• Funds spent on non-medical expenses are taxable and may be subject to a 20% penalty. The 20% penalty does not apply if the participant uses his HSA to pay non-medical expenses after he attains the age required for Medicare eligibility.

Tax rules are complex. Factors such as Medicare eligibility can affect a participant’s eligibility to contribute to an HSA. The participant is encouraged to consult with a tax or financial advisor.

http://irs.gov

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Benefits at a glance .............................................G-2

Important ERISA information ............................. G-3

Eligibility and enrollment .................................... G-3Eligibility ..............................................................G-3Enrollment ..........................................................G-3Coverage costs ...................................................G-3When coverage begins.......................................G-3When coverage ends .........................................G-3

How the benefits work ........................................ G-4Paid sick leave laws ...........................................G-424-hour notice requirement ..............................G-4

The STD benefit amount ...................................... G-5Benefits schedule ..............................................G-5Definition of pay .................................................G-6One or more period(s) of disability in a

single calendar year ...................................... G-7Disabilities that last into the next calendar

year and the 8-week reset period ................G-8Receipt of other disability income or

benefits ........................................................G-10Effect of STD benefits on other Phillips 66

benefits ........................................................G-11

Filing claims and Employee Health Reports (EHR) ................................................................... G-11

Claim denials ....................................................G-12How benefits are paid ......................................G-12When benefits are not paid .............................G-13When STD payments end ................................G-13

Returning to work .............................................. G-14LTD benefit coverage .......................................G-14

IMPORTANT TERMS

• “STD benefit” refers to the short-term disability benefit provided under the Phillips 66 Disability Plan.


• “Participant” is defined as an employee of the company:

– Who has satisfied the eligibility and participation requirements specified in the plan;

– Who has been automatically enrolled in the plan; and

– Whose participation has not terminated under any applicable provisions of the plan.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the STD benefit provided under the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS AT A GLANCEThe STD benefit may provide income for up to 26 weeks if a participant is disabled and unable to work. The STD benefit is a company-provided benefit. The following chart provides a very brief overview of certain STD benefit provisions. It is important to review the entire SPD to obtain an understanding of the STD benefit.


No. If the participant is eligible, he is automatically enrolled. Participation begins on his first day of work as an eligible employee.

Are dependents eligible? No. STD benefits are available to employees only and are available only for the employee’s disability.

Who pays? The STD benefit is a company-funded benefit.

What will the participant receive?

The participant will receive 100% or 60% of his pay for up to 26 weeks if he is disabled and unable to work due to a non-occupational illness or injury, provided that he satisfies the plan’s other requirements.

The number of weeks at 100% of pay depends on the participant’s years of service with the company.

What is a non-occupational illness or injury?

An injury or illness that is not job-related.

Job-related injuries or illnesses are not covered under the plan, but may be covered under Workers’ Compensation.*

What if the participant receives other disability benefits?

STD benefits are reduced dollar-for-dollar for any Social Security disability benefits, state-mandated sick pay or disability benefits, or any other sick pay or disability benefits the participant is eligible to receive.

Does the participant need to pay taxes on his benefits?

Yes. Because the participant does not contribute toward his STD benefit coverage, STD benefits are subject to federal, state and/or local taxes.

What if a participant is covered by a collective bargaining agreement or local policy?

Contact your local HR representative to determine if the collective bargaining agreement or local policy differs from the information provided in this chapter. In the event of a conflict, the collective bargaining agreement or local policy, as applicable, may apply.

* For more information, see the Phillips 66 Accident on Duty (AOD) – Occupational Injury or Illness Policy (available in the Policy Center).

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IMPORTANT ERISA INFORMATIONThis Short-Term Disability chapter is intended to provide an understanding of the STD benefit. There is also other important legal information related to the plan. That information is included in the Other Information chapter beginning on page N-1.

The Other Information chapter contains important information, such as:





ELIGIBILITY AND ENROLLMENTELIGIBILITYAn eligible employee is:


• A U.S. citizen or resident alien employee working within the U.S. who is paid on the direct U.S. dollar payroll. This includes employees rotating abroad.



• A recurring seasonal employee of Phillips 66 (as defined in the Glossary, which begins on page N-60 of the Other Information chapter).


• A participant who is entitled to leave under any federal, state or local paid sick leave law, as provided under the Phillips 66 Supplemental Leave Policy, but has not yet exhausted all leave to which he is entitled under such Policy.

• An employee on a paid or unpaid leave of absence, disability or military leave of absence, or on a leave of absence-Labor Dispute, regardless of whether his leave began before or during the start of the disability. Participants on leave may continue to earn credit for years of service, but are not eligible to receive STD benefits.

ENROLLMENTThe participant is automatically enrolled on the date he becomes eligible.

COVERAGE COSTSThe company funds the STD benefit. Participant contributions are neither required nor permitted.

WHEN COVERAGE BEGINSUnless otherwise provided in a collective bargaining agreement or local policy, coverage begins on the employee’s first day of work with the company, unless he is not eligible on that date, in which case coverage starts on the first day the employee meets the eligibility requirements.

WHEN COVERAGE ENDSCoverage ends on the earliest of the following events:

– The date the participant’s employment ends. – The date the participant is no longer eligible under the terms of the plan.

– The date the participant goes out on a paid or unpaid leave of absence, disability or military leave of absence, or on a leave of absence-Labor Dispute.

– The date the participant exhausts all STD benefits he is eligible to receive.

– The date the participant fraudulently obtains or receives benefits to which he is not entitled.

– The date of the participant’s death. – The date on which the plan is amended or terminated.



HOW THE BENEFITS WORKThe plan provides some financial protection by replacing a portion of the participant’s pay for up to 26 weeks if he is disabled and not able to work. To qualify for benefits:

• The participant must be disabled (see the Glossary, which begins on page N-64, for the definition of “disabled” and “disability”);

• The participant must be covered under the plan when he becomes disabled (e.g., not ineligible, not on an administrative leave or any other type of leave of absence);

• The participant’s supervisor must approve the absence*; and

• If the participant is on a scheduled vacation when he becomes disabled, the participant must complete the scheduled vacation before STD benefits can be received. This requirement does not apply if the participant is admitted to a hospital on an inpatient basis as a result of the disability.

If a participant receiving STD benefits has vacation time remaining at the end of the year, he may be required under a collective bargaining agreement or local policy to exhaust all remaining vacation days before year-end. STD benefits will cease while the participant is exhausting his vacation time, and resume upon the exhaustion of his vacation time if STD benefits are still available to the participant.

If a participant cannot work due to a disability, the participant must aid his recovery. The participant is required to return to work as soon as his disability ends.

* The participant is required to review absences and time off in the applicable company-approved time keeping system for payroll and attendance purposes. If the participant is unable to review his time within the applicable payroll deadline, his supervisor is responsible for ensuring time is accurately recorded.

PAID SICK LEAVE LAWSSTD benefits available to a participant in accordance with the benefits schedule provided on page G-5 will be reduced by the number of days/hours taken under any federal, state or local paid sick leave law applicable to that employee under the Phillips 66 Supplemental Leave Policy. A participant who is entitled to leave under any federal, state or local paid sick leave law, as provided under the Phillips 66 Supplemental Leave Policy, must exhaust all leave to which he is entitled under such Policy before being eligible for STD benefits under the plan.

24-HOUR NOTICE REQUIREMENTA participant must let his immediate supervisor know about an absence due to a disability as far in advance as possible. However, if a participant unexpectedly becomes disabled, he must notify his immediate supervisor no later than 24 hours after his first day away from work.

PROMPT NOTICE REQUIREDA participant’s failure to give adequate notice of his disability may result in the delay or denial of STD benefits.

Because the 24-hour notification period is so important, the participant should plan ahead by telling a family member or friend how to provide notice on his behalf if the participant is unable to do so. It is important, and the participant’s responsibility, to make sure the participant’s emergency contact information is up-to-date in My HR Tools.

Please note that disability due to a job-related injury or illness is not covered under the plan. If the participant experiences a job-related injury or illness at work, he must report the incident to his immediate supervisor (or to another manager or supervisor if his immediate supervisor is unavailable) before leaving the work site. Although a job-related injury or illness is not covered under the plan, it may be covered under Workers’ Compensation.*

* For more information, see the Phillips 66 Accident on Duty (AOD) – Occupational Injury or Illness Policy (available in the Policy Center).

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THE STD BENEFIT AMOUNTGenerally, weekly STD benefits are equal to either 100% or 60% of the participant’s pay, for up to 26 weeks. The amount the participant receives depends on:

• The number of years of service* the participant has during the calendar year of the disability; and

• The participant’s weekly pay.**

* “Years of service,” as defined in the Glossary, is the number of full years of an employee’s continuous service completed during the calendar year in which benefits are requested, as determined by the employee’s service award entry date (“SAED”).

** See next page for the definition of “pay.”

Please note that plan benefits will be reduced by any Social Security disability benefits, state-mandated sick pay or disability benefits, or any other sick pay or disability benefits the participant is eligible to receive.

BENEFITS SCHEDULEDuring each calendar year, the participant is eligible for STD benefits as follows:

Benefits schedule

If the participant has the following years of service* …

The participant is eligible for STD benefits as follows …

100% of pay** 60% of pay**

For up to the following number of weeks* …

Less than six years 10 16

At least six but less than eight years 12 14

Eight years 16 10

Nine years 20 6

At least ten years 26 0

* For more information, see “pay,” “work days,” “week” and “years of service” in the Glossary, which begins on page N-60 of the Other Information chapter.

** Subject to reduction for any Social Security disability benefits, state-mandated sick pay or disability benefits, or any other sick pay or disability benefits the participant is eligible to receive, as determined by the plan administrator.



Notwithstanding the above benefits schedule, immediately following the birth of a child, a participant who is the birth mother is permitted to take up to 10 weeks off at 100% of pay, with the 10-week period beginning on the date of the child’s birth. A participant receiving STD benefits under this provision will receive up to 100% of pay for up to 10 weeks regardless of her years of service and without taking into account STD benefits received for that year prior to the date of the child’s birth. If the participant is required to be off longer than the 10-week period beginning on the date of the child’s birth, STD benefits will be paid for the duration of the absence based on the benefits schedule, taking into account all STD benefits received during that year (and the prior year, if applicable). STD benefits received under this provision will reduce the STD benefits available under the above schedule for the remainder of the year.

For example, if a participant with five years of service takes the full 10-week leave in accordance with the immediately preceding paragraph and has not taken any other time off that calendar year that would qualify for STD benefits, she will have 16 weeks of STD benefits available to her at 60% of pay for the remainder of that year. She would not be eligible for any additional STD benefits at 100% of pay during that calendar year. If the participant instead had eight years of service and had not taken any other time off that calendar year that would qualify for STD benefits, she would be eligible to take 10 weeks of leave in accordance with the immediately preceding paragraph and would have six weeks of STD benefits available to her at 100% of pay and 10 weeks of STD benefits available to her at 60% of pay for the remainder of that year.

DEFINITION OF PAYPay is defined based on participant classification.

If the participant is … “Pay” is defined as …

A salaried exempt or nonexempt employee

The average daily wage the participant would be paid for a single day, based on the number of work days in the pay period of his absence.

If the participant does not have a regularly scheduled number of hours, the company will determine the benefit based on the average number of hours he ordinarily works.

An hourly employee

Generally, the participant’s hourly wage times his regularly scheduled hours in the pay period of his absence. However, payroll practices may vary, depending upon the participant’s location and any applicable collective bargaining agreement or local policy.

Regardless of classification, pay does not include:

• Unscheduled overtime.

• Shift differentials.

• Other premium pay provisions, such as upgrade or holiday pay.

A participant’s STD benefit will never be more than what he would have received as an active, non-disabled employee for the same period. Under some conditions, it could be less than the income he could have received as an active employee. For example, the STD benefit does not include premium pay that the participant might have earned if he had been at work.

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ONE OR MORE PERIOD(S) OF DISABILITY IN A SINGLE CALENDAR YEARBenefits are paid as shown in the benefits schedule on page G-5.

If a participant received STD benefits, recovered from the disability, and then became disabled again in the same calendar year, the following information applies whether he is disabled from the same cause or from something totally unrelated.

Benefits for the second disability are adjusted to reflect the benefits paid for the first disability as shown in the following example.

Suppose that Sandra has six years of service and is disabled for 16 weeks in 2020. Sandra recovered from her 16-week period of disability and returned to work. Later in 2020, she became disabled again and her second disability lasted for 10 weeks.

Sandra’s two periods of disability began and ended in 2020. The following chart shows how her STD benefits for the two periods of disability are calculated.

Weeks of STD benefits at 100% of pay

Weeks of STD benefits at 60% of pay

Based on her years of service, Sandra is eligible for … 12 weeks in 2020 14 weeks in 2020

STD benefits used during Sandra’s FIRST period of disability (16 weeks)

12 weeks (The maximum number of weeks in a calendar year based on her

6 years of service)

4 weeks

STD benefits used during Sandra’s SECOND period of disability (10 weeks)

0 weeks 10 weeks

Because Sandra received STD benefits at 100% of pay for 12 weeks during her first disability, the remaining four weeks of her first disability and her entire second disability were paid at 60% of pay. Sandra’s STD benefits for 2020 were exhausted at the end of her second disability.



DISABILITIES THAT LAST INTO THE NEXT CALENDAR YEAR AND THE 8-WEEK RESET PERIODThe STD benefits schedule resets on the later of January 1 of each calendar year or after the participant returns to his regular work schedule for 8 consecutive weeks.

• If the participant had NOT been receiving STD benefits on January 1 or the participant’s first scheduled work day of the year and had returned to his regular work schedule for at least 8 consecutive weeks on or before January 1 if he had received STD benefits in the prior year, STD benefits for the new calendar year are paid according to the benefits schedule shown on page G-5 without consideration of STD benefits the participant may have received in a prior year.

• If the participant HAD been receiving STD benefits on January 1 or the participant’s first scheduled work day of the year or the participant had not returned to his regular work schedule for 8 consecutive weeks on January 1, available disability benefits for that disability or any disability before the participant returns to his regular work schedule for 8 consecutive weeks would continue from the previous calendar year.

• A participant who is subject to the 8-week reset period will have a total of 26 weeks of STD benefits available to him after the reset. However, in no event will a participant have more than the maximum number of weeks available at 100% of pay in a calendar year, based on his years of service, as indicated in the benefits schedule on page G-5.

For purposes of the 8-week reset requirement, vacation days, 19/30 days and holidays are not counted as an absence unless the participant is scheduled to work on the holiday.

Referring back to Sandra, if she had one 16-week disability that ran from December 2, 2019, through March 22, 2020, Sandra would receive STD benefits as follows:

Based on years of service and whether the disability lasts into the next calendar year, Sandra’s STD benefit …

Paid in …

2019 2020

12 weeks at 100% of pay 4 weeks (December 2 – December 31)

8 weeks (January 1 – February 23)

4 weeks at 60% of pay Not applicable 4 weeks (February 24 – March 22)

As illustrated in the above example, moving into a new calendar year did not change Sandra’s STD benefits for that disability. What does change is how benefits will be paid if she becomes disabled again in that new calendar year (2020).

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This section applies only if:

• The participant is disabled in one calendar year and is still receiving STD benefits for that disability on January 1 or the first scheduled work day of the next calendar year or the participant had not returned to his regular work schedule for 8 consecutive weeks on January 1; and

• The participant becomes disabled again in that next calendar year.

A participant would qualify for an additional 26 weeks of STD benefits only if he completely recovers from his first disability and returns to work performing his essential job functions with or without a reasonable accommodation for at least 8 consecutive weeks without an absence before becoming disabled again.

To meet the 8-week requirement:

• Vacation days are not counted as an absence.

• 19/30 days are not counted as an absence.

• Holidays are not counted as an absence, unless the participant is scheduled to work on the holiday.

Any absence during the 8-week period, other than vacation, 19/30 days and holidays when the participant is not scheduled to work will result in a restart of the 8-week period.

In the previous examples, Sandra’s benefits were based on her six years of service with the company. If she becomes disabled again in 2020, after meeting the 8-week requirement:

• Her available STD benefits at 100% of pay for the second disability would be reduced by the benefits she has already received in 2020. Her new 2020 maximums would be:

– 4 weeks at 100% of pay (12-week* maximum for 2020 minus the 8 weeks already paid in 2020 for her disability that began in 2019); and

– 22 weeks at 60% of pay (26-week* maximum for 2020 after the reset minus the 4 weeks available in 2020 at 100% of pay after the reset).

• The new maximums would be applied to Sandra’s second disability. For example, if she became disabled for 10 weeks beginning on June 22, 2020, her STD benefit for the second disability would be:

– 4 weeks at 100% of pay; and

– 6 weeks at 60% of pay.

* As shown in the benefits schedule on page G-5.

If Sandra had not met the 8-week requirement in 2020, STD benefits for the second disability would be paid under the STD benefits schedule in effect when her STD absence began. In that event, the entire 10 weeks of the second disability would be paid at 60% of pay because she had already exhausted her STD benefits at 100% of pay and had not reset.

The chart below shows how the 8-week requirement can affect STD benefits for a second disability.

Here is how Sandra’s SECOND disability would be paid

If Sandra HAD met the 8-week requirement

If Sandra HAD NOT met the 8-week requirement

• 4 weeks at 100% of pay; and

• 6 weeks at 60% of pay.

• 0 weeks at 100% of pay; and

• 10 weeks at 60% of pay.

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RECEIPT OF OTHER DISABILITY INCOME OR BENEFITSParticipants may be eligible for other disability benefits in addition to STD benefits under the plan. For example, such benefits may include:

• Social Security benefits.

• State-mandated sick pay programs.

• State-mandated disability income programs.

• Any other sick pay or disability benefits.

If a participant is eligible for any sick pay or disability benefits as a result of his disability, the participant’s STD benefits under the plan will be reduced so that the disability income he is eligible to receive from all sources is no more than the STD benefit he is eligible to receive under the plan.

Generally, participants are required to apply for state-mandated sick pay or disability benefits they are eligible to receive. They are also expected to apply for Social Security Disability Income (SSDI) when it is anticipated that the disability will last for an extended period of time. STD benefits will be reduced dollar-for-dollar for any state-mandated sick pay or any other sick pay or disability income benefits (whether SSDI, insurance or otherwise) the participant is eligible to receive, even if he does not apply for those benefits, or if the amount received from those programs is different than the amount determined by the plan administrator. If state law permits a participant to waive his STD benefit, it is the participant’s responsibility to notify HR Connections as soon as possible of his Intention to do so.

ARTURO’S DISABILITY INCOME

Suppose Arturo was hospitalized and was away from work for six weeks. During that time, he qualified for:

• $800 per week in STD benefits; and

• $150 per week in state disability benefits.

To adjust for his state disability benefits, Arturo’s weekly STD benefit from the Phillips 66 Disability Plan was reduced to $650 ($800 STD benefit minus $150 state disability benefit).

Arturo still received a total of $800 in weekly disability benefits, although the amount was received from two sources rather than from the plan alone. Note: If Arturo had failed to apply for the state disability benefit, his STD benefit would nonetheless have been reduced to $650, because he was eligible to receive the $150 state disability benefit.

IMPORTANT NOTICE

STD payments are deemed a substitute for the company’s legally required maintenance obligations under the Maritime Maintenance & CURE, including the Jones Act.

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EFFECT OF STD BENEFITS ON OTHER PHILLIPS 66 BENEFITSGenerally, a participant is permitted to continue participating in other company-sponsored benefit plans for which he is eligible while receiving STD benefits. In addition, participants will not experience a break in service related to benefits or vacation eligibility while receiving STD benefits. However, if a participant receiving STD benefits has vacation time remaining at the end of the year, he may be required under a collective bargaining agreement or local policy to exhaust all remaining vacation days before year-end. STD benefits will cease while the participant is exhausting his vacation time, and resume upon the exhaustion of his vacation time if the participant satisfies the plan’s requirements and STD benefits continue to be available to the participant.

FILING CLAIMS AND EMPLOYEE HEALTH REPORTS (EHR)A participant must submit STD benefit claims through his normal reporting method. Supervisor approval is required for any STD absence.

Generally, if a participant’s non-occupational illness or injury results in an absence that lasts five or more consecutive calendar days (including scheduled time off, weekends and holidays), the plan must be provided an Employee Health Report (EHR) or other medical certification approved by or requested by the plan. However, some collective bargaining agreements and local policies require that EHRs be provided sooner and may also have disciplinary provisions that are triggered by an absence that qualifies for STD benefits. The participant can obtain the EHR form from his local designated Phillips 66 Health Services representative, hr.phillips66.com or by contacting HR Connections.

Additionally, to receive STD benefits, the following requirements must be met:

• A participant’s first EHR must be completed by his physician or other licensed health care provider and is due on his 5th consecutive calendar day of absence (including scheduled time off, vacation, weekends and holidays).

• After the first EHR and while the participant is unable to work without restrictions:

– If the EHR does not specify the next physician appointment, the next EHR is due within 30 calendar days from the date the immediately preceding EHR was signed by his physician or other licensed health care provider.

– If the EHR does specify the next physician appointment, the next EHR is due the later of 30 calendar days from the date the immediately preceding EHR was signed by his physician or other licensed health care provider or within one week after the next physician’s appointment, with a maximum of 60 calendar days between EHR submissions.

• The participant must submit his final EHR on the day he returns to work without restrictions.

• In certain instances, the participant may be required, at the company’s expense, to obtain a second medical certification from a licensed health care provider to determine his eligibility for STD benefits. If the opinions of the company’s licensed health care provider and the participant’s licensed health care provider differ, the participant may be required to obtain medical certification from a third licensed health care provider at the company’s expense.

These requirements and the timing of documentation may be waived or modified at the discretion of the plan administrator.

Failure to submit medical certification or EHRs as required by the plan will result in loss of benefits (including retroactive adjustments) and/or disciplinary action.




IMPORTANT NOTE

Participants covered by a collective bargaining agreement should contact their local HR representative to determine if the collective bargaining agreement differs from the information stated in this or any other sections of the summary plan description. In the event of a conflict, the collective bargaining agreement applies.

CLAIM DENIALSA participant’s failure to follow any of the processes, procedures or requirements described in this chapter will result in the denial of his claim for STD benefits under the plan. If a participant’s claim for STD benefits is denied — or if the participant’s STD benefits are terminated or reduced — the participant has specific rights and responsibilities for appealing the claim denial.

See the Claims and appeals procedures section on page N-48 of the Other Information chapter for information regarding when to expect a response to a claim from the claims administrator and how to file an appeal with the appeals administrator if a claim is denied.

HOW BENEFITS ARE PAIDAs long as the participant’s claim is approved and proper notice was given to his supervisor, as described on page G-4, benefits will be paid as follows:

• If the participant is an exempt employee: Benefits start at the beginning of the first full day of absence on which the participant would normally or regularly be expected to be at work, and continue until the end of the last day prior to his return to work. Each full day of absence will be deducted from the participant’s maximum available benefit.

• If the participant is a nonexempt employee*: Unless a collective bargaining agreement or company policy provides otherwise, benefits start with the participant’s first full hour of absence from work. Each regularly scheduled hour that the participant is absent from work will be deducted from his maximum available benefit.

* Nonexempt employees may include salaried and hourly employees.

Generally, the participant cannot receive STD benefits and also receive other pay from the company for the same day. For example:

• If the participant does not work on a holiday for reasons that qualify him for STD benefits, he would receive STD benefits and not receive holiday pay.

• Generally, the participant cannot interrupt STD benefits to receive benefits under another paid leave policy, such as Death in the Family Leave or Serious Illness in the Family Leave, unless he has returned to work from an STD absence as required by the plan. Although the Interruption of STD benefits may occur and vacation benefits be payable in some locations, a participant cannot be paid STD benefits and vacation benefits for the same day.

• Generally, unless a collective bargaining agreement or local policy states otherwise, a participant may use vacation in lieu of 60% STD. STD benefits will cease while the participant is utilizing his vacation time, and resume if STD benefits are still available to the participant. In addition, participants may use vacation at year end to avoid exceeding the maximum vacation limit for the following year unless a collective bargaining agreement or local policy states otherwise.

IMPORTANT NOTE

If the participant is a split classification employee (i.e., he regularly works a portion of time on one job and a portion of time on another job paid at a different rate of pay), he will receive benefits based on a reasonable division of the participant’s time between the two rates, as determined by the company.

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WHEN BENEFITS ARE NOT PAIDUnder the following circumstances, STD benefits are not payable to the participant:

• If the participant is terminated or not on duty due to layoff, resignation, retirement, discharge or any paid or unpaid leave of absence, disability or military leave of absence, or on a leave of absence-Labor Dispute — regardless of whether these events occurred prior to or during his STD absence.

• While the participant is receiving any other type of income from the company — including, but not limited to, vacation or holiday pay, or benefits received during a paid vacation or under a paid leave or disability-related policy.

• For any time during which the participant is disabled but is performing any work for himself or any other person other than on behalf of the company — regardless of whether the work is for pay or profit. Note: This provision does not apply if the participant has received written permission to perform the work, in advance, from his business unit’s HR manager.

• If the participant is receiving benefits under the Phillips 66 Accident on Duty (AOD) – Occupational Injury or Illness Policy.

• For any time during which the participant or the participant’s attending physician delays treatment or surgery or prolongs the convalescent period beyond a normal period for such disability or surgery, regardless of whether an EHR or other requested medical documentation is submitted.

• If the participant submitted false information about his disability to the plan. Additionally, if the participant accepts benefits based on false information, his action will be considered a breach of faith, and he will be subject to disciplinary action in accordance with applicable local policy.

• If the participant does not comply with any of the plan provisions or requirements; fails to notify his supervisor of his absence; fails to provide objective evidence supporting his claim for STD benefits; or fails to supply medical certification, an EHR or any other type of documentation requested by the plan.

• For any time during which the participant is not under a qualified physician’s care after being absent from work for five or more consecutive calendar days.

• For any time the participant is not following his physician’s treatment or rehabilitation plan.

• For any disability that occurred:

– As a result of an activity of professional participation in sports.

– As a result of any employment for which he is entitled to benefits under any Workers’ Compensation law or act or similar legislation (whether the participant is employed by the company, by any other employer or as a result of self-employment).

– While he was engaged in an illegal occupation.

– As a result of war or act of war during military service.

– While attempting or committing a crime.

STD benefits may not be paid as a result of intentionally self-inflicted injury or illness, regardless of the participant’s state of mind.

WHEN STD PAYMENTS ENDA participant’s STD benefit payments end on the earliest date on which the participant:

• Is no longer disabled.

• Fails to provide satisfactory proof of ongoing disability.

• Does not have a medical examination required by the plan.

• Reaches the 26-week maximum benefit duration.

• Is released to return to work by his physician in transitional duty and the participant fails to return, unless Phillips 66 is unable to accommodate any restrictions required for transitional duty.

• No longer meets the plan’s eligibility requirements.

• Begins receipt of LTD benefits under the plan.

• Dies.



RETURNING TO WORKNothing in the plan amounts to a promise that the participant’s employment will continue while receiving STD benefits or when he is released to return to work. Phillips 66 makes employment decisions consistent with federal, state and local laws and the employment policies of the company.

To ensure a smooth transition back to work, the participant should:

• Notify his immediate supervisor as soon as possible prior to his return date.

• If required, provide a release to return to work from his physician certifying that he is physically able to perform all essential functions of his job, and/or undergo a fitness for duty examination, at the company’s expense, before being allowed to return to work.

If the participant is unable to perform satisfactorily upon returning to work, he may be required to provide a physician’s statement regarding his ability to perform job duties and/or be required to see another health care provider, at the company’s expense, to provide a statement regarding his physical ability to perform job duties.

LTD BENEFIT COVERAGEPhillips 66 also provides long-term disability (LTD) benefits under the Phillips 66 Disability Plan that are designed to protect participants from longer disabilities. Eligible participants can also enroll in and pay premiums for enhanced LTD coverage.

If a participant believes his disability will last longer than six months, he must file a notice of claim for LTD benefits by contacting The Hartford Group as soon as possible.

For more information, see the separate Long-Term Disability chapter.

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PHILLIPS 66 LONG-TERM DISABILITY

Benefits summary ..................................................H-2

Important ERISA information ...............................H-3

Eligibility and enrollment .....................................H-3Eligibility ..............................................................H-3Enrollment ..........................................................H-3

Enrolling in LTD coverage ..............................H-4Coverage costs ...................................................H-5Situations affecting enrollment or coverage ....H-5

Leave of absence ..........................................H-5

When coverage ends .............................................H-6

How the benefits work ..........................................H-6What disabled means ........................................H-6

Disability does NOT include … ...................... H-7The elimination period ....................................... H-7LTD benefit amount ............................................H-8

Pre-disability earnings ..................................H-8If the participant receives other disability

income or benefits ...................................H-9Work incentive benefit ................................H-12

If workplace modifications are needed ..........H-12If the participant returns to work and

becomes disabled again .............................H-13

Filing claims ........................................................ H-14If a claim is denied ...........................................H-14How benefits are paid ......................................H-15When benefit payments end ...........................H-15Maximum benefit duration ..............................H-16

IMPORTANT TERMS

• “LTD benefit” refers to the long-term disability benefit provided under the Phillips 66 Disability Plan.


• When describing elections (for example, enrollment, coverage changes), “participant” is defined as an employee or former employee:

– Who has satisfied the eligibility and participation requirements for the LTD benefit under the plan;

– Who has enrolled in the LTD benefit; and


• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the LTD benefit provided under the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS SUMMARYThe LTD benefit provides income if a participant is unable to work after 180 days (six months) of continuous disability. The following chart provides a very brief overview of certain LTD benefit provisions. It is important to review the entire SPD to obtain an understanding of the LTD benefit.


Yes. Coverage is not automatic. Participants who want LTD coverage must enroll. A participant can enroll, change or cancel coverage at any time. Evidence of insurability is required if he enrolls more than 30 days after the date he is first eligible.

Are dependents eligible? No. LTD benefits are for employees only.

Who pays? The participant pays for LTD coverage.

What is the LTD benefit? There are two levels of LTD coverage:

• Basic level of coverage: Provides 50% of pre-disability earnings if the participant is disabled and unable to work.

• Enhanced level of coverage: Provides 60% of pre-disability earnings if the participant is disabled and unable to work.

When do LTD benefits begin?

Eligibility for LTD benefits begins after the 180-day elimination period. During that period, the participant may be eligible for short-term disability benefits, as described in the separate Short-Term Disability chapter.

What if the participant receives other disability benefits?

The participant’s LTD benefit will be reduced if he receives disability income from any other source.

Does the participant have to pay taxes on LTD benefits?

No. Because LTD benefit premiums are paid for with after-tax dollars, any LTD benefits received are not taxable to the participant.*

* Tax laws change; participants receiving LTD benefits from the plan should consult with a tax advisor.

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IMPORTANT ERISA INFORMATIONThis Long-Term Disability chapter is intended to provide participants with an understanding of the LTD benefit. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.






ELIGIBILITY AND ENROLLMENTELIGIBILITYAn eligible employee is:


• A U.S. citizen or resident alien employee working within the U.S. (or on a personal or family medical leave of absence) who is paid on the direct U.S. dollar payroll. This includes employees rotating abroad.



• A recurring seasonal employee of Phillips 66 (as defined in the Glossary, which begins on page N-60 of the Other Information chapter).


ENROLLMENTParticipants can enroll online or over the phone.

Online at UPoint:

• Go to My HR Tools and click on the UPoint tile.








Enrolling in LTD coverage

The following two items impact the enrollment process and changes to coverage:

• Whether the participant enrolled in or made changes to LTD coverage within 30 days from when he first became eligible.

• Whether evidence of insurability (EOI) is required. EOI involves answering a series of questions about the participant’s health and it may include requiring the participant to complete a medical exam. The claims administrator uses the information to decide if the participant qualifies for LTD coverage.

Enrolling when the participant is first eligible

If the participant enrolls within 30 days of eligibility

EOI is not required

The participant can enroll in the basic or enhanced option.

Coverage begins on the day the participant first became eligible. That is usually his first day at work.

If the 30-day deadline is missed

EOI is required

Coverage begins on the first day of the month after the claims administrator approves the enrollment.*

Enrolling or changing coverage at any other time (including during annual benefits enrollment)

To enroll in or increase coverage

EOI is required

Note: The participant cannot increase coverage if he is on a leave of absence.

If the claims administrator approves the participant’s enrollment or change of coverage, the change takes effect:

• On the next January 1 (if the change was made during annual benefits enrollment).

• On the first day of the following month* (if the change was made at any other time).

To lower or cancel coverage

EOI is not required

The participant can do this at any time.

If coverage is lowered, the change takes effect:



If coverage is cancelled, the change takes effect:


• On the last day of the month in which the Benefits Center receives cancellation (if the change was made at any other time).

For all of the above, LTD coverage begins only if the participant is actively at work on that day. Otherwise, LTD coverage begins on the date the participant returns to work with full pay on his normal schedule.

* If coverage is approved on the first day of the month, coverage will begin on that day. For example, if coverage is approved on March 1, coverage begins on March 1. If coverage is approved on March 5, coverage begins on April 1.

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COVERAGE COSTSThe cost of after-tax LTD coverage depends on the participant’s:

• Pre-disability earnings; and

• Coverage level elected (basic or enhanced).

To see the costs, the participant can go to My HR Tools and click on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Alternatively, he can call the Benefits Center at (800) 965-4421.


Leave of absence

Coverage may continue during an approved leave of absence (excluding a disability, military or leave of absence-Labor Dispute) for up to 12 months from the last day on which the participant is actively at work, provided that he continues to pay the applicable premium. During the leave, the participant pays the same cost for coverage that an active employee would pay.

• If the participant is on a paid leave, the cost will be deducted from the participant’s paycheck on an after-tax basis.

• If the participant is not receiving a paycheck from the company, Phillips 66 will send the participant a bill. Failure to timely pay the required premium will result in the termination of the participant’s LTD coverage. When the participant returns to work, payroll deductions will resume.

If LTD coverage ends while the participant is on leave, the participant must re-enroll if he wants coverage. An EOI is required unless he is returning from a leave of absence, and:

• He re-enrolls in the same or a lower option as he had prior to going on leave; and

• He re-enrolls within 30 calendar days of returning to work.

The participant’s enrollment materials will explain what he is required to do.

Participants on a military leave of absence

If a participant is on a military leave of absence, coverage will be suspended until he returns to work as an active employee. Provided the participant returns to work before the expiration of the leave period, the coverage he had immediately before the leave began will be reinstated on the day the participant returns to work. The participant should contact the Benefits Center to cancel coverage or change to a different coverage level.


If a participant is placed on a leave of absence-Labor Dispute, coverage will end on the last day of the month in which the leave begins. When he returns to work:


• The participant must enroll if the leave was more than 30 days. If the participant enrolls within 30 days after the end of the leave, and does not increase his coverage level, EOI will not be required. If the participant enrolls more than 30 days after the end of the leave, EOI will be required.






WHEN COVERAGE ENDSCoverage ends on the earliest of the following events:


• The last day of the month in which the participant is no longer eligible.

• The last day of the month in which the participant’s coverage is terminated.

• The last day of the month in which the participant does not make the required contributions.

• The last day of the month in which the participant is laid off or goes out on a leave of absence-Labor Dispute, strike or lock-out.


• The date on which the plan is amended or terminated.

HOW THE BENEFITS WORKThe plan provides some financial protection by paying a portion of the participant’s pay if he is disabled and not able to work.

When the participant enrolls in the plan, he has two choices:

• Basic coverage (50% of the participant’s pre-disability earnings); or

• Enhanced coverage (60% of the participant’s pre-disability earnings).

To qualify for benefits:

• The participant must be disabled as described at right;

• The participant’s disability must have lasted at least 180 days (the elimination period); and

• The claims administrator must approve the claim for benefits.

WHAT DISABLED MEANSThe participant must be disabled in order to receive LTD benefits. That means the participant:

• Is unable to work due to accidental bodily injury, sickness, mental illness, substance abuse or pregnancy;

• Is under the care of a physician; and

• Meets the following requirements:

During the 180-day elimination period and for the next 24 months

• The participant is unable to perform one or more of the essential duties of his regular job with the company; and

• The participant is unable to earn more than 80% of his pre-disability earnings or indexed pre-disability earnings.

After the 24-month period

• The participant is unable to earn more than 60% of his indexed pre-disability earnings in the local economy at any gainful occupation for which he is reasonably qualified, taking into account the participant’s training, education, experience and pre-disability earnings.

See the Glossary, which begins on page N-60 of the Other Information chapter, for the definitions of “essential duty,” “indexed pre-disability earnings” and “pre-disability earnings.”

The participant’s loss of earnings must be a direct result of the disability. The claims administrator has the sole authority for determining disability. Economic factors, such as, but not limited to, recession, job obsolescence, pay cuts and job-sharing will not be considered in determining whether he meets the loss of earnings test.

If the participant’s job requires a license, loss of license for any reason does not, in itself, constitute disability.

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Disability does NOT include …

The plan will not pay benefits for disabilities resulting from:

• Conditions for which the participant is not under the regular care of a physician.

• Commission of or attempt to commit a felony.

• Engaging in an illegal occupation.

• An intentionally self-inflicted injury or attempted suicide.

• Any act of war (whether declared or undeclared), insurrection or rebellion.

THE ELIMINATION PERIODA participant must satisfy the elimination period before he is eligible to receive LTD benefits under the plan. The elimination period is the first 180 calendar days of his continuous disability.

• The 180-day period begins the day after the participant was last able to work at his regular job with the company.

• The participant must be under the care of a physician during the entire elimination period.

In certain circumstances, the elimination period might be extended.

If, at the end of the 180-day period … The elimination period is extended until …

The participant has unused vacation days All of the participant’s earned vacation time is used.

The participant is receiving (or is eligible to receive) short-term disability benefits under the plan

The participant’s STD benefits are exhausted.

However, if the participant is receiving STD benefits at 60% of pay, he is permitted to waive the remaining STD benefits and begin receiving LTD benefits instead.*

(STD benefits are described in the separate Short-Term Disability chapter.)

* This option may not be available if the participant is covered by a collective bargaining agreement. Participants should contact the local HR representative for information.



LTD BENEFIT AMOUNTLTD benefits are calculated based on the participant’s:

• Coverage level (basic or enhanced);

• Pre-disability earnings; and

• Disability income benefits he may be eligible to receive from other sources.

LTD benefits begin after the participant has met the 180-day elimination period and continue for as long as he is qualified (subject to the maximum LTD benefit duration described on page H-16).

MAXIMUM AND MINIMUM BENEFITS

The maximum LTD benefit is $20,000 a month.

The minimum LTD benefit is 15% of the participant’s pre-disability earnings (after all benefit reductions).

Note: The minimum does not apply if the participant’s plan benefits have been overpaid or if he is receiving income from any employment while disabled. If the participant’s plan benefits have been overpaid, the minimum benefit will be applied to help resolve the overpayment.

Pre-disability earnings

Pre-disability earnings are the participant’s base pay plus regularly scheduled overtime — as determined by the company — in effect on the day before the elimination period began.

Pre-disability earnings include … Pre-disability earnings do not include …

• Pay increases the participant receives during the elimination period; and

• Contributions the participant makes through payroll deductions to any of the following: – The Phillips 66 Savings Plan. – An executive nonqualified deferred compensation

arrangement. – Amounts contributed under an Internal Revenue

Code Section 125 plan (for example, the participant’s contributions to the Phillips 66 Flexible Spending Plan through payroll deductions for medical or dental coverage).

• Overtime resulting from the 19/30 work schedule.

• Awards and bonuses.

• The grant, award, sale, conversion and/or exercise of shares of stock or stock options.

• Contributions made by the company on the participant’s behalf to any deferred compensation arrangement or retirement plan.

• Holiday pay for hourly employees at the refineries.

• Any other compensation.

For more information, see “pre-disability earnings” in the Glossary, which begins on page N-60 of the Other Information chapter.

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If the participant receives other disability income or benefits

If a participant is eligible to receive other disability benefits, LTD benefits under the plan may be reduced. This would occur if the participant’s total disability benefits (this plan’s benefits plus other disability benefits) are more than 70% of his pre-disability earnings. This reduction is called an offset.

Monthly payments

The following is an example of how an offset works. Annie is enrolled in the basic LTD benefit option (50% of pre-disability earnings). Her pre-disability earnings are $4,000 per month, and she also receives $1,000 per month in Social Security disability benefits.

First, determine any excess income … Then adjust the participant’s benefit …

Step 1: Calculate the participant’s total disability income

Annie’s pre-disability earnings times her LTD benefit %

Plus

Other disability income

$ 4,000 Annie’s pre-disability earnings x 50% her basic LTD benefit percentage

= $ 2,000 Annie’s preliminary LTD benefit

+ $ 1,000 Social Security benefit

= $ 3,000 Annie’s total disability income

Step 2: Calculate the participant’s earnings limit

Annie’s pre-disability earnings times 70% (up to the maximum monthly benefit of $20,000 per month)

$ 4,000 Annie’s pre-disability earningsx 70%

= $ 2,800 Annie’s earnings limit

Step 3: Determine the participant’s excess income

Annie’s total disability income minus her earnings limit

$ 3,000 Annie’s total disability income (step 1 above)– $ 2,800 her earnings limit (step 2 above)

= $ 200 Annie’s excess income

Step 4: Determine the participant’s LTD benefit

Annie’s preliminary LTD benefit minus her excess income

$ 2,000 Annie’s preliminary plan benefit (step 1 above)– $ 200 her excess income (step 3 above)

= $ 1,800 Annie’s final LTD benefit

Each month, Annie will receive an LTD benefit from the plan of $1,800, plus $1,000 from Social Security.

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Lump-sum payment

The previous example showed how Annie’s LTD benefits were reduced because she was receiving monthly Social Security disability benefits.

If, however, Annie had received other income as a lump sum or settlement:

• Proof of the amount of the lump sum or settlement attributed to loss of income and the period of time covered by the lump sum or settlement must be provided to the claims administrator. The claims administrator will pro-rate the amount of the lump sum or settlement attributed to loss of income over the period of time covered by the lump sum or settlement.

• If proof of the amount of the lump sum or settlement attributed to loss of income or the period of time covered by the lump sum or settlement is not provided, the claims administrator will assume the entire amount of the lump sum or settlement to be for loss of income, and the time period covered to be 24 months.

For example, Annie’s monthly pre-disability pay is $4,000 and …

She receives a $30,000 disability settlement from Workers’ Compensation

• Proof that the settlement amount was fully attributed to loss of income and for a period of time representing 30 months was provided.

• The $30,000 settlement divided by 30 months equals $1,000.

• The plan will assume her settlement was paid at $1,000 per month for 30 months.

She receives a $72,000 disability settlement from Workers’ Compensation

• Proof of the settlement amount attributed to loss of income and the period of time covered were not provided.

• The $72,000 settlement divided by 24 months equals $3,000.

• The plan will assume Annie’s settlement was paid at $3,000 per month for 24 months.

From here, the plan does the same calculation shown above on page H-9. The only difference is that the $1,000 Social Security benefit shown in step 1 of that example is replaced by the $1,000 or $3,000 Workers’ Compensation monthly settlement amounts calculated above.

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Using Annie’s $4,000 pre-disability pay and $2,000 preliminary LTD benefit from page H-9, here is what her LTD benefit would be if she received a lump-sum settlement.

For this example, remember that Annie’s total disability benefit from all sources is limited to a maximum of $2,800 (70% of her pre-disability earnings), with a minimum LTD benefit of $600 (15% of her pre-disability earnings).

Annie’s monthly pre-disability pay is $4,000 and …

The plan received proof that her $30,000 Workers’ Comp settlement was paid at $1,000 per month for 30 months

• Annie will receive a reduced LTD benefit of $1,800 per month for 30 months. (The $2,800 maximum benefit minus the $1,000 per month lump-sum settlement.)

• After that, her LTD benefit will be $2,000 per month ($4,000 pre-disability pay times Annie’s 50% basic LTD benefit).

The plan assumes her $72,000 Workers’ Comp settlement was paid at $3,000 per month for 24 months because proof of settlement was not received

• Annie will receive a reduced LTD benefit of $600 (the LTD benefit minimum) per month for 24 months.

• After that, her LTD benefit will be $2,000 per month ($4,000 pre-disability pay times Annie’s 50% basic LTD benefit).

Annie’s example shows how her LTD benefit is reduced for the first 30 (or 24) months to reflect her lump-sum settlement. This period of 30 (or 24) months began on the later of:

• The date she became disabled (the first day of her elimination period); or

• The date the lump-sum payment is made.

Sources of other disability income or benefits

Other disability income or benefits could include:

• Payments from another employer-sponsored group disability insurance plan (excluding disability insurance the participant purchases directly from an insurer).

• Entitlements under mandatory benefit laws, including Workers’ Compensation, Maritime Maintenance & Cure law, occupational disease law or other similar law.

• Third-party liability judgments or settlements the participant receives.

• Disability payments from any federal, state, municipal or other governmental agency, including Canadian governmental agencies.

• Mandatory no fault auto insurance benefits (excluding any supplemental disability benefits the participant purchases under a no-fault auto law).

• Benefits under any government-sponsored compulsory benefit program to which the company contributes or for which it makes payroll deductions.

• Social Security payments (including those received on behalf of the participant’s dependents).

• Benefits from the company’s defined benefit retirement plan. The participant’s monthly LTD benefit will be reduced by the amount of his straight-life annuity payment or its equivalent if the participant elects a lump sum distribution (adjusted for early commencement, if applicable) or receives an involuntary lump-sum payment. If the participant does not commence his retirement plan benefit or if he elects a rollover of his retirement benefit, his LTD benefit under the plan will not be considered disability income. The plan will consider the participant’s straight-life annuity before any applicable qualified domestic relations order (QDRO) offsets.



• Portions of payments the participant received under the plan’s work incentive provisions, as described below.

If the participant’s disability income from other sources is not paid monthly — for example, if payments are received quarterly or annually — they will be prorated to a monthly amount for purposes of calculating the LTD benefit.

Work incentive benefit

The plan’s work incentive benefit allows the participant to be included in a rehabilitation program for up to 12 months while disabled and receiving LTD benefits under the plan. A rehabilitation program is full-time or part-time work that allows the participant to put his available skills and capabilities to use, and transition back into the workforce.

The participant must get his doctor’s and the claims administrator’s approval before starting a rehabilitation program.

Under the plan’s work incentive benefit, if the participant remains disabled after the elimination period and works while disabled:

• The monthly LTD benefit will be reduced by 50% of his current monthly earnings from the rehabilitation program; and

• If the monthly LTD benefit plus 50% of his current monthly earnings from the rehabilitation program and other sources of disability income is greater than 100% of his indexed pre-disability earnings, the monthly LTD benefit will be reduced by the amount of the excess.

For example, if the participant receives $2,000 per month in LTD benefits, and then begins a rehabilitation program making $1,000 per month, his monthly disability income will be:

• $1,000 from the rehabilitation program; plus

• $1,500 in LTD benefits under the plan.

If the total amount of the LTD benefit under the plan received by the participant, work incentive earnings and other sources of disability income add up to more than 100% of his indexed pre-disability earnings:

• The participant’s monthly LTD benefit under the plan will be reduced by the amount that exceeds 100%.

• In that event, the 15% minimum LTD benefit described on page H-8 will not apply.

Family care expenses incurred for participation in rehabilitation

If the participant is working as part of a rehabilitation program, his current monthly earnings from the rehabilitation program will be reduced for a portion of family care expenses in determining the monthly LTD benefit. This reduction for the family care credit is:

• Up to $350/month during the first 12 months (not to exceed $2,500 in a calendar year); and

• Up to $175/month thereafter for up to 12 months.

Family care costs must be documented by a receipt from a caregiver unrelated to the family member receiving care, and must be for:

• The participant’s children under the age of 13; or

• A member of the participant’s household who is mentally or physically handicapped and dependent upon him for care.

IF WORKPLACE MODIFICATIONS ARE NEEDEDIf the participant’s disability is covered under the plan’s LTD benefit, the plan may reimburse Phillips 66, up to an amount that does not exceed one month of the participant’s maximum monthly benefit, for the expense of reasonable modifications to accommodate his return to work as an active employee.

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IF THE PARTICIPANT RETURNS TO WORK AND BECOMES DISABLED AGAINIf the participant returns to work and becomes disabled from an unrelated cause, he may need to complete a new 180-day elimination period and be approved by the claims administrator before LTD benefits will be paid for the second disability. Payment of benefits depends on:

• Whether LTD benefits have already begun; and

• Whether the participant was disabled from the same cause, or from a different cause.

If LTD benefits have NOT begun (The participant has not yet completed his 180-day elimination period)

If the participant returns to work and then …

The participant IS required to start a new elimination period if …

The participant IS NOT required to start a new elimination period if …

Becomes disabled again from the SAME cause

He was back at work for more than 90 days.*

He was back at work for 90 days or less.*

Those workdays will not count toward the 180-day elimination period.

Becomes disabled again from a DIFFERENT cause

He returned to work for any period of time.

Not applicable.

* The 90 days do not have to be consecutive.

If LTD benefits HAVE begun (The participant has received at least one LTD benefit payment)

If the participant returns to work and then …

The participant IS required to start a new elimination period if …

The participant IS NOT required to start a new elimination period if …

Becomes disabled again from the SAME cause

He was back at work for more than six months.

He was back at work for six months or less.

Becomes disabled again from a DIFFERENT cause

He returned to work for any period of time.

Not applicable.

If a new disability occurs while the participant is receiving LTD benefits, the new disability will be treated as part of the same period as his current disability. The maximum LTD benefit duration, limitations and exclusions of the new disability will apply to the current disability. Monthly LTD benefits will continue while he remains disabled.



FILING CLAIMS

The participant must submit an LTD claim within one year of the date he becomes disabled. Claims submitted after that date will not be paid unless it was not reasonably possible to furnish proof of disability during the one-year period and the participant submits that proof as soon as possible.

If the participant expects his disability to continue beyond the end of the 180-day elimination period, he should call the Benefits Center to file a notice of claim as soon as possible. Doing so avoids interruption of income if the participant is approved for LTD benefits. The participant is required to provide the Benefits Center with his:

• Name.

• Social Security number.

• Last day worked.

The participant will then receive a proof of disability packet from the claims administrator.

• The participant and his physician(s) must complete (at the participant’s expense) and return the forms within 90 days after the end of the elimination period.

• The claims administrator may require the participant to file supplemental proof of claim (at the participant’s expense) and/or get a physical exam by a medical specialist chosen by the claims administrator (at the claims administrator’s expense).

• If the participant does not give the claims administrator the additional documentation within 90 days of the claim’s administrator’s request, his claim may be denied.

The claims administrator also requires the participant to provide:

• A signed authorization to release medical and financial information to the claims administrator.

• Proof of disability — including, but not limited to, the date the disability started, its cause and the participant’s prognosis.

• Proof of continuing disability.

• Proof that he is under the appropriate care and treatment of a physician throughout the disability.

• Proof that he has applied for Social Security disability benefits until denied at the Administrative Law Judge level. The participant should contact the claims administrator for help with this process.

• If applicable, proof that he has applied for Workers’ Compensation benefits or benefits under a similar law. If the participant does not provide this proof, his benefit may be reduced. The reduction will be based on what he may expect to receive, as determined by the company or the claims administrator.

• Proof that the participant has applied, or is not eligible, for any of the other types of disability income listed on page H-11. If this proof is not provided, his benefit may be reduced.

• Any other material information related to his disability as required by the claims administrator.

The claims administrator makes the final determination about eligibility for benefit payments.


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HOW BENEFITS ARE PAIDIf a participant qualifies for benefits, payments will begin after completion of the elimination period. The participant will receive payments at the end of each month he is disabled until he no longer qualifies for benefits.

Payment will be recalculated each month and will be adjusted for such things as other disability income or work incentive benefits received.

If the participant is disabled for only a part of a month, his LTD benefit payment for that month will be prorated. Each month is counted as having 30 days, regardless of the actual number of days in a month. For example, if the participant’s disability ends on the 10th of the month, the final payment will be his monthly payment divided by 30 days and then multiplied by 10 days.

WHEN BENEFIT PAYMENTS ENDLTD benefit payments end at the earliest of the following events:

• The date the participant is no longer disabled.

• The date the participant fails to provide satisfactory proof of continuing disability.

• The date the participant is no longer under the regular care of a physician.

• The date the participant does not have a medical examination required by the plan.

• The date the participant reaches the maximum benefit duration shown at right.

• The date the participant no longer meets the eligibility requirements of the plan.

• The date the participant refuses to receive recommended treatment that is generally accepted to cure, correct or limit his disability.

• The date the participant refuses to participate in a rehabilitation program, or refuses to cooperate with or try accommodations to enable him to return to work.

• The date the participant’s current monthly earnings:

– Are equal to or greater than 80% of his indexed pre-disability earnings during the first 24 months of disability.

– Are equal to or greater than 60% of his indexed pre-disability earnings after the first 24 months of disability.

• For mental illness and substance abuse conditions:

– For as long as the participant is confined in the hospital or other place licensed to provide medical care for the disabling condition; or

– If not confined, or after the participant is discharged and still disabled, for a total of 24 months for all such disabilities during his lifetime.

• The date of the participant’s death. If he dies, unpaid LTD benefits for the month of his death will be paid in the following order:

– To his spouse, if living;

– To his children, if living, in equal shares; or

– To his estate. In this case, the plan may pay up to $1,500 to someone related to the participant by blood or by marriage whom the Claims Administrator determines is entitled to this amount.



MAXIMUM BENEFIT DURATIONThe maximum amount of time a participant can receive plan benefits depends on his age on his disability start date.

Age on disability start date

Maximum LTD benefit duration

Under age 60 To the end of the month in which the participant reaches age 65

Age 60 and over 60 months

If a participant is disabled and receiving LTD benefits, and then has a second, unrelated disability:

• The new disability will be treated as part of his current disability.

• The two disabilities together are subject to the maximum LTD benefit durations shown above and to any other limitations and exclusions that may apply.

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PHILLIPS 66 LIFE

Benefits summary ................................................... I-2

Important ERISA information ................................ I-3

Eligibility and enrollment ...................................... I-3Eligibility ............................................................... I-3

Employee eligibility ......................................... I-3Dependent eligibility ...................................... I-4

Enrollment ........................................................... I-5Annual benefits enrollment ........................... I-5Enrolling in supplemental life ........................ I-6Enrolling in spouse and child life ....................I-7

Situations affecting enrollment or coverage ..... I-9Leave of absence ........................................... I-9

When coverage ends ........................................ I-10Continuing coverage after leaving the

company .................................................. I-10

How the plan works ..............................................I-11Coverage costs .................................................. I-11Coverage for the participant ............................. I-11

Basic and supplemental life options .......... I-11Occupational accidental death (OAD)

coverage .................................................. I-12Spouse and child life coverage ........................ I-12Accelerated benefits for terminal illness ......... I-13Travel assistance benefits ................................ I-13

Naming a beneficiary ...........................................I-15If a beneficiary is not named ............................ I-15

Filing claims .......................................................... I-16If a claim is denied ............................................ I-16How benefits are paid ....................................... I-16When benefits are not paid ...............................I-17

OAD exclusions and restrictions...................I-17Travel assistance exclusions and

restrictions ................................................I-17

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Group Life Insurance Plan.” The life, travel assistance and occupational accidental death (OAD) coverage described here are components of the plan.




– Who has been automatically enrolled in the plan or has been enrolled in dependent life coverage; and

– Whose participation has not terminated under any other applicable provisions of the plan.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the life insurance benefit, OAD benefit and travel assistance benefit provided under the plan. The Other Information chapter includes important legal information related to the plan.



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PHILLIPS 66 LIFE

BENEFITS SUMMARYThe plan’s life, travel assistance and occupational accidental death (OAD) benefits are summarized below. It is important to review the entire SPD to obtain an understanding of these benefits.

Coverage type Benefit amount

For the participant

Basic life insurance Company paid

One times annual pay, rounded to the next higher $100, up to a maximum benefit of $3 million

Supplemental life insurance The participant can choose to buy additional coverage for himself

One to eight times annual pay, rounded to the next higher $100, up to a maximum benefit of $12 million for basic and supplemental life combined

Occupational accidental death (OAD) coverage Company paid

• $100,000 for recurring seasonal employees

• $500,000 for all other employees

For the participant’s family

Dependent life insurance The participant can choose to buy coverage for his dependents

• Spouse coverage: $50,000 to $500,000, in increments of $50,000

• Child coverage (this election covers all eligible children): $15,000, $20,000 or $25,000

For the participant and family

Travel assistance benefits Company paid as part of the plan’s basic life coverage

• Pre-trip information

• Help in an emergency

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IMPORTANT ERISA INFORMATIONThis Employee Life chapter is intended to provide participants with an understanding of the life, travel assistance and OAD coverage provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.










• A regular full-time or part-time employee of Phillips 66 scheduled to work an average of at least 20 hours a week; or a recurring seasonal employee of Phillips 66 (as defined in the Glossary, which begins on page N-60 of the Other Information chapter); and






PHILLIPS 66 LIFE


See also Enrolling in spouse and child life on page I-7.



The participant’s spouse (including a state-recognized common-law spouse) X

The participant’s divorced or legally separated spouse X

The participant’s domestic partner (unless state law allows and the participant is enrolled in coverage under the plan)*

X

The participant’s unmarried biological child, stepchild, legally adopted or placed for adoption child under age 26, provided the child:

• Does not have a full-time job. Full-time means the child averages 40 or more hours of work per week. Summer or part-time jobs do not count; and

• Depends on the participant for more than half of his financial support

For a stepchild to be eligible:

• The biological parent must be the participant’s spouse; and

• The participant and his spouse either remain married and live in the same household, or the spouse died while married to the participant

X

The participant’s child or stepchild, meeting the requirements above who is age 26 or older, provided the child was disabled prior to attaining age 26, the child cannot work, and coverage is approved by the plan within the deadline


X

The participant’s child or stepchild who does not meet the requirements shown above X

The participant’s domestic partner’s child (unless state law allows and the participant is enrolled in coverage under the plan)*

X

* The participant should contact the Benefits Center for more information.

An individual is not an eligible dependent if he is on active duty in any military service of any country. In addition, a child or stepchild is not eligible if he is:

• Eligible to be covered as a Phillips 66 employee.

• A stillborn child or is not yet born.

A participant must notify the Benefits Center within 30 days if an enrolled dependent is no longer eligible for coverage (for example, following a divorce or a child reaching age 26).

For assistance with questions about dependent eligibility, participants should contact the Benefits Center.

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If a participant enrolls a dependent who does not meet the plan’s requirements or fails to cancel coverage within 30 days of the date on which the dependent ceases to meet the requirements, the dependent will be considered ineligible for the plan.





ENROLLMENT


Participants are automatically enrolled in basic life, travel assistance and OAD coverage.

• A participant is automatically enrolled at no cost on the first day he becomes eligible. For most participants, that is their first day of work at Phillips 66.

• The participant must be actively at work on that day. If the participant calls in sick or otherwise misses work, coverage will not begin until the participant is actively at work. (“Actively at work” is defined in the Glossary, which begins on page N-60 of the Other information chapter.)

The participant must enroll in supplemental life, spouse life, and/or child life if he wants that coverage. He can enroll online or over the phone.

Online at UPoint:




NAMING A BENEFICIARY

As part of enrollment, the participant should name (or designate) a beneficiary to receive the participant’s basic life, supplemental life and OAD benefits if he dies while covered under the plan.

The participant can name or change his beneficiary designation at any time. See page I-15 for details.





PHILLIPS 66 LIFE

Enrolling in supplemental life

As shown in the table below, two things affect enrollment or when a participant can make changes to coverage:

• Whether the participant enrolled or made changes within 30 days from when he first became eligible.

• Whether evidence of insurability (EOI) is required. EOI involves answering a series of questions about the participant’s health. It may include a medical exam. The claims administrator uses that to decide if the participant qualifies for supplemental life.

Supplemental life

Enrolling when the participant is first eligible

If the participant enrolls within 30 days of eligibility EOI is required if the participant chooses more than four times annual pay in supplemental life coverage

• If EOI is NOT required: Coverage begins on the day the participant first became eligible. That is usually his first day at work.

• If EOI is required: Coverage begins on the first day of the month after the claims administrator approves the enrollment.*

If the 30-day deadline is missed EOI is required in all cases

Coverage begins on the first day of the month after the claims administrator approves the enrollment.*


To enroll in or increase coverage EOI is required in all cases

Note: The participant cannot increase coverage if he is on a leave of absence

If the claims administrator approves the enrollment or change, coverage begins as shown below:

• On the next January 1 (if the change is made during annual benefits enrollment).

• On the first day of the following month* (if the change is made at any other time).

To lower or cancel coverage EOI is not required

The participant can do this at any time. The change takes effect:

• On the next January 1 (if the change is made during annual benefits enrollment).

• On the first day of the following month* (if the change is made at any other time).

For all of the above, coverage begins only if the participant is actively at work on that day. Otherwise, coverage will begin on the first date he is actively at work. “Actively at work” is defined in the Glossary, which begins on page N-60 of the Other Information chapter.

* If the coverage is approved ON the first day of the month, coverage will begin on that day. For example, if coverage is approved on March 1, coverage begins on March 1. If coverage is approved on March 5, coverage begins on April 1.

COVERAGE START DATES UPON RETURNING FROM A LEAVE OF ABSENCE-LABOR DISPUTE

There are additional provisions regarding coverage start dates for returning from a leave of absence, including a leave of absence-Labor Dispute. See page I-9 for further details.

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Enrolling in spouse and child life

Spouse and child life coverage options are based on when the participant is eligible to enroll. Evidence of insurability (EOI) does not apply to child coverage.

Spouse life

Enrolling when the participant and/or his spouse are first eligible

If the participant enrolls within 30 days of eligibility EOI is required if the participant chooses more than $50,000 in spouse life coverage

• If EOI is NOT required: Coverage begins on the day the participant first became eligible. That is usually his first day at work.

• If EOI is required: Coverage begins on the first day of the month after the claims administrator approves the enrollment.*

If the 30-day deadline is missed EOI is required in all cases

Coverage begins on the first day of the month following enrollment.*


To enroll in or increase coverage EOI is required in all cases.

Note: The participant cannot increase coverage if he is on a leave of absence

The change takes effect:



To lower or cancel coverage The participant can do this at any time. The change takes effect:





PHILLIPS 66 LIFE

Child life

Enrolling when the participant and/or his dependent child are first eligible

If the participant enrolls within 30 days of eligibility

Coverage begins on the later of:

• The date the participant became eligible (usually his first day at work); or

• The date the participant’s dependent child became eligible (for example, the participant’s wedding day or a child’s birth date).

If the 30-day deadline is missed Coverage begins on the first day of the month following enrollment.*


To enroll in or increase coverage Note: The participant cannot increase coverage if he is on a leave of absence

The change takes effect:



To lower or cancel coverage The participant can do this at any time. The change takes effect:



For all of the above, the dependent’s coverage will be delayed if he is hospitalized or unable to perform normal activities as defined in the Glossary, which begins on page N-60 of the Other Information chapter.



There are additional provisions regarding coverage start dates for returning from a leave of absence, including a leave of absence-Labor Dispute. See page I-9 for further details.

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Leave of absence

OAD coverage stops while the participant is out on leave. It will start again when he returns to work.

The participant’s other plan benefits continue during an approved leave of absence (excluding a leave of absence-Labor Dispute). The participant’s cost for supplemental, spouse and child life does not change, but the participant may pay it differently:


• If the participant is not receiving a paycheck from the company, Phillips 66 will send the participant a bill, and he will pay the cost on an after-tax basis. When the participant returns to work, payroll deductions will resume on an after-tax basis.

If supplemental, spouse or child life coverage ends while the participant is on leave, the participant must re-enroll if he wants that coverage. EOI may be required for supplemental or spouse life coverage.


Federal law provides certain rights for members of the military. See USERRA coverage on page N-47 of the Other Information chapter for information.


If the participant is placed on a leave of absence-Labor Dispute, coverage for the participant and his dependents will end on the last day of the month in which the leave begins. If coverage ends, the participant and his dependents can convert their basic, supplemental, spouse and/or child life coverage to individual policies.



• The participant must re-enroll if the leave was more than 30 days and he wants supplemental, spouse and/or child life coverage. Evidence of Insurability (EOI) may be required for supplemental and spouse coverage. Coverage will begin:

– On the date the participant returns to work, if he enrolls within 30 days after his return to work*.

– On the first day of the month on or following the participant’s enrollment and approval of any required EOI, if he enrolls more than 30 days after his return to work.

* EOI may be required if the participant elects a higher coverage amount than he had prior to his leave. In that event, the extra coverage will not begin until the first day of the month on or following the participant’s enrollment and approval of the required EOI.

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PHILLIPS 66 LIFE

WHEN COVERAGE ENDSCoverage for the participant and all of his dependents ends on the earliest of the following:

• The last day of the month in which the participant’s employment ends. (OAD coverage ends on the day employment ends.)


• December 31 immediately following the end of annual benefits enrollment if the participant cancels coverage during annual benefits enrollment. (Applies to supplemental, spouse and child life only.)

• The last day of the month in which the participant cancels coverage (except during annual benefits enrollment) or does not pay the required cost of coverage. (Applies to supplemental, spouse and child life only.)


• The date coverage is stopped, if Phillips 66 stops offering coverage. (This can apply to just one benefit (e.g., spouse or child life) or it can apply to the entire plan.)







º Spouse and child life coverage ends on the last day of the month in which death occurs.

º All other plan coverage ends on the date of death.


• The last day of the month in which that person is no longer an eligible dependent.

• The date a dependent becomes eligible for coverage as a Phillips 66 employee.

• The date of a dependent’s death. In this case, coverage ends for that dependent only. Coverage for any other dependent will continue.


Basic, supplemental, spouse and/or child life insurance may be continued. EOI is not required. OAD and travel assistance benefits cannot be continued.

There are two ways to continue coverage — portability or conversion. The participant’s option depends on how old he is when coverage ends and whether he is still working or is on leave at that time.

• The participant cannot convert to greater coverage than he had prior to termination.

• Coverage will be reduced starting at age 65.

• If the participant or a covered dependent dies within the 31-day continuation-election period, the amount of coverage the participant had prior to the coverage termination date will be paid to the participant or his beneficiaries.

To continue coverage, the participant must apply for it and pay the cost within 30 days of the date of the coverage termination notice or within 31 days from the coverage termination date, whichever is later. The option of continuing coverage is never available beyond 91 days from the coverage termination date.

To continue coverage, participants should contact the Benefits Center.

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HOW THE PLAN WORKSCOVERAGE COSTSThe company pays for the participant’s basic life and occupational accidental death (OAD) coverage.

The participant pays for his supplemental life, spouse and child life coverage with after-tax payroll deductions. To see the costs, he should visit My HR Tools and click on the UPoint tile or call the Benefits Center at (800) 965-4421.

The cost for supplemental life is based on the participant’s age, how much coverage he elects and whether he uses tobacco. It can go up during the year if the participant gets a raise or if a birthday pushes the participant to a higher age group.

An individual is considered to be a tobacco user if he has used tobacco more than four times in the prior six months.

COVERAGE FOR THE PARTICIPANT

Basic and supplemental life options

Upon meeting the plan’s eligibility requirements, the participant is automatically covered for company-paid basic life insurance.

The coverage amount is one times annual pay, rounded to the next higher $100. The maximum benefit is $3 million.

The participant has the option to purchase additional supplemental coverage of one to eight times his annual pay (in whole multiples). The maximum combined basic and supplemental life benefit is $12 million.

ANNUAL PAY IS …

Annual pay is the participant’s base salary and regularly scheduled overtime. Annual pay does not include overtime resulting from the 19/30 work schedule, commissions or bonuses.

The plan will pay benefits to the participant’s designated beneficiary(ies). If the participant or his spouse has a terminal illness, that individual can elect to receive part of his benefit in advance (see page I-13).

The plan pays more if the participant’s death was the result of an occupational accident (see page I-12).

Imputed income

Imputed income is the value of company-provided basic life insurance over $50,000. Under the Internal Revenue Code, employees must pay taxes on that value, which is calculated based on IRS tables.

• If the participant’s basic life insurance amount is $50,000 or less, he has no imputed income.

• If the participant’s basic life insurance amount is over $50,000, he has imputed income on the value of the amount over $50,000. The value of the participant’s imputed income is shown on each of his paychecks and included as part of the participant’s taxable income on his annual W-2.

Also by law, the cost of coverage for dependent life insurance is included in calculating the participant’s imputed income for the year.

At Phillips 66, imputed income does not apply to supplemental life or OAD coverage.




PHILLIPS 66 LIFE

Occupational accidental death (OAD) coverage

OAD coverage pays a benefit if the participant dies as a direct result of a bodily injury caused by a covered occupational accident.* The participant is automatically enrolled in this coverage at no cost.

The OAD benefit is:

• $100,000 for recurring seasonal employees.

• $500,000 for all other employees.

There are a few basic requirements:

• The participant must have been eligible for coverage at the time the accident occurred;

• The accident was the sole cause of the bodily injury;

• The bodily injury, independent of all other causes, was the sole cause of death; and

• Death occurred within 365 days after the date of the accident.

*“Occupationalaccident”isdefinedintheGlossary,whichbeginsonpageN-60oftheOther Informationchapter.Someexclusionsapply;see“Whenbenefitsarenotpaid”onpageI-17.

SPOUSE AND CHILD LIFE COVERAGEThe plan includes dependent life coverage that pays a benefit if the participant’s covered spouse or children die before the participant. The participant can make separate elections for his spouse and his children.

• Coverage for a spouse: $50,000 to $500,000, in increments of $50,000.

• Coverage for each dependent child: $15,000, $20,000 or $25,000.

Here are some details:

• Dual coverage is allowed. That means if both parents work for Phillips 66, each parent can elect dependent coverage for the children.

• Once the participant is enrolled in dependent life coverage:

– New dependent children are covered automatically. The participant does not need to enroll them separately. (Automatic coverage does not apply to all Phillips 66 benefit plans. For example, the participant must enroll his dependents in Phillips 66 medical or dental benefits if the participant wants that coverage.)

– If the participant and his spouse divorce or legally separate or if the participant no longer has any eligible dependent children, he must cancel their coverage. Payroll deductions will continue until the participant cancels that coverage, but his ineligible spouse or dependents will not be covered. Plan benefits are based on meeting the plan’s eligibility provisions. If the participant’s dependent does not meet the eligibility provisions at the time of death, regardless of whether payroll deductions are being taken, the plan will not pay benefits.

To cancel coverage, the participant should visit My HR Tools and click on the UPoint tile. Alternately, he can call the Benefits Center at (800) 965-4421.

• Go to My HR Tools and click on the UPoint tile. The cost of coverage for dependent life insurance is included in calculating the participant’s imputed income for the year. (See Imputedincome on page I-11.)



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ACCELERATED BENEFITS FOR TERMINAL ILLNESSUnder the accelerated benefit option, the participant may elect to receive up to 50% of his coverage early if the participant or his spouse is terminally ill. That money can be used for any purpose.

Here is how it works:

For the participant • The plan will pay up to 50% of the participant’s basic + supplemental life coverage amount if the participant is terminally ill with a life expectancy of 24 months or less.

• The minimum payout is $10,000.

• The maximum payout is $1,000,000.

For the participant’s spouse

• The plan will pay up to 50% of the participant’s spouse’s dependent life coverage amount if the spouse is terminally ill with a life expectancy of 24 months or less.

• The minimum payout is $25,000.

• The maximum payout is $250,000.

Some rules apply:

• The benefit is payable only once.

• The participant cannot increase his coverage after his election is made.

• The participant will continue to make payments for the full amount of coverage as long as the participant is covered as an active employee.

• If the participant has assigned the rights to his plan benefits, he must obtain a release from the assignee.

To apply for accelerated benefits, participants should contact the Benefits Center.

TRAVEL ASSISTANCE BENEFITSTravel assistance benefits are available to the participant and his dependents* if the participant is traveling more than 100 miles from home for 90 days or less. Travel assistance is available inside and outside the U.S.

• The participant must contact the travel assistance claims administrator (contact information is on page A-11 of the Contacts chapter) and obtain approval for the service or expense in advance of incurring the service. If the participant does not do this, the plan will not cover the cost.

• The plan helps the participant in an emergency, but it does not pay his medical expenses. Those expenses are the participant’s responsibility, the same as if he were at home.

• Some situations are not covered. See When benefits are not paid on page I-17 for details.

* The participant’s spouse and dependent children (under age 19 or under age 26 if a full-time student in actual attendance at an accredited school or college and primarily dependent on the participant for support and maintenance).


PHILLIPS 66 LIFE

Here are some of the available benefits. Participants should visit zurichtravelassist.com for the most up-to-date information.

Pre-trip information • Visa, passport, inoculation and immunization requirements

• International hotspots and travel advisories

Emergency medical assistance

• Medical referrals, monitoring and evacuation resources

• Repatriation — Arrangement for transportation home for further medical treatment

• Dependent children assistance — When dependent children are left unattended due to the participant’s hospitalization, travel arrangements and funding for their return home with a qualified escort

• Visit by a family member or friend — If the participant is traveling alone and is hospitalized for at least seven consecutive days or is in critical condition, travel arrangements and funding for a family member or friend to visit, if that service is deemed medically necessary

• Emergency medical payments — Funds advanced to cover on-site medical expenses

Emergency personal services

• Emergency travel arrangements — Airline, hotel and car rental reservations or changes. The participant pays the cost of airfare (unless it was approved as medically necessary by the attending physician), food, hotel and car expenses

• Emergency cash — Cash advance service

• Locating lost items — Help in locating lost luggage and personal possessions

• Legal assistance — Help in locating an attorney

Maximum benefit • $1 million per family per trip


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The participant can name or change his beneficiary designation at any time online by going to My HR Tools and clicking on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Or, he can call the Benefits Center at (800) 965-4421.

The participant’s beneficiary receives his basic life, supplemental life and OAD benefits if the participant dies while covered under the plan. The participant chooses (or designates) his beneficiary.

• The participant may name as many beneficiaries as he wishes — including individual persons, an estate, a trust, or a church or charitable organization.

– If the participant names more than one beneficiary, he should indicate the benefit percentage the participant wants paid to each of them. If the participant does not do this, benefits will be divided equally among them.

• The participant can name one or more contingent beneficiaries. Contingent beneficiaries receive the participant’s life and OAD benefits if all of the participant’s primary beneficiaries die before the participant.

• When naming a beneficiary, the participant should provide the full name, address, date of birth and other information that may be requested.

• By law, benefits cannot be paid directly to a beneficiary who is under age 18 (a minor) or legally incompetent at the time of the participant’s death. Instead, the benefit must be paid to the guardian, conservator or any other person legally responsible for the management of the estate that belongs to the minor or legally incompetent beneficiary. Participants should contact the claims administrator for additional details.

• A divorce does not affect the participant’s designation. If the participant no longer wants his ex-spouse as a beneficiary, the participant must make a new designation.

• Beneficiary designations must be kept up-to-date. If a beneficiary moves or dies, the participant should update his beneficiary information.

• Beneficiary designations take effect on the day the claims administrator accepts them.

• Dependent life benefits are always paid to the participant. No exceptions.

IF A BENEFICIARY IS NOT NAMEDIf the participant does not name a beneficiary, the participant’s basic life, supplemental life and OAD benefits will be paid in the following order:

• The insured’s legally married spouse;

• The insured’s child(ren);

• The insured’s parents;

• The insured’s brothers and sisters; or

• The insured’s estate.

If the beneficiary survives the participant for any period of time and then dies, the participant’s basic life, supplemental life and OAD benefit will be paid to the beneficiary’s estate.

Any payments made will relieve the claims administrator and the plan of all liability for life benefits under the plan.




PHILLIPS 66 LIFE

FILING CLAIMS

Claims must be received by the Benefits Center within 30 days after the date of the death or as soon as reasonably possible. Proof of loss should be submitted within 90 days after the date of death. To file a claim for travel assistance services, participants should contact Zurich Travel Assistance at (800) 263-0261 or zurichtravelassist.com.

To file a claim, the first step is to call the Benefits Center. The Benefits Center will help the participant or his beneficiary through the process and will ask for:

• The deceased person’s name;

• The deceased person’s Social Security number;

• The date of death; and

• Information regarding a spouse or next of kin:

– Name;

– Address;

– Phone number; and

– Relationship to the deceased.

The claims administrator must be provided with a certified copy of the death certificate. In addition, the claims administrator may:

• Ask for additional documents (for example, a copy of trust or estate documents).

• Require an autopsy (provided that an autopsy is not prohibited by local law). The plan pays for the requested autopsy.


HOW BENEFITS ARE PAIDOnce the claim has been approved, the plan will pay benefits as follows:

• Basic and supplemental life and OAD benefits: The plan will pay benefits to the participant’s designated beneficiary(ies). The benefit amount is based on the participant’s annual pay at the time of his death.

• Dependent life: The plan will pay benefits to the participant.

Benefits are paid to the participant or his beneficiary(ies) in a lump-sum payment.

The claims administrator may elect to pay up to $500 for burial expenses to the person handling those details.

Restrictions apply if a beneficiary is under age 18 or is legally incompetent. For example, the benefit may be paid to a guardian or into a trust. The claims administrator will provide details.


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WHEN BENEFITS ARE NOT PAID

OAD exclusions and restrictions

The plan will not pay an OAD benefit if the occupational accidental death was the result of:

• Physical or mental illness or physical injury or associated treatments (including, without limitation, an adverse reaction to a medication used to treat a physical or mental condition). Note: This exclusion does not apply if the illness that contributed to or caused the death was:

– A pus-forming infection that occurred through an accidental wound; or

– A contagious disease (such as tuberculosis, brucellosis, hepatitis A or plague, but not including flu or cold) that was contracted at work.

• An infection, unless it was caused by an external wound that can be seen and that was sustained in an occupational accident.

• Suicide or attempted suicide, whether sane or insane.

• Injuring oneself on purpose.

• Voluntary use or consumption of any poison, chemical compound or drug, including but not limited to prescription medications, unless it was taken as prescribed by or was administered by a physician.

• War or act of war, whether declared or not.

• Involvement in a riotous activity or fight that the deceased person initiated.

• Injury sustained while committing or attempting to commit a felony.

• Operating a land, water or air vehicle while legally intoxicated as defined by the laws of the jurisdiction in which the vehicle was being operated.

• Violation of a state or federal law.

• Violation of company safety rules or operating procedures.

• A non-occupational accident.

• Presence on company property as a member of the general public rather than as an employee.

• Voluntary participation in a wellness program or in a medical, fitness or recreational activity such as blood donation, physical examination, flu shot, exercise class, basketball, volleyball and other exercise activities.

• Eating, drinking or preparing food or drink for personal consumption (whether bought on company premises or brought in).

• Choking on a non-food-related product.

• Performance of personal tasks (unrelated to job responsibilities, and the accident was not a result of company negligence).

• Operating a vehicle or walking or otherwise moving on a company parking lot, company access road or company sidewalk or walkway.

Travel assistance exclusions and restrictions

The plan does not provide services or pay for expenses if:

• The covered trip was taken for the specific purpose of securing medical treatment.

• The illness or injury requiring medical treatment resulted from the participant being under the influence of intoxicants or any controlled substance, unless the controlled substance was prescribed by a physician and was taken in accordance with the prescribed dosage.

• With respect to medical evaluation, the medical care which is being provided is consistent with western medical standards or it is medically necessary to transport the participant to another hospital or medical facility. (The claims administrator has the sole discretion to make these determinations.)


PHILLIPS 66 LIFE

This document provides a general description of the primary features and characteristics of the life benefit provided under the plan. Refer to the policy for a detailed description of the insurance coverage, including the exclusions, limitations, restrictions, and termination. In the event of a discrepancy between this document and the policy, the terms of the policy shall apply. All benefits are subject to the terms and conditions of the policy.

• Based on the medical condition of the participant and/or local conditions, the claims administrator determines that medical evaluation or medical repatriation is not appropriate. (The claims administrator has the sole discretion to make these determinations.)

• Any local, state, country, or international law that prohibits the provision of the transportation or service under the coverage.

• The transportation or service under the plan was not pre-authorized by the claims administrator.

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PHILLIPS 66 ACCIDENTAL DEATH & DISMEMBERMENT

Benefits summary ...................................................J-2

Important ERISA information ................................J-3

Eligibility and enrollment ......................................J-3Eligibility ............................................................... J-3

Employee eligibility ......................................... J-3Dependent eligibility ......................................J-4

Enrollment ...........................................................J-5Benefits enrollment ........................................J-5Enrolling dependents .....................................J-6Changing elections midyear ..........................J-6

Coverage costs .................................................... J-7Situations affecting enrollment or coverage ..... J-7

Leave of absence ........................................... J-7When coverage ends ..........................................J-8

Continuing coverage after leaving the company ....................................................J-8

Understanding the AD&D benefit .........................J-9What the AD&D benefit pays ............................ J-10

If more than one loss occurs .......................J-11Additional AD&D benefits ............................J-12

Naming a beneficiary .......................................... J-14If a beneficiary is not named ............................J-15

Filing claims ......................................................... J-15If a claim is denied ............................................J-15How benefits are paid ....................................... J-16When benefits are not paid .............................. J-16

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Group Life Insurance Plan.” The accidental death and dismemberment (AD&D) benefit is a component of the plan.




– Who has enrolled in the AD&D benefit; and

– Whose participation has not terminated under any other applicable provisions of the AD&D benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the AD&D benefit provided under the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS SUMMARYThe AD&D benefit is paid if a participant or covered dependent dies or suffers a covered injury as a direct result of a work-related or non-work-related accident. It is important to review the entire SPD to obtain an understanding of this benefit.


Yes. Coverage is not automatic. If the participant wants AD&D coverage for himself and his family, the participant must enroll. The participant must also name a beneficiary.

Who pays? The participant pays for AD&D coverage.

What is the AD&D benefit?

There are several levels of AD&D benefits available, as summarized below.

The participant can purchase AD&D coverage in $50,000 increments ranging from …

For the participant Minimum: $50,000.

Maximum: $1 million or 12 times the participant’s annual pay, whichever is less.

For the participant’s spouse

Minimum: $50,000.

Maximum: $500,000.


For each of the participant’s eligible children

Minimum: $10,000.

Maximum: $50,000.

If the participant or a covered dependent dies due to an accident or suffers a covered injury …

The AD&D benefit pays

For accidental death: 100% of the coverage amount (which is called the principal sum) to the participant or his beneficiary.

For a covered accidental injury: A percentage of the covered person’s principal sum.

Additional benefits may be paid as well.

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IMPORTANT ERISA INFORMATIONThis Accidental Death & Dismemberment chapter is intended to provide participants with an understanding of the AD&D benefit provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.










• A regular full-time or part-time employee of Phillips 66 scheduled to work an average of at least 20 hours a week; or a recurring seasonal employee of Phillips 66 (as defined in the Glossary, which begins on page N-60 of the Other Information chapter); and








See also Enrolling dependents on page J-6.



The participant’s spouse under age 70 (including a state-recognized common-law spouse) X

The participant’s divorced or legally separated spouse X

The participant’s domestic partner (unless state law allows and the participant is enrolled in coverage under the plan)*

X

The participant’s unmarried biological child, stepchild, legally adopted or placed for adoption child under age 26, provided the child:

• Does not have a full-time job. Full-time means the child averages 40 or more hours of work per week. Summer or part-time jobs do not count; and

• Depends on the participant for more than half of his financial support

For a stepchild to be eligible:

• The biological parent must be the participant’s spouse; and

• The participant and his spouse either remain married and live in the same household, or the spouse died while married to the participant

X

The participant’s child or stepchild meeting the requirements above who is age 26 or older, provided the child was disabled prior to attaining age 26, the child cannot work, and coverage is approved by the plan within the deadline


X

The participant’s child or stepchild who does not meet the requirements shown above X

The participant’s domestic partner’s child (unless state law allows and the participant is enrolled in coverage under the plan)*

X

* The participant should contact the Benefits Center for more information.

An individual is not an eligible dependent if he is on active duty in any military service of any country. In addition, a child or stepchild is not eligible if he is:

• Eligible to be covered as a Phillips 66 employee.

• A stillborn child or is not yet born.

A participant must notify the Benefits Center within 30 days if an enrolled dependent is no longer eligible for coverage (for example, following a divorce or a child reaching age 26).

For assistance with questions about dependent eligibility, participants should contact the Benefits Center.

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If a participant enrolls a dependent who does not meet the plan’s requirements or fails to cancel coverage within 30 days of the date on which the dependent ceases to meet the requirements, the dependent will be considered ineligible for the plan.





ENROLLMENT

Benefits enrollment


Online at UPoint:





As part of enrollment, the participant should name (or designate) a beneficiary to receive the participant’s AD&D benefit if he dies while covered under the plan.

The participant can name or change his beneficiary designation at any time. See page J-14 for details.

Participants may enroll in AD&D coverage or change enrollment elections as shown below, following the instructions provided in their enrollment materials. The Benefits Center can assist with questions. Evidence of insurability (EOI) is not required.

If the participant enrolls or changes coverage … Coverage begins …

Within 30 days of his eligibility date

On the participant’s or his dependent’s eligibility date. That is usually the participant’s first day at work. For a new dependent, that is usually his wedding day or the date of the child’s birth or adoption.


On the next January 1

Any other time during the year

On the first day of the month following enrollment*

*IftheparticipantenrollsONthefirstdayofthemonth,coveragewillbeginonthatday.Forexample,iftheparticipantenrollsonMarch1,coveragebeginsonMarch 1.IftheparticipantenrollsonMarch5,coveragebeginsonApril1.






Regardless of when the participant enrolls, coverage for the participant and his dependents begins only if the participant is actively at work* on the day coverage is scheduled to begin. If the participant calls in sick or otherwise misses work, coverage will not begin until the participant is actively at work.

*“Activelyatwork”isdefinedintheGlossary,whichbeginsonpageN-60oftheOther Informationchapter.

Enrolling dependents

A participant who enrolls in AD&D coverage can also purchase coverage for his spouse and/or eligible dependent children at any time. Their coverage will begin as shown in Benefitsenrollment on page J-5.

Here are some details:

• Dual coverage is allowed. That means if the participant and his spouse both work for Phillips 66, the participant and his spouse can both enroll in AD&D coverage. In addition, each of them can elect dependent coverage for their children. There are a few points to keep in mind:

– The combined maximum amount of coverage for the participant or his spouse cannot exceed $1 million per covered person.

– The combined maximum for each of the participant’s children cannot exceed $50,000. For example, if the participant purchased $30,000 coverage for each of his children, the participant’s spouse could purchase no more than $20,000 for each.

• Once the participant is enrolled in dependent coverage:

– New dependent children are covered automatically. The participant does not need to enroll them separately. (Automatic coverage does not apply to all Phillips 66 benefit plans. For example, the participant must enroll his dependents in a Phillips 66 medical and/or dental option if the participant wants that coverage.)

– If the participant and his spouse divorce or legally separate or if the participant no longer has any eligible dependent children, the participant needs to cancel their coverage. Payroll deductions will continue until the participant cancels that coverage, but his ineligible spouse or dependents will not be covered. Plan benefits are based on meeting the plan’s eligibility provisions. If the participant’s dependent does not meet the eligibility provisions at the time of a covered accident, regardless of whether payroll deductions are being taken, the plan will not pay benefits.

– To cancel coverage, the participant should go to My HR Tools and click on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Or, call the Benefits Center at (800) 965-4421.

Changing elections midyear

The participant may enroll, change or cancel coverage for himself or his dependents at any time.

To make changes, the participant should go to My HR Tools and click on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Alternatively, he can call the Benefits Center at (800) 965-4421.






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COVERAGE COSTSThe participant pays for his AD&D coverage with after-tax payroll deductions. To see the costs, he should visit My HR Tools and click on the UPoint tile or call the Benefits Center at (800) 965-4421.


There are additional provisions regarding coverage start dates for returning from a leave of absence, including a leave of absence-Labor Dispute. See Participants on a leave of absence-Labor Dispute at right for further details.


Leave of absence

The participant’s AD&D benefits continue during an approved leave of absence (excluding a leave of absence-Labor Dispute). The participant’s cost does not change, but the participant may pay it differently:


• If the participant is not receiving a paycheck from the company, Phillips 66 will send the participant a bill, and he will pay the cost on an after-tax basis. When the participant returns to work, payroll deductions will resume on an after-tax basis.

If coverage ends for the participant or his dependents while the participant is on leave, the participant must re-enroll if he wants AD&D coverage.


Federal law provides certain rights for members of the military. See USERRA coverage on page N-47 of the Other Information chapter for information.


If the participant is placed on a leave of absence-Labor Dispute, coverage for the participant and his dependents will end on the last day of the month in which the leave begins. If coverage ends, the participant and his dependents can convert their coverage to individual policies.



• The participant must re-enroll if the leave was more than 30 days and he wants AD&D coverage. Coverage will begin:

– On the date the participant returns to work, if he enrolls within 30 days after his return to work.

– On the first day of the month following the participant’s enrollment, if he enrolls more than 30 days after his return to work. (If the participant enrolls ON the first day of the month, coverage will begin on that day.)




WHEN COVERAGE ENDSCoverage for the participant and all of his dependents ends on the earliest of the following:






• The last day of the month in which the participant dies.

• The date coverage is stopped, if Phillips 66 stops offering AD&D coverage. (This can apply to one benefit (e.g., AD&D) or it can apply to the entire plan.)







• The last day of the month in which that person is no longer an eligible dependent.

• The last day of the month in which the participant’s spouse reaches age 70 or the participant’s child reaches age 26, as applicable.

• The date a dependent becomes eligible for coverage as a Phillips 66 employee.

• The date of a dependent’s death.


AD&D coverage may be continued through a group conversion policy offered by the insurance company, subject to the following:

• The participant must apply for continuation of coverage within the timeframe listed on the application he receives.

• Generally, the participant cannot continue more coverage than he had when coverage ended.

• Rates will be based on the participant’s current age and may differ from what the participant paid while employed.

• If the participant or a covered dependent dies from a covered accident within the 31-day continuation-election period, the amount of coverage the participant had when it ended will be paid to the participant or his beneficiaries.

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UNDERSTANDING THE AD&D BENEFITAD&D coverage pays a benefit if the participant or his covered dependent dies or suffers a covered injury as a direct result of a work-related or non-work-related accident. AD&D benefits are in addition to any other life insurance or occupational accidental death (OAD) benefits payable under the plan.

When the participant enrolls in the AD&D benefit, he can elect coverage for himself and his eligible dependents. The amount of coverage elected is called the principal sum.


For the participant Minimum: $50,000

Maximum: $1 million or 12 times the participant’s annual pay, whichever is less

For the participant’s spouse Minimum: $50,000

Maximum: $500,000


For each of the participant’s eligible children

Minimum: $10,000

Maximum: $50,000

ANNUAL PAY IS …

Annual pay is the participant’s base salary and regularly scheduled overtime. Annual pay does not include overtime resulting from the 19/30 work schedule, commissions or bonuses.

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WHAT THE AD&D BENEFIT PAYSAD&D benefits are paid based on the type of injury:

• If the participant or his dependent dies, the entire amount of the principal sum is paid.

• If the participant or his dependent is injured, the AD&D benefit pays a percentage of the principal sum, depending on the specific injury. For example, if the participant lost a hand or a foot, the AD&D benefit would pay 50% of the participant’s principal sum. But if the participant lost both a hand and a foot, the AD&D benefit would pay 100% of the principal sum.

Here is the percentage of the total benefit amount that the participant and/or his covered dependent would receive in the event of death or severe injury resulting from a covered accident.

For the following covered loss …The AD&D benefit pays this

amount of the principal sum …

Life 100%

Hand or foot 50%

Sight in one eye 50%

Both hands or both feet, or sight in both eyes 100%

Either hand or foot and sight in one eye 100%

One hand and one foot 100%

Thumb and index finger of either hand 25%

Speech and hearing in both ears 100%

Speech or hearing in both ears 50%

Movement of both upper and lower limbs (quadriplegia)

200%

Movement of both lower limbs (paraplegia) 75%

Movement of three limbs (triplegia) 75%

Movement of the upper and lower limbs of one side of the body (hemiplegia)

66%

Movement of one limb (uniplegia) 50%

Traumatic brain injury 100%

Coma 1% monthly beginning on the 31st day of the coma and lasting for the duration of the coma (or up to

100% of the participant’s principal sum)

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In order to be covered, the loss must be the direct result of the covered accident and must have occurred within 365 days of the covered accident. For purposes of the AD&D benefit:

• Loss of sight means entire and irrecoverable loss of sight in the eye.

• Loss of thumb and index finger of same hand means that the thumb and index finger are permanently severed through or above the metacarpophalangeal joints.

• Loss of speech means the entire and irrecoverable loss.

• Loss of hearing means the entire and irrecoverable loss of hearing in both ears.

• Movement means the complete and irreversible paralysis of a limb.

• Traumatic brain injury means physical damage to the brain within 90 days after the covered accident and after at least five days in the hospital and that is certified by a physician at the end of 12 consecutive months to be permanent, complete and irreversible. The damage must prevent the injured person from performing all the substantial and material functions and activities of a person of like age and gender in good health.

• Coma means at least 30 continuous days of complete and continuous unconsciousness that begins within 30 days after the covered accident. It includes the inability to respond to external or internal stimuli as verified by a physician.

Participants should contact the Benefits Center for more information about what qualifies as a loss.

If more than one loss occurs

If a covered accident results in more than one covered loss to a covered individual, the AD&D benefit would pay for each loss, but not more than the principal sum. For example, if the participant lost movement in both lower limbs (75% benefit), and sight in one eye (50% benefit), the total benefit would be 100% of the participant’s principal sum.



Additional AD&D benefits

If AD&D benefits are paid as the result of a covered accident, additional benefits may be paid, as described on the following pages. Restrictions and limitations apply. Participants should contact the Benefits Center for details.

AD&D benefit Description

Common disaster A higher benefit is paid for the participant’s spouse if the participant and his covered spouse die as the result of the same covered accident or in separate covered accidents that occur within 24 hours of each other.

Child education* Child education benefits are available if the participant or his covered spouse dies as a result of injuries suffered in a covered accident.

The benefit is the lesser of:

• The actual cost; or

• An annual amount equal to 20% of the participant’s or his spouse’s principal sum, up to a maximum AD&D benefit of $25,000 per year.

The minimum benefit is $2,500.

The benefit may be payable annually for up to four consecutive years to each of the participant’s covered children. The child must be enrolled as a full-time student (at least 12 course credit hours per semester) in an accredited post-high school institution on the date of the death or must enroll within 365 days of the death.

Before the AD&D benefit is paid each year, the covered child may be required to present written proof of full-time, higher learning institution enrollment to the claims administrator.

If the participant and his covered spouse die simultaneously, AD&D benefits under this provision will not exceed the overall maximum applied to the combined total of the participant’s and his spouse’s principal sums.

(continued)

* If there is no surviving dependent who qualifies for this benefit, an AD&D benefit of $2,500 (for the child education or spouse education benefit) or $1,000 (for the day care benefit) will be paid to the participant’s designated beneficiary.

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Seat belt use (Includes child restraint device)

An additional benefit is paid if the participant or his covered dependent is injured or dies as a result of a motor vehicle accident and that person was wearing a properly fastened seat belt at the time of the accident.

Motor vehicle refers to a self-propelled, four or more wheeled vehicle not being used as a common carrier, including a:

• Private passenger car, station wagon, van or sport utility vehicle;

• Motor home or camper; or

• Pick-up truck.

Motor vehicle does not include farm equipment, snowmobiles, all-terrain vehicles, lawnmowers or any other type of equipment vehicles.

Common carrier is a conveyance operated by a concern, other than the company, organized and licensed for the transportation of passengers for hire and operated by that concern. It excludes conveyances hired or used for a sport, gamesmanship, contest, sightseeing, observatory and/or recreational activity, regardless of whether such conveyance is licensed.

Seat belt refers to an unaltered belt, lap restraint or lap and shoulder restraint installed by the manufacturer of the motor vehicle or proper replacement parts installed as required by the motor vehicle’s manufacturer’s specifications, or a child restraint device that meets the standard of the National Safety Council and is properly secured and used in accordance with applicable state law and installed according to the recommendations of its manufacturer for children of like age and weight.

Note that a police officer investigating the accident must certify that the seat belt was properly fastened. This certification must be included with the claim.

The benefit is equal to 10% of the covered person’s principal sum, up to a maximum of $25,000. The minimum benefit is $1,000. This benefit is payable to the covered person’s beneficiary.

Spouse education* If the participant dies as a result of injuries suffered in a covered accident, the spouse education benefit covers tuition and material expenses incurred within two years of the participant’s death for the participant’s spouse to obtain occupational training.

The maximum benefit is $25,000. The minimum is $2,500.

This benefit is payable to the participant’s surviving spouse who enrolls in occupational training (an education, professional or trade training program) within one year of the participant’s death. The training must prepare the participant’s spouse for an occupation for which he was not previously qualified.

(continued)

* If there is no surviving dependent who qualifies for this benefit, an AD&D benefit of $2,500 (for the child education or spouse education benefit) or $1,000 (for the day care benefit) will be paid to the participant’s designated beneficiary.




Day care benefit* The day care benefit is available if the participant or his covered spouse dies as a result of injuries suffered in a covered accident.

The benefit is the lesser of:

• The actual cost; or

• 10% of the participant’s or his spouse’s principal sum, up to a maximum benefit of $10,000 per year.

The minimum benefit is $1,000.

The benefit is payable for up to four years for each of the participant’s covered children who is enrolled in day care on the date of the death or who enrolls within 365 days of the death. Benefits stop when a child reaches age 12.

Note that child care must be provided either by:

• A licensed day care center or a facility operated by a licensed day care provider that charges for its services; or

• Someone who provides child care on a daily basis for 12 months a year and charges for his services.

The child care provider cannot be the participant’s beneficiary.

*Ifthereisnosurvivingdependentwhoqualifiesforthisbenefit,anAD&Dbenefitof$2,500(forthechildeducationorspouseeducationbenefit)or$1,000(forthedaycarebenefit)willbepaidtotheparticipant’sdesignatedbeneficiary.


The participant can name or change his beneficiary designation at any time online by going to My HR Tools and clicking on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Or, he can call the Benefits Center at (800) 965-4421.

The participant’s beneficiary receives his AD&D benefits if the participant dies. The participant chooses (or designates) his beneficiary.



• The participant can name one or more contingent beneficiaries. Contingent beneficiaries receive the participant’s AD&D benefits if all of the participant’s primary beneficiaries die before the participant.




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• For spouse and dependent child AD&D benefits, benefits are always paid to the participant. No exceptions.

IF A BENEFICIARY IS NOT NAMEDIf the participant does not name a beneficiary the participant’s AD&D benefit will be paid in the following order:




• The insured’s brothers and sisters; or


If the beneficiary survives the participant for any period of time and then dies, the participant’s AD&D benefit will be paid to the beneficiary’s estate.

Any payments made will relieve the claims administrator of all liability for AD&D benefits under the plan.

FILING CLAIMS

Claims must be received by the Benefits Center within 30 days after the date of the death or covered loss or as soon as reasonably possible. Proof of loss should be submitted within 90 days after the date of death.


• The covered person’s and employee’s name;

• The covered person’s and employee’s Social Security number;

• The date of the accident or death; and


– Name;

– Address;


– Relationship to the deceased.

The claims administrator must be provided with a certified copy of the death certificate. In addition, the claims administrator may ask for additional documents (for example, a copy of trust or estate documents).




HOW BENEFITS ARE PAIDOnce the claim has been approved, benefits will be paid as soon as the insurance company receives proof supporting the claim. Most AD&D benefits are paid in a single lump-sum payment to the participant or to his designated beneficiary(ies).


WHEN BENEFITS ARE NOT PAIDAD&D benefits will not be paid if the death or injury was caused by, contributed to or the result of:

• Suicide or attempted suicide, whether sane or insane.

• Intentionally self-inflicted injury.

• War or act of war, whether declared or not, in certain countries (participants should contact the Benefits Center for the list of current countries, which is subject to change).

• Service as a full-time member of the armed forces (land, water, air) of any country or international authority except Reserve National Guard Service.

• Travel on any aircraft:

– As a student pilot, crew member or pilot, unless the aircraft is owned or leased on behalf of the company;

– As a flight instructor or examiner; or

– Being used for tests, experimental purposes, stunt flying, racing or endurance tests.

• Intake of drugs, including but not limited to sedatives, narcotics, barbiturates, amphetamines or hallucinogens, unless as prescribed by or administered by a physician.

• Committing or attempting to commit a felony.

• Injury while intoxicated. Intoxicated means the individual meets or exceeds the legal definition of intoxication, or of being under the influence, under the law of the state in which the incident occurred when measured by the individual’s:

– Blood alcohol content;

– Results of other means of testing blood alcohol level; or

– Results of other means of testing other substances.

This document provides a general description of the primary features and characteristics of the AD&D benefit provided under the plan. Refer to the policy for a detailed description of the insurance coverage, including the exclusions, limitations, restrictions, and termination. In the event of a discrepancy between this document and the policy, the terms of the policy shall apply. All benefits are subject to the terms and conditions of the policy.

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P H I L L I P S 6 6 l E M E R G E N C Y R E S P O N D E R S I N S U R A N C E l 2 0 1 8 K - 1

PHILLIPS 66 EMERGENCY RESPONDERS INSURANCE

Benefits summary ..................................................K-2

Important ERISA information ...............................K-2

Eligibility and enrollment .....................................K-3Employee eligibility ............................................. K-3Enrollment .......................................................... K-3Coverage during a leave of absence ................. K-3When coverage ends ......................................... K-3

How the plan works ...............................................K-4Emergency responders benefits .......................K-4

Aggregate loss maximum .............................K-6Other benefits .....................................................K-6

Naming a beneficiary ............................................K-8If a beneficiary is not named .............................K-9

Filing claims ...........................................................K-9If a claim is denied ........................................... K-10How benefits are paid ...................................... K-10When benefits are not paid ............................. K-10

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Group Life Insurance Plan.” The emergency responders benefit is a component of the plan.


• “Participant” is defined as an employee:

– Who has satisfied the eligibility and participation requirements specified in this Emergency Responders Insurance chapter;

– Who has been automatically enrolled in that coverage; and

– Whose participation has not terminated under any other applicable provisions of the emergency responders benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the emergency responders benefit provided under the plan. The Other Information chapter includes important legal information related to the plan.



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BENEFITS SUMMARYEmergency responders benefits offered under the plan provide the participant’s family with valuable financial protection in the event of his death, dismemberment or other covered loss due to a covered accident.

This coverage is in addition to any basic, supplemental, spouse, child life, accidental death and dismemberment, and occupational accidental death (OAD) insurance available under provisions of the plan.

The company pays the full cost of coverage for the emergency responders benefit under the plan.

IMPORTANT ERISA INFORMATIONThis Emergency Responders Insurance chapter is intended to provide participants with an understanding of the emergency responders coverage provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.






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ELIGIBILITY AND ENROLLMENTEMPLOYEE ELIGIBILITYAn eligible employee is:


• A U.S. citizen or resident alien employee working in the U.S. who is paid on the direct U.S. dollar payroll; and

• Recorded on company records as a trained and active member of an Emergency Rescue Unit prior to the emergency event at Bayway, NJ; Los Angeles, CA; Santa Maria, CA; or Rodeo, CA work locations.


• An employee on a leave of absence or family medical leave of absence (FMLA).

• An employee in a classification that is not described above.


For example, temporary employees, intermittent and recurring seasonal employees, independent contractors and commission agents or any employee not classified as an emergency responder at the listed locations are not eligible to participate in the emergency responders benefit.

ENROLLMENTThere are no enrollment requirements for emergency responders benefits under the plan. Coverage begins automatically once a participant meets the eligibility requirements.

COVERAGE DURING A LEAVE OF ABSENCEIf a participant is on a leave of absence or a leave of absence-Labor Dispute, the emergency responders benefit under the plan is suspended until he returns to work and meets the eligibility requirements.

WHEN COVERAGE ENDSCoverage will end on the earliest of the following events:

• The date on which the participant’s employment ends for any reason.

• The date on which the participant no longer meets the plan’s eligibility requirements.

• The date the participant goes on a leave of absence or leave of absence-Labor Dispute.

• The date on which the participant’s coverage is terminated for any other reason not stated in this section.


• The date the company terminates the emergency responders benefit under the plan.

• The date on which the plan is terminated.



HOW THE PLAN WORKSEMERGENCY RESPONDERS BENEFITSThe amount of coverage — the principal sum — is $509,000. The following table shows the percentage of the principal sum that a participant or his beneficiary would receive in the event of the participant’s death or severe injury resulting from a covered accident.

For the following covered loss1 …The emergency responders benefit pays this portion of the total principal sum2 …

Loss of life 100%

Loss of both hands or both feet or sight in both eyes

100%

Loss of one hand and one foot 100%

Loss of a hand permanently severed through or above the wrist joint

75%

Loss of a foot permanently severed through or above the ankle

75%

Loss of hand or foot and sight in one eye 100%

Loss of sight in one eye 50%

Loss of the thumb and index finger of same hand 25%

Loss of speech and loss of hearing 100%

Loss of speech or loss of hearing 50%

Movement3 of both arms and both legs (quadriplegia)

100%

Movement3 of both legs (paraplegia) 100%

Movement3 of the arm and leg on either side of the body (hemiplegia)

50%

Movement3 of one arm or leg (uniplegia) 25%

Traumatic brain injury4 100%

Coma5 1% monthly beginning on the 8th day of the coma for the duration of the coma, to a maximum of 100% of the principal sum, less all other payments from the dismemberment and permanent total disability benefits.

(continued)

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For the following covered loss1 …The emergency responders benefit pays this portion of the total principal sum2 …

Critical burn Cost of reconstructive surgery resulting from a covered dismemberment and/or paralysis benefit, up to a maximum of $500,000, due to burns more severe than second degree burns that result in scarring over at least 25% of the body that will last indefinitely and can only be corrected through reconstructive surgery.

Permanent total disability6 Up to a maximum of $500,000 payable in installments of 1.64% of the principal sum monthly up to a maximum of 60 months and beginning after the disability commencement and qualification periods.7

1 Loss means:– Loss of sight means total and permanent loss of sight.– Loss of thumb and index finger of same hand means actual severance through or above the metacarpophalangeal joint of

a thumb or index finger. – Loss of speech means total and permanent loss of speech. – Loss of hearing means total and permanent loss of hearing. – Loss of hand or foot means actual severance through or above wrist or ankle joints.

2 In the event of a covered accident, no more than the principal sum will be paid as a result of a single accident with multiple losses.

3 Movement means the permanent, complete and irreversible paralysis of such limbs. 4 Traumatic brain injury means physical damage to the brain which, at the end of 12 consecutive months, a physician has

certified is permanent, complete and irreversible and prevents the insured person from performing all the substantial and material functions and activities of a person of like age and gender in good health. The traumatic brain injury must result in hospitalization for at least 7 days during the first 60 days following the accident and continue for 12 consecutive months.

5 Coma means a profound state of unconsciousness from which the Insured cannot be aroused to consciousness, even by powerful stimulation, as determined by a Physician. Such state must begin within 31 days of the accidental injury and continue for 7 consecutive days.

6 Permanent total disability means the insured person is totally and continually disabled preventing an Insured from performing the material and substantial duties of any occupation for which the Insured is qualified by reason of education, training, or experience. Benefits will be paid provided the injury occurred before age 70 and total disability began within the 30-day disability commencement period and continues without interruption for at least 12 months. Payments will cease the earlier of: the participant ceases to be permanently totally disabled, or the total sum of all benefits paid equals the full amount due of the principal sum, or the date the participant dies.

7 Total payable combined for loss of life and permanent total disability due to the same accident will not exceed the principal sum.

If a participant is exposed to the elements because of a covered accident due to forced landing, stranding, sinking or wrecking of a conveyance in which he was an occupant at the time of the accident and the forced landing, stranding, sinking or wrecking results in a loss of life or injury, the principal sum or benefit portion of the principal sum will be paid. It will be presumed the participant suffered a loss of life if his body has not been found within one year after a covered accident involving the disappearance of a conveyance in which he was an occupant at the time due to accidental forced landing, stranding, sinking or wrecking.



Aggregate loss maximum

The plan has an aggregate maximum whereby it pays no more than $2,500,000 for all covered losses and injuries sustained by all insured persons under this plan as a result of any one covered accident or series or combination of covered accidents directly arising out of one or more associated events.

• Events are associated if they have a common cause or are a chain of events forming part of a larger or broader event even if the individual events themselves are separate in time and place.

• If the total amount claimed by all insured persons is greater than this amount, then the amount paid to each insured person will be reduced in the same proportion, so that the total amount does not exceed $2,500,000.

The loss must be the direct result of the covered accident and must be incurred within 365 days after the accident.

OTHER BENEFITSIf emergency responders benefits are paid as the result of a covered accident, the following benefits may also apply:

Emergency responders benefit Description

Seat belt & air bag See the Glossary, which begins on page N-60 of the Other Information chapter, for the definitions of “air bag” and “private automobile.”

• The seat belt emergency responders benefit is equal to 10% of the principal sum, up to a maximum emergency responders benefit of $25,000.

• The air bag emergency responders benefit is equal to 5% of the principal sum, up to a maximum emergency responders benefit of $10,000.

• It is payable if the participant sustains an injury as a result of an automobile accident, and he was: – In an accident while driving or riding as a passenger in a private passenger

automobile designed for use primarily on public roads; and – Wearing an original, equipped, factory installed or manufacturer authorized

and unaltered seat belt or lap and shoulder restraint that was properly fastened at the time of the accident.

• A police officer investigating the accident must certify that the seat belt was properly fastened. A copy of such certification must be submitted with the claim for benefits.

• If the seat belt benefit is payable, the air bag benefit is payable if the participant was positioned in a seat equipped with a factory-installed air bag and properly strapped in the seat belt when the air bag inflated.

Accident medical expense

• The accident medical expense benefit is a maximum of $2,500 for only reasonable expenses in excess of any medical care benefits provided by any other plan.

• The first expense must be incurred within 52 weeks after the covered accident, and expenses are covered up to five years after the covered accident.

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Felonious assault • The felonious assault benefit is the lesser of 20% of the principal sum or $20,000.

• It is payable to the participant, if alive, or to his beneficiary if proof is provided that the injury resulted in a payable benefit within 365 days of the injury and was a result of a violent or criminal act directed at the participant during the course of a criminal act; or any attempt of same which constitutes a felony under the law. The act must be committed by someone other than the participant, his immediate family (spouse, the participant’s or spouse’s parents, children (natural, step or adopted), siblings, grandparents or grandchildren) or a member of the participant’s household or an employee of the company.

Human immunodeficiency virus (HIV) Occupational Accident

• The HIV benefit is 20% of the principal sum.

• It is payable to the participant, if alive, or to his beneficiary if the participant sustains an accidental cutaneous exposure through abraded skin, percutaneous exposure or mucocutaneous exposure in a covered accident while in the performance of his occupational duties and provides proof of a Workers’ Compensation injury report to the company within 48 hours of the injury and the participant submits results of a negative blood test for HIV and AIDS related complex (ARC) within 48 hours of the injury; and he tests positive for HIV or ARC within 52 weeks after the date of the injury.

Rehabilitation training • The rehabilitative training benefit is the lesser of 10% of the principal sum or $25,000.

• It is payable to the participant for rehabilitative training within 365 days of the covered accident that is required for his injury or to prepare him for an occupation in which he would not have engaged except for the loss due to the injury. The expense must be incurred within two years of the date of the covered accident.

Therapeutic counseling • The therapeutic counseling benefit is 10% of the principal sum, up to a maximum of $25,000.

• It is payable to the participant after charges are provided for therapeutic counseling (to treat an emotional or psychological condition resulting from the covered loss) that has been prescribed by the attending physician within 90 days and provided within one year of the covered accident. A licensed therapist or registered or certified counselor must provide the counseling.

(continued)




Accident Weekly Indemnity

• The disability benefit is $1,250 per week.

• It is payable to the participant weekly, beginning on the eighth day of his complete and continuous inability to perform all the duties of his regular occupation if that disability is a direct result within 30 days of an injury from a covered accident and the participant requires the regular care of a physician.

• The benefit is payable until the earliest of the date: – The participant dies; – The participant fails to submit required proof of disability; – The participant no longer meets the disability provisions; or – 26 weeks of benefit payments have been paid.

Home alteration & vehicle modification

• The home alteration & vehicle modification benefit is 10% of the principal sum, to a maximum of $25,000.

• It is payable to the participant if, due to an injury from the covered accident, the participant is required to use a wheelchair to be ambulatory on a permanent basis and modifications are needed to make the primary residence wheelchair accessible and habitable or the private automobile drivable or accessible by the participant. The modifications must be one-time costs, recommended by a recognized organization associated with the covered loss and provided by a person experienced in such modifications. Vehicle modifications must be approved by the Motor Vehicle Department.


The participant can name or change his beneficiary designation at any time online by going to My HR Tools and clicking on the UPoint tile. No additional password is needed. (My HR Tools can also be accessed from the Internet at hr.phillips66.com > Resources > Employee Self-Service.) Or, the participant can call the Benefits Center at (800) 965-4421.

The participant’s beneficiary receives his emergency responders benefits if the participant dies from covered injuries sustained as a result of a covered accident while covered under the plan. The participant chooses (or designates) his beneficiary.





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• The participant can name one or more contingent beneficiaries. Contingent beneficiaries receive the emergency responders benefits if all of the participant’s primary beneficiaries die before the participant.






IF A BENEFICIARY IS NOT NAMEDIf the participant does not name a beneficiary— the participant’s emergency responders benefit will be paid in the following order:




• The insured’s brothers and sisters;


If the beneficiary survives the participant for any period of time and then dies, the participant’s emergency responders benefit will be paid to the beneficiary’s estate.

Any payments made will relieve the claims administrator of all liability for emergency responders benefits under the plan.

FILING CLAIMS

Claims must be received by the Benefits Center within 30 days after the date of the death or covered loss or as soon as reasonably possible. Proof of loss should be submitted within 90 days after the date of death.


• The participant’s name;

• The participant’s Social Security number;

• The date of the accident or death; and


– Name;

– Address;


– Relationship to the participant.

The claims administrator must be provided with a certified copy of the death certificate. In addition, the claims administrator may:

• Ask for additional documents (for example, a copy of trust or estate documents).

• Require an autopsy (provided that an autopsy is not prohibited by local law). The plan pays for the requested autopsy.

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HOW BENEFITS ARE PAIDOnce the claim has been approved, the plan will pay benefits as follows:

• If the participant dies, emergency responders benefits will be paid to his designated beneficiary(ies).

• All other emergency responders benefit payments will be paid to the person(s) designated by plan provisions.

Benefits are paid to the participant or his beneficiary(ies) in a lump sum.


WHEN BENEFITS ARE NOT PAIDEmergency responders benefits are not payable for injuries or death caused by, contributed to or resulting from any of the following conditions:

• Suicide or attempted suicide.

• Intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury.

• Being legally intoxicated while operating a motor vehicle.

• Involvement in any type of active military service. For purposes of this exclusion, orders to active military service for thirty (30) days or less will not be considered involvement in active military services.

• Any incident related to travel on any aircraft unless, and only to the extent, benefits are specifically described in the policy.

• War or act of war, whether declared or undeclared.

• Illness or disease; medical or surgical treatment of illness or disease; or complications following the surgical treatment of illness or disease; except for accidental ingestion of contaminated foods.

This document provides a general description of the primary features and characteristics of the emergency responders benefit provided under the plan. Refer to the policy for a detailed description of the insurance coverage, including the exclusions, limitations, restrictions, and termination. In the event of a discrepancy between this document and the policy, the terms of the policy shall apply. All benefits are subject to the terms and conditions of the policy.

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PHILLIPS 66 RETIREE MEDICAL

Phillips 66 retiree medical benefit options........ L-2Non-Medicare eligible options ........................... L-2Medicare eligible options ...................................L-4

Important ERISA information ............................... L-5

Eligibility and enrollment ..................................... L-6Eligibility ...............................................................L-6

Retiree eligibility .............................................L-6Surviving spouse/domestic partner/

eligible dependent child eligibility ............ L-7Dependent eligibility ...................................... L-7If the participant is eligible for Medicare

and his dependent is not (or vice versa) .........................................................L-9

If a participant (or his dependent) is enrolled in the non-Medicare eligible option but later becomes eligible for Medicare ....................................................L-9

Tell the Benefits Center about other coverage ..................................................L-10

Enrolling in, changing or cancelling coverage .......................................................L-10

Paying coverage premiums...............................L-10Enrollment .........................................................L-11

Annual benefits enrollment .........................L-11Changing elections midyear .............................L-12

Midyear election changes due to a qualified change in status event ............L-12

Midyear election changes under HIPAA special enrollment provisions .................L-14

When coverage ends ........................................L-14For the non-Medicare eligible options ........L-14For the Medicare eligible options ................L-15

Continuing coverage through COBRA ..............L-16Continued coverage for surviving

dependents ..................................................L-16If the participant’s surviving spouse or

domestic partner is a Phillips 66 employee or retiree ......................................L-16

Rehired employees ........................................... L-17

Understanding the non-Medicare eligible options .................................................................. L-17

The HDHP and PPO options .............................. L-17Kaiser HMO .......................................................L-18Health Coverage Resources Exchange

options ..........................................................L-18

Understanding the Medicare eligible options .................................................................. L-18

Aon Retiree Health Exchange options .............L-18Medicare-eligible PPO option ...........................L-19

Covered and not covered services ..............L-19Kaiser HMO .......................................................L-20

Medicare Part D ................................................... L-20Creditable prescription drug coverage ............L-20

Health savings accounts (HSA) .......................... L-22HSA eligibility .....................................................L-22

Appendix A — Retiree Medical Accounts (RMA) ..................................................................... L-22

How an RMA balance is used to offset premiums .....................................................L-24

Appendix B — Other important information ..... L-25

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IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Medical and Dental Assistance Plan.” The retiree medical benefit (including prescription benefit) and Retiree Medical Account (RMA) are components of the plan.


• When describing elections (for example, enrollment, coverage changes), “participant” is defined as a retiree or qualified dependent:

– Who has satisfied the eligibility and participation requirements specified in the retiree medical benefit;

– Who has enrolled in the retiree medical benefit; and

– Whose participation has not terminated under any other applicable provisions of the retiree medical benefit.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the retiree medical benefit under the plan. The Other Information chapter includes important legal information related to the plan.



PHILLIPS 66 RETIREE MEDICAL BENEFIT OPTIONSPhillips 66 offers several retiree medical benefit options. The following sections will describe the health care coverage options a participant may be eligible for depending on the participant’s age and eligibility for Medicare.*

Phillips 66 does not subsidize the cost of retiree medical coverage. However, some retirees may have credits available in an RMA that can be used to offset all or part of their medical monthly premiums. See Appendix A — Retiree Medical Accounts (RMA) on page L-22.

NON-MEDICARE ELIGIBLE OPTIONSIn general, a participant is eligible for the non-Medicare eligible options if he is an eligible retiree or dependent who is not eligible for Medicare. Generally, a participant may not be eligible for Medicare if he is:

• Under age 65; or

• Age 65 or over and:

– Does not qualify for Social Security retirement benefits; or

– Is not a U.S. citizen; or

– Is not a permanent U.S. resident who has lived in the U.S. continuously for five years prior to applying for Medicare.

For assistance in determining whether an individual may be eligible for a non-Medicare eligible option, participants should contact the Benefits Center at (800) 965-4421.

* Medicare eligibility provisions are subject to change based on federal regulations and legislation. Participants should also reference Medicare.gov for the most recent provisions, which may not qualify an individual as Medicare eligible.

http://Medicare.gov

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Non-Medicare eligible options

HDHP option*

And

PPO option

For both the HDHP and PPO options, coverage is provided through either Aetna or BlueCross BlueShield of Texas (BCBSTX), based on the primary participant’s home ZIP code.

The HDHP option and the PPO option, in most cases, cover the same services and supplies, as well as share the same provider network. However, there are important differences between these two options, which are detailed in the Employee Medical chapter.

The HDHP and PPO options are described in the Employee Medical chapter (pages B-14 – B-59).

Kaiser Health Maintenance Organization (Kaiser HMO)

Kaiser HMO is available only to retirees in California who live within the Kaiser service area.

• Kaiser HMO information is summarized on page B-64 of the Employee Medical chapter. Participants will receive a separate Evidence of Coverage (EOC) from Kaiser HMO that describes coverage details.

• Some parts of this handbook will still apply to Kaiser HMO participants’ coverage. See Understanding Kaiser HMO on page B-64 of the Employee Medical chapter for more information.

Healthcare Exchange

Phillips 66 retirees can access resources to help identify health insurance options available to them by contacting Health Coverage Resources (healthcoverageresources.com/Phillips66/home).

The options available on the exchange will vary based on the retiree’s Medicare eligibility and where he lives.

Note: Retirees eligible for the Phillips 66 RMA may use their credits to offset all or part of their medical monthly premiums for all of the options listed above.

* The HDHP option is a qualified high deductible health plan and is the only option for retirees who want to contribute to a health savings account. See Health savings accounts (HSA) on page L-22, as well as the Flexible Spending Plan chapter, for information.

Participants who meet the eligibility criteria above can learn more about their coverage options by:

• Contacting the Benefits Center at (800) 965-4421; or

• Contacting Health Coverage Resources through healthcoverageresources.com/Phillips66/home.

Participants can use the tools available on UPoint or check with a personal tax advisor to help identify the best option.

See also If a participant (or his dependent) is enrolled in the non-Medicare eligible option but later becomes eligible for Medicare on page L-9 and Understanding the Medicare eligible options on page L-18.







MEDICARE ELIGIBLE OPTIONSThe available Medicare eligible options depend on the individual’s age and eligibility for Medicare.

Aon Retiree Health Exchange optionsAvailable only for those OVER age 65 and eligible for Medicare

Eligibility In general, a participant is eligible for the Medicare eligible options offered through the Aon Retiree Health Exchange if he is an eligible retiree or dependent who:

• Is age 65 or over and eligible for Medicare*; and

• Is enrolled in Medicare Parts A and B; and

• Has a U.S. mailing address.

Description Phillips 66 does not offer medical options for participants who are over age 65 and Medicare eligible. However, an individual may obtain medical coverage by enrolling in a health plan through the Aon Retiree Health Exchange (retiree.aon.com). The options available through the Aon Retiree Health Exchange will vary based on Medicare eligibility and where the individual lives.

Medicare-eligible PPO optionAvailable only for those UNDER age 65 and eligible for Medicare

Eligibility Participants under age 65 who are eligible for Medicare* may be eligible for the Medicare-eligible PPO option available through Phillips 66. To qualify for Medicare while under age 65, an individual generally must be:

• Entitled to Social Security disability benefits for at least 24 months (which need not be consecutive);

• Receiving a disability pension from the Railroad Retirement Board and meet certain conditions;

• Diagnosed with Lou Gehrig’s disease (amyotrophic lateral sclerosis), which qualifies the individual immediately;

• Diagnosed with permanent kidney failure requiring regular dialysis or a kidney transplant — and the individual or the individual’s spouse has paid Social Security taxes for a certain length of time, depending on age.

Description For the Medicare-eligible PPO option, coverage is provided through either Aetna or BlueCross BlueShield of Texas (BCBSTX), based on the participant’s home ZIP code.

• The Medicare-eligible PPO option does not pay benefits for expenses that are covered by Medicare. An eligible individual may choose to enroll in the Medicare-eligible PPO option with or without pharmacy coverage.

• If an individual is enrolled in Medicare Part D, he may choose to enroll in the medical only option (without pharmacy coverage).

The Medicare-eligible PPO option, in most cases, covers the same services and supplies as well as shares the same provider network as the PPO option available to non-Medicare eligible participants.

The PPO option is described beginning on page B-14 of the Employee Medical chapter.

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Kaiser HMOAvailable only for those UNDER age 65 and eligible for Medicare who live in California within the Kaiser HMO’s service area

Eligibility Participants must meet the same eligibility requirements listed in the Medicare-eligible PPO option row on the previous page AND live in California within the HMO’s service area.

Description Individuals must contact the Kaiser HMO directly to find out more information regarding eligibility and how to enroll.

They should also read the Kaiser HMO’s Evidence of Coverage (EOC), contact Kaiser HMO for information on the specific benefits provided by that option and reference page B-64 of the Employee Medical chapter for additional information on the Kaiser HMO.

RMA

Retirees eligible for the Phillips 66 RMA may use their credits to offset all or part of their medical monthly premiums for all of the options listed above.

* Medicare eligibility provisions are subject to change based on federal regulations and legislation. Participants should also reference Medicare.gov for the most recent provisions, which may qualify an individual as Medicare eligible.

Participants can contact the Benefits Center for assistance in determining whether an individual may be eligible for a Medicare eligible option.

Eligible participants can learn more about their coverage options by:

• Contacting the Benefits Center at (800) 965-4421; or

• Contacting the Aon Retiree Health Exchange through retiree.aon.com or by calling (844) 335-9044.

IMPORTANT ERISA INFORMATIONThis Retiree Medical chapter is intended to provide participants with an understanding of the retiree medical benefit provided under the plan. There is also other important legal information related to the plan included in the Other Information chapter beginning on page N-1.








http://Medicare.gov





Retiree eligibility

A participant is eligible for retiree medical coverage if all of the following applied when his employment ended or employment status changed:

• He was a U.S. citizen or U.S. resident alien;

• He was a non-store employee paid on the direct U.S. dollar payroll; and

• He met the following age and service requirements:

Retiree age and service requirements

If the participant was at least age 45 and was employed at Phillips 66 on December 31, 2012

The participant was at least age 50 and had 10 or more years of service with the company when employment ended. The total of age and years of service on his employment end date must have been at least 65.

For example, the participant was eligible if he was 52 years old and had 13 years of service (52 + 13 = 65). He was not eligible if he was 58 years old and had 7 years of service. Even though age and years of service equaled 65 (58 + 7 = 65), he had not met the minimum 10-year service requirement.

If a participant was NOT at least age 45 and employed by Phillips 66 on December 31, 2012, he must have satisfied the age and service requirements described in the row below.

For all other retirees The participant was at least age 55 and had 10 or more years of service with the company when employment ended.

A participant’s years of service is the difference between employment end date and service award entry date (SAED).

Different eligibility provisions may apply in some instances. The individual should contact the Benefits Center for information if he was:

• Disabled and receiving long-term disability (LTD) benefits under the Phillips 66 Disability Plan at the time employment ended;

• On a leave of absence-Labor Dispute; or

• Qualified for Phillips 66 retiree medical coverage while, or prior to, participating in coverage as an active employee of Phillips 66 and changed to an employment status or hours making him ineligible for such active coverage.

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Surviving spouse/domestic partner/eligible dependent child eligibility

A surviving spouse, domestic partner or dependent child is eligible if the individual is:

• A surviving spouse/eligible dependent child of an employee or retiree who was, or would have been, eligible for the retiree medical benefit under the plan; or

• A surviving domestic partner of an employee or retiree who was, or would have been, eligible for this plan, provided the surviving domestic partner was enrolled in the employee’s or retiree’s medical coverage on the date of the retiree’s death.

Surviving children of a domestic partner are not eligible for retiree medical coverage.

See Continued coverage for surviving dependents on page L-16 for more information.


Dependents are enrolled in the plan upon completion of the dependent verification process. The process includes certifying that the person is an eligible dependent and may require providing documents (for example, a birth certificate or a marriage license) that verify this status. The participant is required to provide dependent verification documents required under the plan within 60 days of enrollment. Participants should contact the Benefits Center for forms and information.

As indicated in the dependent eligibility chart below, dependent eligibility is partially based on age.

Dependent age requirements

For the:

• HDHP option

• PPO option

• Kaiser HMO*

• Non-Medicare eligible options available through the Healthcare Exchange

• Medicare-eligible PPO option

In general:

• A spouse or domestic partner must be: – Under age 65; – Age 65 or over and not eligible for Medicare; or – For the Medicare-eligible PPO option, under age 65 and eligible

for Medicare.

• A child must be under age 26.**

For the Medicare eligible options available through the Aon Retiree Health Exchange

A spouse, domestic partner or child*** must be age 65 or over, have a U.S. mailing address and be enrolled in Medicare Parts A and B.

* Participants enrolled in the HMO option should refer to the Kaiser HMO’s Evidence of Coverage for additional eligibility requirements.

** A child age 26 or older may be eligible for coverage, provided he was disabled prior to attaining age 26 and coverage is approved by the plan within the deadline. Participants should contact the Benefits Center for information.

*** A child age 65 or over is eligible for coverage if he was disabled prior to attaining age 26 and coverage is approved by the plan within the deadline. Participants should contact the Benefits Center for information.



Refer to the chart below for additional details on dependent eligibility.

Dependent eligibility* Yes No

The participant’s spouse (including a state-recognized common-law spouse) or domestic partner (as defined in the Glossary, which begins on page N-60 of the Other Information chapter) that meets the age requirements shown on the previous page

X


X

The participant’s biological, legally adopted, placed for adoption or foster child (as defined in the Glossary, which begins on page N-60 of the Other Information chapter) that meets the age requirements shown on the previous page

X

The participant’s stepchild that meets the age requirements shown on the previous page, provided:



X

The participant’s domestic partner’s biological or legally adopted child that meets the age requirements shown on the previous page, provided:




X



X


X


X



* Participants enrolled in the HMO option should refer to the Kaiser HMO’s Evidence of Coverage for additional eligibility requirements.

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• Already covered under another Phillips 66 medical benefit as an employee, retiree, COBRA participant or dependent.


A participant is required to notify the Benefits Center within 30 days if an enrolled dependent is no longer eligible for coverage (for example, following a divorce or a child reaching the plan’s age limits).



If a participant enrolls a dependent who does not meet the plan’s requirements or fails to cancel coverage within 30 days of the date on which the dependent ceases to meet the requirements, the dependent will be considered ineligible under the plan.



• The participant may be subject to termination of coverage.


If the participant is eligible for Medicare and his dependent is not (or vice versa)

If the participant is eligible for Medicare and enrolled in a Medicare eligible option, his non-Medicare eligible dependent may be eligible to enroll in a non-Medicare eligible option.

Likewise, if the participant is not eligible for Medicare and enrolled in a non-Medicare eligible option, his Medicare eligible dependent may be eligible to enroll in a Medicare eligible option.

Participants should contact the Benefits Center for more information.

If a participant (or his dependent) is enrolled in the non-Medicare eligible option but later becomes eligible for Medicare

The participant must inform the Benefits Center within 30 days if he or a covered dependent becomes eligible for Medicare for any reason.

Also, to avoid Medicare late enrollment penalties, retirees age 65 or over should contact the Benefits Center at least three months prior to their retirement date.

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Once the participant has notified the Benefits Center, his coverage is affected as follows:

For the participant who became eligible for Medicare …

If Medicare eligibility is due to the participant reaching age 65 …

The participant must contact the Benefits Center to learn more about coverage options through the Aon Retiree Health Exchange.

If the Medicare eligible participant is under age 65 …

The Medicare-eligible PPO option is the participant’s only Phillips 66 retiree medical option available.* The participant must contact the Benefits Center.

Participants in California who live within the Kaiser HMO service area can choose the Kaiser HMO option by contacting Kaiser HMO directly.

* More options may be available through the Health Exchange at healthcoverageresources.com/phillips66/home.



In addition, once every calendar year, the claims administrator will ask whether anyone in the enrolled family has other medical coverage. The participant can respond by mail or by calling toll-free. The participant must respond in order to have future claims paid. A prompt response will prevent delay in processing and paying claims.

ENROLLING IN, CHANGING OR CANCELLING COVERAGEThe rules vary between the non-Medicare eligible and the Medicare eligible options. For details, please see:

• Pages L-17 – L-18 (for the non-Medicare eligible options).

• Pages L-18 – L-20 (for the Medicare eligible options).

PAYING COVERAGE PREMIUMSParticipants pay the full cost of their Phillips 66 retiree medical coverage through:

• Automatic monthly deductions from the participant’s savings or checking account;

• Monthly payment to the Benefits Center or the claims administrator, as applicable; or

• If eligible, Phillips 66 RMA credits may be used to offset the cost of coverage. See Appendix A — Retiree Medical Accounts (RMA) beginning on page L-22 for details.

The enrollment materials will show the participant’s cost and payment options. Participants can also find the current premiums for the HDHP option, the PPO options and the pre-age-65 Kaiser HMO option on hr.phillips66.com.

Premium payments are due by the first of the month. If premiums are not paid on time, coverage may be cancelled retroactive to the last day of the month in which a payment was received.

Phillips 66 does not subsidize the cost of retiree medical coverage. However, some retirees may have credits available in an RMA that can be used to offset all or part of their retiree medical monthly premiums. See Appendix A — Retiree Medical Accounts (RMA) on page L-22.

http://healthcoverageresources.com/phillips66/home


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ENROLLMENT



Online at UPoint: • From a computer or mobile device, go to digital.alight.com/phillips66 and enter your UPoint user ID and password.


• Participants eligible for Medicare may also call Aon Retiree Health Exchange: (844) 335-9044

Participants may enroll in coverage or change enrollment elections as shown below, following the instructions provided in their enrollment materials. The Benefits Center can assist with questions.

When to enroll When coverage begins

When the participant first becomes eligible to participate in a Phillips 66 retiree option

To have coverage, the participant must enroll within 30 days of:

• The day he became eligible; or

• The last day of his employee coverage.

Coverage begins on the date the participant became eligible or the first day after his employee coverage ended.

When the participant first becomes eligible to participate as a surviving spouse/domestic partner/dependent

The surviving individual must enroll within:

• For Phillips 66 retiree medical coverage, within 30 days after the end of the month of the employee’s/retiree’s death (or by the date on the enrollment form, if later).

• For COBRA coverage, within 65 days after the end of the month of the employee’s/retiree’s death (or by the date on the enrollment notice form, if later). See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

The individual will not be eligible after that date.

If the surviving individual later cancels his coverage, he cannot re-enroll at a later date.

If enrollment is completed within the allotted time frame, coverage begins on the first of the month following the date of the employee’s/retiree’s death.

(continued)




When to enroll When coverage begins


The participant may enroll in or change retiree medical coverage elections each year during annual benefits enrollment.



When the participant first becomes eligible to participate, or any time after his 65th birthday

The participant may enroll at any time.

If he enrolls within 30 days of his 65th birthday, coverage begins on the first of the month of his birthday.*

Otherwise, coverage begins on the first of the month following his enrollment.

* If the participant’s birthday is ON the first of the month, coverage begins on the first day of the previous month.



For assistance with questions about qualified change in status events, participants should contact the Benefits Center at (800) 965-4421, 8:00 a.m. to 6:00 p.m. Central time, Monday through Friday. It is important that all midyear election changes be made within the applicable timeframe specified on the next page. Untimely midyear changes will not be permitted.






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To ADD a dependent

A participant has:

• 90 days to ADD a newborn, newly placed foster child, or newly adopted or placed for adoption child as a new dependent. If the above deadline is missed, the new child will be covered for the first 31 calendar days only and the participant will be required to wait until the next annual benefits enrollment to add him or her to the participant’s coverage. This applies even if the participant already has coverage for other dependents.

• 30 days to ADD a new dependent (other than a newborn, newly placed foster child, or newly adopted or placed for adoption child). If the above deadline is missed, the participant will be required to wait until the next annual benefits enrollment to add the dependent to the participant’s coverage. This applies even if the participant already has coverage for other dependents.


A participant has 30 days to REMOVE a dependent who is no longer eligible. If a participant fails to remove an ineligible dependent and the plan pays any medical claims on behalf of that dependent, the claims will be reprocessed and the participant will be required to reimburse the plan for the amount paid.

To make a change in coverage, the participant should go to My HR Tools and click on the UPoint tile. Alternately, he can call the Benefits Center at (800) 965-4421.


The following qualified change in status events allow, or require, changes to a participant’s medical elections:




• A qualified medical child support order (QMCSO) that requires the participant to provide medical coverage for a child. (QMCSOs are described on page N-8 of the Other Information chapter.)



















The participant should contact the Benefits Center or Aon Retiree Health Exchange for more information or to make changes depending on the plan in which he is enrolled.

WHEN COVERAGE ENDS

Note: If coverage is terminated or lowered during the month, no reimbursements for any difference in medical coverage level (You only, You + spouse, etc.) are made for the month.

For the non-Medicare eligible options





• The date the participant is eligible for the Employee Medical Plan if he is rehired by the company or if his employment status changes.

• The last day of the month before the participant becomes eligible for the Medicare eligible options.

• If the participant became eligible for this plan because he was on LTD benefits and his disability ends or his LTD benefits end:

– Coverage for the participant and his dependents ends on the last day of the month in which his LTD benefits end or he is no longer disabled (whichever is earlier).

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– Note: In the event of the participant’s death prior to the date his LTD benefits were scheduled to end, coverage for his surviving spouse and eligible dependents will continue until the last day of the month in which his death occurred. His surviving spouse and eligible dependents will be notified regarding their eligibility to continue coverage beyond that date.

• If the participant dies:

– Coverage for the participant ends on the date of death.

– Coverage for dependents who were enrolled under the participant’s coverage at the time of his death ends on the last day of the month in which the death occurred.


• The last day of the month in which the participant’s coverage is terminated for any other reason.





• The last day of the month before the dependent becomes eligible for the Medicare eligible options.

• For a surviving spouse/surviving domestic partner, the last day of the month in which a surviving spouse/surviving domestic partner remarries or establishes a new domestic partnership with someone who is not eligible under the plan.


If a participant or dependent is in the hospital on the day retiree medical coverage under the plan ends, and:

• He is NOT covered by another medical plan, the remainder of the hospital stay will be covered by this plan if:

– The hospitalization began before the participant’s coverage ended; and

– The participant had paid his costs for coverage up to the date coverage ended.

• He IS covered by another medical plan, this plan will pay benefits for the hospital stay through the last day of coverage, and the other plan will be responsible for expenses incurred after that date.

For the Medicare eligible options

Coverage for the participant and/or his dependents enrolled in the retiree medical benefit under the plan will end on the earliest of the following events:

• The last day of the month in which the participant or his dependents do not pay the required cost for coverage.

• The date of the participant’s death (coverage will continue until the last day of the month for his covered dependents).



CONTINUING COVERAGE THROUGH COBRAWhen coverage ends, the participant or his dependents may be eligible to continue non-Medicare coverage under COBRA. To elect COBRA, the participant and/or his dependents must enroll within 65 days of the day the non-Medicare coverage ends or, if later, within 65 days of the date of the COBRA Enrollment Notice. COBRA cannot be elected if this deadline is missed. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

COBRA coverage is not available when Medicare eligible coverage ends under the plan.

CONTINUED COVERAGE FOR SURVIVING DEPENDENTS

Note: This section does not apply to store employees or to the children of a domestic partner. A surviving dependent who does not qualify for survivor coverage (or who qualifies but chooses not to enroll in survivor coverage) may be eligible to continue coverage through COBRA. See COBRA continuation coverage on page N-11 of the Other Information chapter for details.

In the event of the participant’s death, his eligible dependents may be able to continue medical coverage under the plan. Retiree medical coverage for surviving covered dependents will continue until the last day of the month in which the participant’s death occurs. Enrolled dependents may be eligible to continue coverage through the plan or through COBRA.

If the participant’s surviving spouse and/or eligible children were not covered under the plan on the date of the participant’s death:

• Once the death has been reported to the Benefits Center, the surviving dependents will be notified if they are eligible for retiree medical coverage under the plan and given the chance to enroll.

• If the participant has a surviving spouse/domestic partner and eligible dependent children, his children (excluding children of the domestic partner) can enroll in a retiree medical option under the plan even if the surviving spouse/domestic partner does not enroll.

The participant’s surviving spouse or surviving domestic partner may be able to apply his unused RMA credits to offset some or all of the cost of retiree medical coverage under the plan. See Appendix A — Retiree Medical Accounts (RMA) on page L-22.

IF THE PARTICIPANT’S SURVIVING SPOUSE OR DOMESTIC PARTNER IS A PHILLIPS 66 EMPLOYEE OR RETIREEIf the participant’s surviving spouse/domestic partner is eligible for coverage as an active employee or retiree:

• He can enroll in medical coverage as an employee/retiree or as a surviving spouse/domestic partner; and then

• Cover any eligible children as dependents under that coverage.

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REHIRED EMPLOYEESIf a participant is rehired as an active employee, his retiree medical coverage will end on the date his coverage as an eligible active employee begins.

After that, when the participant leaves the company again, he can:

• Choose the retiree medical coverage for which he is eligible at that time; or

• If eligible, elect COBRA continuation coverage.

Note: The participant cannot enroll in retiree medical coverage and elect COBRA continuation coverage for medical coverage.

UNDERSTANDING THE NON-MEDICARE ELIGIBLE OPTIONSParticipants who meet the eligibility criteria may be eligible for the non-Medicare eligible options, which are:

• The PPO option;

• The HDHP option;

• The Kaiser HMO option, for participants in California within the HMO’s service area; and

• A public exchange option through Health Coverage Resources (healthcoverageresources.com/Phillips66/home).

These options are briefly described on this page and the following page. See Appendix B — Other important information on page L-25 for details on other portions of this handbook that apply to retiree medical benefits.

THE HDHP AND PPO OPTIONSThe HDHP and PPO options cover medically necessary medical, mental health and substance abuse, and prescription drug services and supplies. The following is a general description of the HDHP and PPO options:

• The HDHP and PPO options partner with claims administrators to provide benefits.



• Participants should reference pages B-14 – B-59 of the Employee Medical chapter for additional information regarding the HDHP and PPO options:

– Covered and non-covered services and supplies.

– Provider information.

– Pre-certification and pre-determination of benefits.

– Coverage while traveling.

– Mental health and substance abuse coverage.

– Prescription drug coverage.

– Traveling outside of the U.S.

– Filing claims.

– If a claim is denied.

– Coordination of Benefits (COB).

– Determining the primary plan.

– Coordination with Medicare.





KAISER HMOParticipants should contact the Kaiser HMO for information on the specific benefits provided by that option. Participants should also reference page B-64 of the Employee Medical chapter for additional information on the Kaiser HMO and read the Kaiser HMO’s Evidence of Coverage (EOC) to learn about the benefits provided by the Kaiser HMO.

HEALTH COVERAGE RESOURCES EXCHANGE OPTIONSParticipants enrolled in a Health Coverage Resources Exchange option should contact their health plan for the specific benefits provided by that option.

Participants can learn more about coverage options available to them by contacting the Benefits Center at (800) 965-4421 or Health Coverage Resources at healthcoverageresources.com/Phillips66/home.

UNDERSTANDING THE MEDICARE ELIGIBLE OPTIONSParticipants who meet the eligibility criteria may be eligible for the Medicare eligible options, which are:

• The Aon Retiree Health Exchange options (retiree.aon.com) for eligible participants age 65 and over who are enrolled in Medicare;

• The Medicare-eligible PPO option for participants who are under age 65 and eligible for Medicare; or

• The Kaiser HMO for participants who are under age 65 and eligible for Medicare AND who live in California within the HMO’s service area.

These options are briefly described on this page and the following two pages. See Appendix B — Other important information on page L-25 for details on other portions of this handbook that apply to retiree medical benefits.

Participants who are under age 65 and eligible for Medicare, cannot enroll in the HDHP option that is available to non-Medicare eligible participants.

AON RETIREE HEALTH EXCHANGE OPTIONSPhillips 66 does not offer Medicare eligible options to participants who are age 65 or over. Participants who meet the eligibility criteria may be eligible to enroll in a health plan through the Aon Retiree Health Exchange. Participants can learn more about coverage options available to them by contacting the Benefits Center at (800) 965-4421 or the Aon Retiree Health Exchange at retiree.aon.com or by calling (844) 335-9044.




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This chapter does not include details about what is covered or not covered under the Aon Retiree Health Exchange options. Participants enrolling in a health plan option through the Aon Retiree Health Exchange will receive information in the enrollment materials provided by the Aon Retiree Health Exchange.

Before enrolling in an option through the Aon Retiree Health Exchange, participants should read the applicable Certificate of Coverage to learn about such things as:

• The services provided to participants.

• Who’s eligible to receive these services, and when they may be denied.


• How to appeal a denied benefit claim.

Participants should contact the Aon Retiree Health Exchange to request a certificate or for answers to questions.

MEDICARE-ELIGIBLE PPO OPTIONParticipants under age 65 who meet the eligibility criteria may be eligible to enroll in the Phillips 66 Medicare-eligible PPO option.

For Medicare-eligible PPO option participants, Medicare is the primary plan and pays benefits first. The Medicare-eligible PPO option pays second. When Medicare is, or would otherwise be, the primary plan, the plan assumes all covered expenses are eligible for Medicare, whether or not the participant or a covered dependent is actually enrolled in Medicare, and does not pay charges for expenses that qualify for Medicare Part A or B payment.

The participant must notify the Benefits Center if he or his covered dependent(s) becomes eligible for Medicare prior to age 65.

Covered and not covered services

The Medicare-eligible PPO option provides the same services and coverage as the PPO option available to non-Medicare eligible participants. The Medicare-eligible PPO option covers medically necessary medical, mental health and substance abuse, and prescription drug services and supplies. The following is a general description of the Medicare-eligible PPO option:

• The Medicare-eligible PPO option partners with claims administrators to provide benefits.



– The difference between the PPO option available to non-Medicare eligible participants and the Medicare-eligible PPO option is that the Medicare-eligible PPO option assumes the individual is enrolled in Medicare, and the option does not pay benefits for expenses that are covered by Medicare.

– In addition, if an individual is enrolled in Medicare Part D, he can elect to waive prescription drug coverage under the Medicare-eligible PPO option.



• Participants should reference pages B-14 – B-59 of the Employee Medical chapter for additional information regarding the PPO option:

– Covered and non-covered services and supplies.

– Provider information.

– Pre-certification and pre-determination of benefits.

– Coverage while traveling.

– Mental health and substance abuse coverage.

– Prescription drug coverage.

– Traveling outside of the U.S.

– Filing claims.

– If a claim is denied.

– Coordination of Benefits (COB).

– Determining the primary plan.

– Coordination with Medicare.

KAISER HMOParticipants should contact the Kaiser HMO and read the Kaiser HMO’s Evidence of Coverage (EOC) for information on the specific benefits provided by that option. In addition, a written request can be submitted to Kaiser HMO for materials that explain:

• The benefits and services provided to Kaiser HMO participants.

• Whether coverage is available for family members who live outside the Kaiser HMO’s service area.

• Eligibility to receive such services, and when services may be denied.


• How to appeal a denied benefit claim.

MEDICARE PART DParticipants who are eligible for Medicare are also eligible to enroll in Medicare Part D prescription drug coverage.

CREDITABLE PRESCRIPTION DRUG COVERAGE

Creditable prescription drug coverage is drug coverage that is considered to be at least as good as Medicare Part D coverage.

If the participant does not enroll in Medicare Part D coverage when first eligible, or if the participant does not have creditable prescription drug coverage, his Medicare Part D premiums will permanently be 1% higher than they would otherwise be for each month he is without creditable coverage.

The 1% per month penalty is waived if the participant has creditable coverage under an employer group health plan.

• For Aon Retiree Health Exchange options and Health Coverage Resources exchange options and Kaiser HMO, the option may or may not provide creditable coverage, depending on the option elected.

• The HDHP option, PPO option and the Medicare-eligible PPO option (with prescription drug coverage) provide creditable coverage. Therefore, participants are not required to enroll in a Medicare Part D plan while covered under one of those options.

• If a participant loses creditable coverage (for example, by cancelling coverage under the HDHP option or PPO option or electing to cancel the Medicare-eligible PPO option’s prescription drug coverage), he must enroll in a Medicare Part D plan within 63 days of the loss of creditable coverage. If he does not enroll, the 1% per month penalty will apply.

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Each year, Phillips 66 is required by law to provide information regarding whether prescription drug coverage under the HDHP option, PPO option and the Medicare-eligible PPO option (with prescription drug coverage) remains creditable coverage for purposes of Medicare Part D.

Participants enrolled in a health plan through the Aon Retiree Health Exchange, Kaiser HMO, a Health Coverage Resources exchange option or another health insurance plan will be informed by their health plan whether it provides creditable prescription drug coverage.

For answers to questions about Medicare Part D, participants should contact Medicare at (800) 633-4227 (TTY communications device users should call (877) 486-2048) or go to medicare.gov).

ABOUT MEDICARE

Medicare is the health insurance program sponsored by the federal government for people age 65 or over (and for disabled people who are eligible). There are three parts to the coverage:

• Part A — Hospital insurance that covers reasonable and medically necessary inpatient hospitalization and some nursing facility expenses. Employees and employers pay for it through payroll taxes. Normally, the hospital accepts Medicare’s payment, and participants will not pay additional fees.

• Part B — Covers physician and surgeon services, outpatient hospital, home health service, diagnostic tests and other medical benefits. Medicare Part B is funded by premiums paid by participants and by general funds collected from taxpayers.

• Part D — Provides prescription drug coverage. Medicare Part D is funded by premiums paid by participants and by general funds collected from taxpayers.

For detailed information on how Medicare benefits are calculated, participants should contact the Social Security Administration. Medicare does not pay benefits outside the United States. For more details, go to medicare.gov.

http://medicare.gov

http://medicare.gov



HEALTH SAVINGS ACCOUNTS (HSA)An HSA is a savings account that the participant can use to put aside additional dollars to pay eligible medical expenses.

To learn more about HSAs, go to irs.gov.

Participants should consult with a tax or financial advisor before enrolling in or paying expenses from an HSA.

ELIGIBLE EXPENSES

The IRS determines what constitutes an eligible expense under an HSA. For more information, see Publication 502 at irs.gov.

HSA ELIGIBILITYTo be eligible to contribute to an HSA, a participant:

• Must be enrolled in a high deductible health plan;

• Cannot be covered by any other non-high deductible health plan (for example, as a dependent under a spouse’s plan);

• Cannot be covered by Medicare; and

• Cannot be claimed as a dependent on anyone else’s federal tax return.

PAYING A DEPENDENT’S MEDICAL EXPENSES

A participant is generally permitted to use his HSA to pay his dependent’s medical expenses if:

• The participant can claim the individual as a dependent on his federal tax return; and

• The participant’s HSA was open at the time the dependent incurred the medical expenses.

APPENDIX A — RETIREE MEDICAL ACCOUNTS (RMA)On January 1, 2013, the company set up an RMA for individuals who:

• Were actively employed by Phillips 66 on December 31, 2012; or

• Retired from Phillips 66 between May 1, 2012 and December 31, 2012.

Here is how RMAs work:

• An RMA is not a bank account. It is an unfunded notional account consisting of RMA credits.

• Retirees can use RMA credits only to offset monthly premiums for retiree medical coverage obtained through:

– The Phillips 66 retiree medical options.

– Kaiser Permanente.

– Tricare.

– Aon Retiree Health Exchange.

– A public health insurance exchange. (Phillips 66 retirees can access resources to help identify options available to them by contacting Health Coverage Resources at healthcoverageresources.com/Phillips66/home.)

– Continuous COBRA coverage.

RMA credits cannot be used for any other type of expense.

• Employees and retirees cannot contribute to their RMA.

• Employees on a leave of absence-Labor Dispute cannot use RMA credits.

• Phillips 66 reserves the right to discontinue completely or change the amounts credited to RMAs or to discontinue the ability to offset retiree medical premiums under the plan at any time.

http://irs.gov

http://irs.gov



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• If an employee leaves the company or changes to an ineligible status before becoming eligible for retiree medical benefits, the employee forfeits the credits in his account.

– If he is rehired or returns to an eligible status within 30 days, his account may be reinstated as if eligibility had not terminated.

– If he is rehired or returns to an eligible status after 30 days, his account will not be reinstated.

• When the employee retires:

– The company stops allocating credits to his RMA.

– The retiree may use his accumulated RMA credits to offset his retiree medical premiums until his credits are exhausted. The retiree pays 100% of the cost of coverage not offset by credits in his RMA.

The company currently credits RMAs as follows:

Initial account balance

In January 2013, the company credited each eligible individual’s RMA with:

• $1,050 of credits for each of his full years of service, prorated monthly, through the earlier of December 31, 2012 or his retirement date; plus

• Interest credits.

Annual credits $1,050 for a full year of service, prorated monthly, will be credited to his account each year until he retires or until the program end date, whichever comes first.

Annual interest credits

3% of his December 31 RMA balance will be credited on January 1 of the following year. These credits are added each year until the individual retires or until the program end date, whichever comes first.

Credits to the RMA are discretionary and may change or be discontinued by the company at any time.

Employees will receive RMA credits each year of their employment until the earlier of January 1, 2030 (the program end date) or the program’s termination date. After that date:

• The company stops crediting the RMAs. This applies even if an employee is still employed and has not yet retired from the company on that date.

• If an employee meets the eligibility requirements on his employment end date, he has access to his existing credits after he retires from the company. When he retires, he can use them to offset his retiree medical premiums as described on the next page.

• In the event of an employee’s death, any remaining credits in his RMA will transfer to his spouse or eligible domestic partner and may be used to offset the spouse’s or eligible domestic partner’s monthly medical premiums as described on the next page.

• If remaining credits in an employee’s RMA transfer (or would have transferred) to his spouse or eligible domestic partner, in the event of the spouse’s or eligible domestic partner’s death or if the employee is unmarried and does not have an eligible domestic partner at the time of his death, any remaining credits in his RMA will transfer to his eligible dependent(s) covered under a medical benefit option or the retiree medical benefit and may be used to offset the eligible dependent’s monthly medical premiums as described on the next page.



HOW AN RMA BALANCE IS USED TO OFFSET PREMIUMS RMA procedures vary based on retiree medical coverage.

If coverage is through … RMA procedures are as follows …

• HDHP option

• PPO option

• Kaiser HMO

• Medicare-eligible PPO option

The retiree can choose to use his RMA credits to pay 25%, 50%, 75% or 100% of the monthly premium, until the balance is exhausted. Or he can choose to save his RMA credits for future retiree medical premiums under the plan.

If the retiree chooses to have only a portion of his monthly premium paid with RMA credits, he will be direct debited or billed for the remainder of the premium. If the retiree chooses to have the entire premium paid, he will not receive a bill for his retiree medical premium payment unless his RMA credits are depleted.

The retiree must contact the Benefits Center if he wants to use RMA credits to offset part or all of his retiree medical premiums. He may change his RMA election at any time prospectively. However, the RMA will not retroactively reimburse prior monthly premium payments for the HDHP option, the PPO option or the Medicare-eligible PPO option.

• Aon Retiree Health Exchange

• Public Health Exchange

• Tricare

• COBRA

Once a retiree or his dependents enrolls, the retiree must contact the Benefits Center to request reimbursement for his premium payments.

He must also contact his plan’s claims administrator for a proof of premium payment letter to submit for reimbursement under the RMA. Instructions for submitting claims for reimbursement are available at resources.hewitt.com/phillips66.

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APPENDIX B — OTHER IMPORTANT INFORMATION

FOR THE AON RETIREE HEALTH EXCHANGE, HEALTH COVERAGE RESOURCES EXCHANGE AND KAISER HMO OPTIONS

This handbook does not cover specific plan benefits provided under the options listed above. Participants enrolled in an Exchange or Kaiser HMO option should refer to the Certificate of Coverage provided by their option for coverage details.

However, certain portions of this handbook do apply to Exchange and Kaiser HMO participants, as described in this section.

In addition to this Retiree Medical chapter, portions of the Employee Medical chapter and the Other Information chapter apply to the retiree medical benefit. This Retiree Medical chapter, the Employee Medical chapter, the Other Information chapter and (when applicable) the participant’s Certificate of Coverage, when combined, constitute the summary plan description for the retiree medical benefit provided under the plan.

Specific portions of this handbook that apply to the retiree medical benefit are as follows:

• This Retiree Medical chapter.

• From the Employee Medical chapter:

– The HDHP and PPO options section (pages B-14 – B-59).

– The Understanding the Kaiser HMO section (page B-64).

• From the Other Information chapter, which begins on page N-1:

– Administrative information

– If the plan changes or ends

– ERISA rights

– COBRA continuation coverage*

– Claims and appeals procedures*

– HIPAA privacy rules*

– ERISA plan information

• The Glossary, which begins on page N-60.

• The Contacts chapter, which begins on page A-1.

* Does not apply to all of the retiree medical options. Refer to the Other Information chapter for details.

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P H I L L I P S 6 6 l S E V E R A N C E l 2 0 1 8 M - 1

Benefits at a glance .............................................M-2

Important ERISA information ..............................M-2

Eligibility and enrollment ....................................M-2Employee eligibility ............................................ M-2Enrollment ......................................................... M-3Situations impacting enrollment or

coverage ....................................................... M-3Coverage during a leave of absence ........... M-3

When coverage ends ........................................ M-3Coverage costs .................................................. M-3Qualifying for benefits ....................................... M-3

A participant is NOT eligible for benefits if … ............................................................ M-4

How the plan works ..............................................M-5Severance benefits ........................................... M-5

Basic benefit ................................................. M-5Supplemental benefits ................................. M-5Calculating severance benefits ................... M-7Educational reimbursement ........................ M-8

General release of liability ................................ M-8

How to file a claim ................................................M-9

How benefits are paid ........................................M-10Errors or mistakes ........................................... M-10Waiving benefits .............................................. M-10

Rehiring or death ................................................M-10A participant is rehired ................................... M-10A participant dies ............................................ M-10

Appendix A — Change in Control provisions ...M-11

PHILLIPS 66 SEVERANCE

IMPORTANT TERMS

• “Plan” refers to the “Phillips 66 Severance Pay Plan.”

• “Phillips 66” or the “company” refers to Phillips 66 Company and any other subsidiary or affiliated company that has adopted the plan and is a participating employer. – “Participant” is defined as an employee: – Who has satisfied the eligibility and

participation requirements specified in the plan;

– Who has been automatically enrolled in the plan; and

• Whose participation has not terminated under any applicable provisions of the plan.

• “SPD” generally refers to this chapter and the Other Information chapter, which together serve as the summary plan description for the plan.



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BENEFITS AT A GLANCEIf an employee is laid off or loses his job at the company as a result of an event such as a reduction in force or job elimination, the company may provide severance benefits.

Benefits under the plan may include:

• Severance pay — A cash payment, which is based on the participant’s pay and years of service with the company.

• Educational reimbursement — Reimbursement for tuition, books and fees for courses that can help the participant qualify for a new job or career.

It is important to review the entire SPD to obtain an understanding of severance benefits.

To receive the highest level of benefits, the participant must sign a release stating that he will not pursue legal action against the company for employment-related claims.

Please note that severance benefits are not available in all situations. For example, severance benefits are not paid if a participant is offered a comparable job with the company and he turns that job down.

IMPORTANT ERISA INFORMATIONThis Severance Pay chapter is intended to provide the participant with an understanding of the benefits provided under the plan. There is also other important legal information related to the plan. That information is included in the Other Information chapter beginning on page N-1.






ELIGIBILITY AND ENROLLMENTTo be eligible for severance benefits, a participant must be an eligible employee and his layoff must meet the qualifying circumstances shown in Qualifying for benefits on page M-3.

EMPLOYEE ELIGIBILITYAn eligible employee is:

• A regular full-time or regular part-time employee of Phillips 66 in salary grade 22 or below;

• Paid on a participating employer’s direct U.S. dollar payroll; and

• Not otherwise excluded from the plan.



• A represented employee whose collective bargaining agreement does not provide for participation in the plan. However, even if the participant’s collective bargaining agreement specifically provides for coverage under the plan, he is not eligible to participate in the plan while he is on a leave of absence-Labor Dispute.

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ENROLLMENTProvided the employee is eligible, he does not need to enroll in the plan. Participation is automatic for eligible employees.

SITUATIONS IMPACTING ENROLLMENT OR COVERAGE

Coverage during a leave of absence

A participant is not eligible for severance benefits under the plan if a notice of layoff is given while he is on a personal leave of absence. For information regarding other types of leaves, please contact HR Connections.


If a participant is placed on a leave of absence-Labor Dispute, his coverage will end on the day the leave begins. Coverage will resume automatically upon his return to work as an eligible employee.

WHEN COVERAGE ENDSA participant’s coverage under the plan ends on the day:

• His employment ends.

• He is no longer an eligible employee.

• He goes out on a leave of absence-Labor Dispute.

• He goes out on a personal leave of absence, unless the leave is related to approved FMLA or military service.

• Phillips 66 terminates the plan or otherwise stops offering coverage.

COVERAGE COSTSThe company pays the entire cost of the plan — employee contributions are not required or permitted.

QUALIFYING FOR BENEFITSThe participant must satisfy all of the following requirements to qualify for severance benefits under the plan:

• The participant is laid off;

• The participant is given a written notice of layoff by the company;

• Following the notice of layoff, the company terminates the participant’s employment on a date determined by the company;

• The participant is an employee on his date of layoff; and

• The participant’s termination meets one of the following conditions:

– He is a salary grade level 20 or below whose termination of employment is either caused by a reduction in force, a job elimination or a corporate event, or is designated as a layoff by the Chief Executive Officer of Phillips 66 Company;

– He is a salary grade level 21 or 22 whose termination of employment is prior to a Change in Control* and is designated as a layoff by the Chief Executive Officer of Phillips 66 Company; or

– His termination of employment is on or after a Change in Control* and is either caused by a reduction in force, a job elimination or a corporate event, or is designated as a layoff by the Chief Executive Officer of Phillips 66 Company or its successor.

For purposes of the plan, a “corporate event” includes a sale of assets, sale of stock, joint venture, outsourcing, etc. See the Glossary, which begins on page N-60 of the Other Information chapter.

* See Appendix A — Change in Control provisions on page M-11 for details.



A participant is NOT eligible for benefits if …

Even if a participant received a notice of layoff, he is not eligible for benefits under the plan if:

• His employment is terminated as a result of a corporate event, and a successor employer offers him a job with comparable pay.

– For this purpose, comparable pay means at least 80% of his prior regular base pay, including regularly scheduled overtime, but not including overtime due to the 19/30 program.

• His employment is terminated as a result of a corporate event, and he accepts any job offered by a successor employer.

• He is on inactive disability status as of his date of layoff.

• He is on a personal leave of absence as of his date of layoff.

• He is discharged (terminated for cause).

• He resigns as of a date prior to the layoff date specified in the notice of layoff.

• His employment is terminated because he failed to accept any of the following jobs within seven calendar days of the offer:

– A job offered by an employer at comparable pay and at a comparable employment level, but in a different geographical area, for which he would receive relocation assistance.

– A job offered by an employer at comparable pay and at a comparable employment level and in the same geographical area.

– A transfer job at comparable pay offered by an affiliate that is not considered an employer under this plan, but which is made based on a mutual agreement between the company and the affiliate offering the job.

• He accepts any transfer job offered by an affiliate that is not considered an employer under this plan, but which is made based on a mutual agreement between the company and the affiliate offering the job.

Please note that the participant may be required to provide the company with additional information (including proposed pay) relating to any job offer by another employer.

In addition to the preceding list, the participant is not eligible for severance benefits if:

• He accepted benefits under any other layoff plan, severance plan or similar program maintained by the company (other than a retention bonus).

• He received layoff pay or termination pay under a negotiated working agreement or collective bargaining agreement.

• He is an hourly employee covered by a collective bargaining agreement or working policy, and he has not exhausted his rights to accept a job in place of less senior employees in the same work unit.

• At the time benefits would be paid, he owes money to the company — including an obligation to repay benefits received from this plan or any other severance plan of the company — and he has not made an arrangement that is satisfactory to the company to repay that obligation.

• He waived benefits under this plan.

EXAMPLES OF INDIVIDUALS WHO ARE NOT ELIGIBLE FOR SEVERANCE PAY:

• A participant who leaves his job voluntarily to work for another company.

• A participant who leaves his job voluntarily to go back to school.

• A participant who was terminated for breaking the law on company premises.

• A participant who is part of a group that was bought by another energy company in a nearby location, and he turned down a job at the new company at the same pay.

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HOW THE PLAN WORKSIf a participant is laid off and meets all of the eligibility requirements shown under Qualifying for benefits on page M-3, the plan may provide the following benefits:

Severance benefitGeneral release of liability required?

Basic benefit • If less than one year of service: Two weeks pay.

• If one or more years of service: Four weeks pay.

No

Supplemental benefit

• Three weeks pay for each year of service, up to a maximum of 60 weeks pay, minus the basic benefit.

Yes

Educational reimbursement

• Up to $2,000 for approved tuition, required fees and books for courses that can reasonably be expected to lead to the participant’s re-employment.

• The participant must complete the courses and make requests for reimbursement no later than the first anniversary of his date of layoff.

Yes

For more information about the general release of liability, see page M-8.

SEVERANCE BENEFITS

Basic benefit

The basic benefit is as follows.

• If less than one year of service: Two weeks pay.

• If one or more years of service: Four weeks pay.

A participant who is eligible will receive the basic benefit even if he does not sign a general release of liability (as that term is defined on page N-67 of the Other Information chapter).

Supplemental benefits

A participant is eligible to receive supplemental benefits only if:

• He is eligible for benefits under the plan; and

• He signs and returns a general release of liability.

– The legally binding general release of liability releases the company from liability for employment-related claims, meaning that the participant agrees that he will not pursue legal action against the company for additional employment-related claims related to his employment or layoff.

– His completed general release of liability must be in a form acceptable to the company, and must be signed and returned within 60 days after his date of layoff.

Supplemental benefits are paid in addition to the basic benefit. The benefit is three weeks pay for each year of service, minus the weeks of pay that will be paid as a basic benefit. The maximum plan benefit (basic + supplemental) is 60 weeks.



The table below shows what the participant receives in basic and supplemental benefits, depending on his years of service. (If he does not sign and return a general release of liability, his benefit would be limited to the basic benefit.)

Total layoff pay (basic + supplemental benefits)

Years of service Number of weeks pay

Less than 1 2 (basic benefit)

1 4 (basic benefit)

2 6

3 9

4 12

5 15

6 18

7 21

8 24

9 27

10 30

11 33

12 36

13 39

14 42

15 45

16 48

17 51

18 54

19 57

20 or more 60

“Years of service” includes the participant’s service with ConocoPhillips prior to the spin-off of Phillips 66, as well as service with Phillips 66 since the spin-off.

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LIMIT ON SUPPLEMENTAL BENEFITS

A participant’s supplemental benefits may be reduced if the total of his basic + supplemental benefits is more than two times the maximum annual pay that can be considered for retirement plan purposes in the calendar year before the calendar year in which his layoff occurs. A participant will be notified if this provision applies to his benefits under the plan.

Calculating severance benefits

As shown in the following examples, the participant’s benefit depends on whether he signs and returns a general release of liability.

Here is how severance pay is calculated for a Phillips 66 employee who had 10 years of service when he was laid off.

General calculation of benefit As applied to 10 years of service

First, calculate the participant’s weekly pay

A participant’s weekly pay is based on his pay in effect on his date of layoff.

If he is a salaried employee, it is his monthly pay divided by 4.333.*

The participant’s monthly pay is $2,600.

His weekly pay is $600 ($2,600 ÷ 4.333).

If the participant does NOT sign and return a general release of liability

He will get the basic benefit, which is the number of weeks pay shown in the table on page M-6.

$ 600 (weekly pay) x 4 (total weeks of basic benefit)

= $ 2,400 (basic benefit)

If the participant DOES sign and return a general release of liability**

He will get the basic + supplemental benefit, which is the number of weeks pay shown in the table on page M-6.

The participant had 10 years of service. That means he gets 30 weeks pay.

$ 600 (weekly pay) x 30 (# of weeks of pay)

= $ 18,000 (basic + supplemental benefit)

* Please see “weekly pay” in the Glossary, which begins on page N-60 of the Other Information chapter, for more detailed information and to see how weekly pay is calculated for hourly employees.

** The general release of liability must be timely signed and returned to the plan administrator or the participant’s Human Resources representative and must not be revoked. Please see the “General release of liability” section on page M-8.



Educational reimbursement

The plan’s supplemental benefits also include an educational reimbursement benefit of up to $2,000 for tuition, required fees and books. This reimbursement is for course work that may help the participant find a new job. Human Resources must approve his proposed classes.

To qualify for educational reimbursement, the participant must do all of the following:

• Sign a general release of liability (discussed at right).

• Within 90 days after layoff, submit a plan of course studies that can reasonably be expected to help the participant find a new job.

• Enroll in classes from an accredited college, university, trade school or in classes that are part of a certified/licensed instructional program.

• Finish all classes and request reimbursement no later than the first anniversary of the participant’s date of layoff. He will need to provide evidence that he has finished his classes as well as receipts or bills for tuition and books.

Note: The plan will not pay any educational costs that are already reimbursed by any federal, state or local governmental agency or by any private source.

GENERAL RELEASE OF LIABILITYTo receive supplemental or educational benefits, the participant must sign a general release of liability, which will be provided by the company. The general release of liability must be received by the plan administrator or the participant’s Human Resources representative no later than the 60th calendar day after the participant’s date of layoff.

• If the 60th calendar day is a scheduled company holiday, the general release of liability must be received by the next business day.

• A faxed copy of the general release of liability will be accepted, as long as the original signed general release of liability is provided within a reasonable period of time after receipt of the faxed copy.

The general release of liability is revocable during the seven-day period after the participant signs it. After seven days, it is irrevocable, and he cannot change his mind. The participant will not receive payments for supplemental or educational benefits until after the expiration of the seven-day period.

PARTICIPANT DEATH AFTER NOTICE OF LAYOFF

If a participant dies after receiving a notice of layoff but before signing a general release of liability, his spouse or his estate’s representative must sign the general release of liability and return it to the plan administrator or the participant’s Human Resources representative no later than the 60th calendar day after the participant’s date of layoff or such other deadline established by the plan administrator.

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Either the participant, his surviving spouse, a representative of his estate (if he died) or the company can request that the plan administrator extend the deadline for submitting the general release of liability. The plan administrator:

• Will approve such extensions if the additional time was needed to clarify issues relating to the scope or coverage of the general release of liability.

• Will not approve the extension if it is being made only to extend the time that benefit payments would otherwise be made under the plan.

If the plan administrator does not receive the signed general release of liability by the required deadline (including any approved extensions), the participant (or his spouse or estate) will not be entitled to supplemental benefits or educational reimbursement benefits. The plan would pay only the basic benefit.

HOW TO FILE A CLAIMBecause severance benefits are paid automatically, ordinarily, a participant is not required to file a claim to receive benefits under the plan.

However, the participant must file a claim if he believes he should have received severance benefits but did not or if he believes the amount of the benefit was less than he should have received. Any claim for benefits under the plan must be provided in writing to the plan administrator within 24 months after the participant’s employment end date.

If a claim is denied, he has specific rights and responsibilities for appealing the denial. See the Other Information chapter for details.

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HOW BENEFITS ARE PAIDAll severance benefits — basic, supplemental and educational reimbursement — will be paid to the participant in a lump-sum cash payment. Any required federal, state or local taxes will be withheld from payments. If the participant is an expatriate employee, withholding will be for assumed taxes.

ERRORS OR MISTAKESIf a participant or the company makes a mistake, the payment may be adjusted in the future — or the participant may have to repay some or all of the amount received. This could happen if:

• The company or its agents or representatives make a mistake related to eligibility for benefits or the amount of a participant’s benefit; or

• The participant or his beneficiary misstate a fact, or fail to state an important fact, in an application or claim for benefits or in an information request.

WAIVING BENEFITSA participant may waive (or refuse) benefits under the plan by filing a written waiver with the plan administrator.

The waiver must be in proper form, must apply to all benefits payable under the plan, and must be irrevocable.

Contact the plan administrator for details.

REHIRING OR DEATHA PARTICIPANT IS REHIREDGenerally, a participant who has received benefits under the plan or a predecessor plan and is rehired is not required to repay those benefits.

However, his years of service for any future severance benefits will be determined using his Severance Service Date (SSD) under the company’s Service Recognition Policy, which may be adjusted to reflect his earlier severance benefits.

In addition, he will become eligible for future benefits only if he:

• Satisfies the rules for eligibility to be a participant based on his service after he is rehired; and

• Satisfies all of the plan’s requirements for receipt of benefits.

A PARTICIPANT DIESIf a participant dies after receiving notice of layoff but before receiving his benefit under the plan, payment will be made to his surviving spouse or to his estate if he is not married at the time of death. To receive supplemental benefits, his spouse or his estate’s representative must sign a general release of liability and return it to the plan administrator or the participant’s Human Resources representative no later than the 60th calendar day after the participant’s date of layoff or such other deadline established by the plan administrator.

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P H I L L I P S 6 6 l S E V E R A N C E l 2 0 1 8 M - 1 1

APPENDIX A — CHANGE IN CONTROL PROVISIONSThe following definitions apply to the Change in Control provisions in section 10 of the plan document.

Affiliate Has the meaning ascribed to such term in Rule 12b-2 of the General Rules and Regulations under the Exchange Act, as in effect on May 1, 2012.

Associate With reference to any person:

(a) Any corporation, firm, partnership, association, unincorporated organization or other entity (other than the company or a subsidiary of the company) of which such person is an officer or general partner (or officer or general partner of a general partner) or is, directly or indirectly, the beneficial owner of 10% or more of any class of equity securities;

(b) Any trust or other estate in which such person has a substantial beneficial interest or as to which such person serves as trustee or in a similar fiduciary capacity; and

(c) Any relative or spouse of such person, or any relative of such spouse, who has the same home as such person.

Beneficial owner

With reference to any securities, any person if:

(a) Such person or any of such person’s affiliates and associates, directly or indirectly, is the beneficial owner of (as determined pursuant to Rule 13d-3 of the General Rules and Regulations under the Exchange Act, as in effect on May 1, 2012) such securities or otherwise has the right to vote or dispose of such securities;

(b) Such person or any of such person’s affiliates and associates, directly or indirectly, has the right or obligation to acquire such securities (whether such right or obligation is exercisable or effective immediately or only after the passage of time or the occurrence of an event) pursuant to any agreement, arrangement or understanding (whether or not in writing) or upon the exercise of conversion rights, exchange rights, other rights, warrants or options, or otherwise; provided, however, that a person shall not be deemed the beneficial owner of, or to beneficially own:

(i) Securities tendered pursuant to a tender or exchange offer made by such person or any of such person’s affiliates or associates until such tendered securities are accepted for purchase or exchange; or

(ii) Securities issuable upon exercise of exempt rights; or

(continued)



Beneficial owner

(continued)

(c) Such person or any of such person’s affiliates or associates:

(i) Has any agreement, arrangement or understanding (whether or not in writing) with any other person (or any affiliates or associates thereof) that beneficially owns such securities for the purpose of acquiring, holding, voting (except as set forth in the proviso to subsection (a) of this definition) or disposing of such securities; or

(ii) Is a member of a group (as that term is used in Rule 13d-5(b) of the General Rules and Regulations under the Exchange Act) that includes any other person that beneficially owns such securities.

Provided, however, that nothing in this definition shall cause a person engaged in business as an underwriter of securities to be the beneficial owner of, or to beneficially own, any securities acquired through such person’s participation in good faith in a firm commitment underwriting until the expiration of 40 days after the date of such acquisition. For purposes hereof, “voting” a security shall include voting, granting a proxy, consenting or making a request or demand relating to corporate action (including, without limitation, a demand for a stockholder list, to call a stockholder meeting or to inspect corporate books and records) or otherwise giving an authorization (within the meaning of Section 14(a) of the Exchange Act) in respect of such security.

The terms “beneficially own” and “beneficially owning” shall have meanings that are consistent with this definition of the term beneficial owner.

Board The Board of Directors of Phillips 66.

(continued)

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Change in Control

Any of the following events occurring on or after May 1, 2012:

(a) Any person (other than an exempt person) shall become the beneficial owner of 20% or more of the shares of common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding; provided, however, that no Change in Control shall be deemed to occur for purposes of this subsection (a) if such person shall become a beneficial owner of 20% or more of the shares of common stock or 20% or more of the combined voting power of the voting stock of the company solely as a result of (i) an exempt transaction or (ii) an acquisition by a person pursuant to a reorganization, merger or consolidation, if, following such reorganization, merger or consolidation, the conditions described in clauses (i), (ii) and (iii) of subsection (c) of this definition are satisfied;

(b) Individuals who, as of May 1, 2012, constitute the Board (the “Incumbent Board”) cease for any reason to constitute at least a majority of the Board; provided, however, that any individual becoming a director subsequent to May 1, 2012 whose election, or nomination for election by the company’s shareholders, was approved by a vote of at least a majority of the directors then comprising the Incumbent Board shall be considered as though such individual were a member of the Incumbent Board; provided, further, that there shall be excluded, for this purpose, any such individual whose initial assumption of office occurs as a result of any actual or threatened election contest that is subject to the provisions of Rule 14a-11 of the General Rules and Regulations under the Exchange Act;

(c) The company consummates a reorganization, merger, or consolidation, in each case, unless, following such reorganization, merger, or consolidation:

(i) 50% or more of the then outstanding shares of common stock of the corporation resulting from such reorganization, merger, or consolidation and the combined voting power of the then outstanding voting stock of such corporation are beneficially owned, directly or indirectly, by all or substantially all of the persons who were the beneficial owners of the outstanding common stock immediately prior to such reorganization, merger, or consolidation in substantially the same proportions as their ownership, immediately prior to such reorganization, merger, or consolidation, of the outstanding common stock;

(ii) No person (excluding any exempt person or any person beneficially owning, immediately prior to such reorganization, merger, or consolidation, directly or indirectly, 20% or more of the common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding) beneficially owns, directly or indirectly, 20% or more of the then outstanding shares of common stock of the corporation resulting from such reorganization, merger, or consolidation or the combined voting power of the then outstanding voting stock of such corporation or other entity; and

(iii) At least a majority of the members of the board of directors of the corporation, or the body that is most analogous to the board of directors of a corporation if not a corporation, resulting from such reorganization, merger, or consolidation were members of the Incumbent Board at the time of the initial agreement or initial action by the Board providing for such reorganization, merger, or consolidation; or

(continued)



Change in Control

(continued)

(d)

(i) The shareholders of the company shall approve a complete liquidation or dissolution of the company unless such liquidation or dissolution is approved as part of a plan of liquidation and dissolution involving a sale or disposition of all or substantially all of the assets of the company to a corporation with respect to which, following such sale or other disposition, all of the requirements of clauses (ii)(A), (B), and (C) of this subsection (d) are satisfied; or

(ii) The company shall consummate the sale or other disposition of all or substantially all of the assets of the company, other than to a corporation, with respect to which, following such sale or other disposition, (A) 50% or more of the then outstanding shares of common stock of such corporation and the combined voting power of the voting stock of such corporation is then beneficially owned, directly or indirectly, by all or substantially all of the persons who were the beneficial owners of the outstanding common stock immediately prior to such sale or other disposition in substantially the same proportion as their ownership, immediately prior to such sale or other disposition, of the outstanding common stock, (B) no person (excluding any exempt person and any person beneficially owning, immediately prior to such sale or other disposition, directly or indirectly, 20% or more of the common stock then outstanding or 20% or more of the combined voting power of the voting stock of the company then outstanding) beneficially owns, directly or indirectly, 20% or more of the then outstanding shares of common stock of such corporation and the combined voting power of the then outstanding voting stock of such corporation or other entity, and (C) at least a majority of the members of the board of directors of such corporation, or the body that is most analogous to the board of directors of a corporation if not a corporation, were members of the Incumbent Board at the time of the initial agreement or initial action of the Board providing for such sale or other disposition of assets of the company.

Common stock

The common stock, par value $.01, of the company.

Company Shall mean Phillips 66.

Election contest

A solicitation of proxies of the kind described in Rule 14a-12(c) under the Exchange Act.

Exchange Act

The Securities Exchange Act of 1934, as amended.

Exempt person

The company, any subsidiary of the company, any employee benefit plan of the company or any subsidiary of the company, and any person organized, appointed or established by the company for or pursuant to the terms of any such plan.

Exempt rights

Any rights to purchase shares of common stock or other voting stock of the company if at the time of the issuance thereof such rights are not separable from such common stock or other voting stock (i.e., are not transferable otherwise than in connection with a transfer of the underlying common stock or other voting stock), except upon the occurrence of a contingency, whether such rights exist as of May 1, 2012, or are thereafter issued by the company as a dividend on shares of common stock or other Voting Securities or otherwise.

(continued)

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Exempt transaction

An increase in the percentage of the outstanding shares of common stock or the percentage of the combined voting power of the outstanding voting stock of the company beneficially owned by any person solely as a result of a reduction in the number of shares of common stock then outstanding due to the repurchase of common stock or voting stock by the company, unless and until such time as:

(a) Such person or any affiliate or associate of such person shall purchase or otherwise become the beneficial owner of additional shares of common stock constituting 1% or more of the then outstanding shares of common stock or additional voting stock representing 1% or more of the combined voting power of the then outstanding voting stock; or

(b) Any other person (or persons) who is (or collectively are) the beneficial owner of shares of common stock constituting 1% or more of the then outstanding shares of common stock or voting stock representing 1% or more of the combined voting power of the then outstanding voting stock shall become an affiliate or associate of such person.

Person Any individual, firm, corporation, partnership, association, trust, unincorporated organization or other entity.

Voting stock With respect to (i) a corporation, all securities of such corporation of any class or series that are entitled to vote generally in the election of directors of such corporation (excluding any class or series that would be entitled so to vote by reason of the occurrence of any contingency, so long as such contingency has not occurred); and (ii) an entity that is not a corporation, all securities of any class or series that are entitled to vote generally in the election of, or to appoint by contract, members of the body that is most analogous to the board of directors of a corporation.

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PHILLIPS 66 OTHER INFORMATION

Important information .......................................N-2

How this chapter is organized ..........................N-3

General information ..........................................N-4

Administrative information ...............................N-4Plan identification information ........................N-4Plan administration ..........................................N-4Agent for service of legal process ...................N-4

Assignment of benefits .....................................N-5

If the plan changes or ends ..............................N-5If the Severance Pay Plan changes or ends ...N-6

ERISA rights ........................................................N-6

Medical, Dental, Vision, Employee Assistance Plan (EAP) and Flexible Spending Plan (FSP) ..........................................N-8

General information ...........................................N-8Qualified Medical Child Support Order

(QMCSO) .......................................................N-8Subrogation rights (recovery of benefits

paid) .............................................................N-8Right of recovery ............................................N-11

For medical, dental and vision benefits ...N-11For Flexible Spending Plan

reimbursements ...................................N-11

COBRA continuation coverage ...................... N-11How COBRA works .........................................N-12Qualifying events ............................................N-14

For the participant .....................................N-14For the participant’s dependent ...............N-14

Qualified beneficiaries ...................................N-15Disability extension of COBRA coverage ......N-16Second qualifying events ...............................N-16Changing COBRA coverage ............................N-17

Changing COBRA elections midyear ........N-17Enrolled in COBRA coverage and in

another company’s plan or Medicare ......N-19Paying for COBRA coverage ...........................N-20When COBRA coverage ends ........................N-21Questions regarding COBRA ..........................N-21

USERRA continuation coverage .................... N-21

HIPAA privacy rules ......................................... N-23Use and disclosure of protected health

information ................................................N-23

Claims and appeals procedures .....................N-27Making a decision on claims .........................N-28

Deadlines for decisions on benefit claims ....................................................N-28

Special rules for medical, dental and EAP urgent and pre-service claims .... N-30

Denials of claims .......................................N-31How to file an appeal......................................N-32

Review of denied claim on appeal .......... N-36Denials of appeals ....................................N-37Second level appeal to appeals

administrator ........................................N-37Deadlines for decisions on appeals ........ N-38The appeals administrator’s decision

is final ................................................... N-38External review ......................................... N-39

Fraudulent claims .......................................... N-42

ERISA plan information .................................. N-43

Life, accident and disability plans ................ N-46

Right of recovery ............................................. N-46For Short-Term Disability (STD) benefits ...... N-46For Long-Term Disability (LTD) benefits ........ N-46

Payments to a minor or legally incompetent person ........................................ N-47

USERRA coverage ........................................... N-47

Claims and appeals procedures .................... N-48Required information and consents ............ N-48If a claim is denied ........................................ N-49How to file an appeal..................................... N-50

If an appeal is denied ...............................N-52The appeals administrator’s decision

is final ....................................................N-52Fraudulent claims .......................................... N-53


Severance Pay Plan ........................................ N-56

Plan administration ........................................ N-56

Right of recovery ............................................. N-56

Claims and appeals procedures .................... N-57How to file a claim ..........................................N-57

Review of claim denial ............................. N-58


Glossary ........................................................... N-60

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• “Plan” refers to one or more of the health and welfare plans, as applicable, sponsored and maintained by Phillips 66 Company.


• “Participant” is defined as an employee:

– Who has satisfied the eligibility and participation requirements specified in a plan; and


• “SPD” generally refers to another chapter and this Other Information chapter, which together serve as the summary plan description for the relevant plan. This Other Information chapter includes important legal information related to each plan.

• Many additional terms used throughout this SPD are defined in the Glossary, which begins on page N-60. It is important that participants review the Glossary carefully to ensure that they understand the meaning of defined terms used throughout the SPD. Failure to understand the meaning of a defined term could result in a failure to fully understand the plan benefits, requirements, limitations, etc.


IMPORTANT INFORMATIONCertain aspects of each of the Phillips 66 health and welfare plans — who’s eligible, what’s covered (and not), how to use benefits, when coverage ends, etc. — are described in other chapters. This Other Information chapter contains additional important information related to each of the plans.

Each of the separate chapters PLUS this Other Information chapter and any summary of material modification make up the complete SPD for each of the Phillips 66 health and welfare plans.

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HOW THIS CHAPTER IS ORGANIZEDSee pages … For …

N-4 – N-7 Information that applies to all of the Phillips 66 health and welfare plans

N-8 – N-45 Information specific to the:

• Phillips 66 Medical and Dental Assistance Plan – Employee medical benefits – Employee dental benefits – Employee vision benefits – Retiree medical benefits

• Phillips 66 Employee Assistance Plan

• Phillips 66 Flexible Spending Plan – Before-Tax Premiums – Health Care Flexible Spending Account – Dependent Care Flexible Spending Account – Health Savings Account


• Phillips 66 Group Life Insurance Plan – Employee life insurance – Occupational accidental death insurance (OAD) – Accidental death and dismemberment (AD&D) insurance – Emergency Responders Insurance

• Phillips 66 Disability Plan – Short-term disability – Long-term disability


• Phillips 66 Severance Pay Plan

N-60 – N-92 A Glossary of terms used in the health and welfare plan chapters.



ADMINISTRATIVE INFORMATIONPLAN IDENTIFICATION INFORMATIONThe primary employer (also the Plan Sponsor) and identification number are:

Phillips 66 Company c/o Total Rewards Department P.O. Box 421959 Houston, TX 77242-1959

(832) 765-1877

Employer ID#: 37-1652702

PLAN ADMINISTRATIONExcept as otherwise provided in another chapter, or in another section of this chapter, the plan administrator is:

Manager, HR Operations (or successor) Phillips 66 Company Adams Building 411 S. Keeler Avenue Bartlesville, OK 74003-6670

(918) 977-6009

As a named fiduciary, the plan administrator:

• Has discretionary authority to interpret and administer, in its sole discretion, the terms of the plan and make factual determinations.

• Determines all claims and appeals for eligibility to participate in the plan.

• Has the power to delegate responsibilities and authority (including discretionary authority) under the plan. Some responsibilities and authority that may be delegated include reviewing claims and appeals, and construing the terms of the plan and insurance contract (if applicable) under the plan.

AGENT FOR SERVICE OF LEGAL PROCESSFor disputes arising under the plan, legal process may be served on:

General Counsel Phillips 66 Company 2331 CityWest Blvd. Houston, TX 77042

Service of legal process may also be made upon the plan administrator or claims administrator at the addresses shown for them.

General informationUnless otherwise noted, the information in this section applies to all of the health and welfare plans listed on page N-3.

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ASSIGNMENT OF BENEFITSThe participant cannot assign his plan rights or benefits, which means that he cannot give, transfer (voluntarily or involuntarily) or promise his plan rights and benefits to anyone else. For example, the participant cannot use his right to benefits as collateral on a loan or as payment on a debt.

Any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge or otherwise dispose of any right to benefits payable under a plan shall be void. The company shall not in any manner be liable for, or subject to, the debts, contracts, liabilities, engagements or torts of any person entitled to benefits under a plan.

However, a medical or dental provider can file claims on a participant’s behalf and can be paid back directly from the medical or dental coverage. In no event is the plan’s direct payment of benefits to a medical provider, dental provider or any other provider a waiver of the plan’s anti-assignment provisions. Additionally, in no event is a medical provider, dental provider or any other provider a beneficiary of a plan.

The benefits provided by the Severance Pay Plan cannot be used as security for a loan. However, Severance Pay Plan benefits are subject to garnishment, attachment or other legal process. If the participant’s benefits are garnished or attached by legal process, the company will pay the garnished or attached amount in accordance with the decree ordering such payment. Neither the company nor any plan fiduciary is required to investigate the validity of any decree which appears to be valid on its face. In the event the participant has an outstanding obligation to the participating employer, he may, with the consent of the company, assign all or a portion of his Severance Pay Plan benefit to the participating employer to the extent of such obligation.

IF THE PLAN CHANGES OR ENDSPhillips 66 reserves the right to amend, modify, suspend or terminate a plan, in part or in whole, at any time, with or without notice.

Plan changes or terminations generally apply to benefits that become payable after the date of the change. For example, if plan benefits were changed on January 1, 2018, that change would not affect a claim for covered benefits, services or supplies that were obtained on or before December 31, 2017.

If a coverage option changes, the participant may be able to obtain COBRA continuation coverage. (This applies to the Phillips 66 Medical and Dental Assistance Plan (excluding the Medicare-eligible post-65 retiree medical options), Employee Assistance Plan and the Health Care Flexible Spending Account provided under the Flexible Spending Plan only.)

In the event of a termination of the Phillips 66 Medical and Dental Assistance Plan, assets remaining in the self-insured components of the plan will be used to pay medical and dental expenses and benefits that are due under the plan. After that, any remaining assets may be transferred to a successor plan or, if there is no successor plan, refunded to plan participants. In general, plan assets do not revert to the company.



IF THE SEVERANCE PAY PLAN CHANGES OR ENDSSeverance Pay Plan changes or terminations will not affect benefits that are currently payable to the participant. Benefits for which he is eligible and entitled at the time of the change or termination and that have not completely been paid to him will be paid.

Subsidiary companies that have adopted the plan have the right to decline amendments with respect to their employees’ participation and to end their participation in the plan at any time.

In addition, the Severance Pay Plan cannot be amended, terminated, suspended or withdrawn within 24 months after a change in control of the company, with a few exceptions. The plan can be changed:

• To comply with legal requirements; or

• If the changes do not negatively affect eligibility to participate in the plan, the amount of benefits or other rights under the plan.

These restrictions apply to the 24 months after the first event that is considered a change in control. The restrictions end at the end of the 24-month period, even if another change in control occurs.

ERISA RIGHTSAs a participant in one or more of the benefit plans listed on page N-3, the participant is entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA), as amended. ERISA provides that all plan participants are entitled to:

• Receive information about the plan and benefits, as follows:

– Examine, without charge, at the plan administrator’s office and at other locations (field offices, plants and selected work sites), all documents governing the plan including insurance contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available for review at the Public Disclosure Room of the Employee Benefits Security Administration;

– Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan descriptions. The Plan Administrator may make a reasonable charge for the copies; and

– Receive a summary of the plan’s annual financial report at no charge (the plan is required by law to furnish each participant with a copy of this summary annual report).

• Continue group health plan coverage (medical, dental, vision, EAP and Health Care Flexible Spending Account), as follows:

– Continue health care coverage for the participant, his spouse/domestic partner (if applicable) and/or his dependents, if coverage is lost as a result of a qualifying event. The participant or his dependents may have to pay for such coverage. Review the applicable SPD chapter and the documents governing the plans for the rules that apply to COBRA continuation coverage rights.

– Reduction or elimination of any exclusionary periods for pre-existing conditions under the group health plan (medical and dental).

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Prudent actions by plan fiduciaries

In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the plan. The people who operate the plan, called fiduciaries of the plan, have a duty to operate the plan prudently and in the interest of the participants and beneficiaries. No one, including the participant’s employer, his union or any other person, may fire him or discriminate against him in any way to prevent him from obtaining benefits under the plan or exercising his rights under ERISA.

Enforce the participant’s rights

If a claim for a benefit is denied or ignored, in whole or in part, the participant has a right to know why this was done, to obtain copies of documents relating to the decision, without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps the participant can take to enforce his rights. For instance, if he requests a copy of plan documents or the latest annual report from the plan and does not receive them within 30 days, he may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay the participant up to $110 a day until he receives the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator.

If the participant has a claim for benefits that is denied or ignored, in whole or in part, after following the required claims and appeals procedures and exhausting all administrative remedies described in The appeals administrator’s decision is final section of this chapter, he may file suit in federal court. In addition, if he disagrees with the plan’s decision or lack thereof concerning the qualified status of a medical child support order, he may file suit in federal court. If the plan fiduciaries misuse the plan’s money, or if the participant is discriminated against for asserting his rights, he may seek assistance from the U.S. Department of Labor or file suit in a federal court. The court will decide who should pay court costs and legal fees. If the participant is successful, the court may order the person he has sued to pay these costs and fees. If he loses — for example, if the court finds the claim is frivolous — the court may order him to pay these costs and fees.

ASSISTANCE WITH QUESTIONS

For questions about the plan, participants should contact the appropriate plan administrator or claims administrator.

For questions about this statement or about rights under ERISA, or for assistance in obtaining documents from the plan administrator, participants should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor listed in the telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, DC 20210.

Participants can obtain certain publications about rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at (866) 444-3272.



The information in this section applies to the following plans:

• The Phillips 66 Medical and Dental Assistance Plan, which includes employee medical (including prescription drug and mental health/substance abuse) dental and vision benefits and retiree medical benefits;

• The Employee Assistance Plan (EAP); and

• The Flexible Spending Plan (FSP), which includes before-tax premium payments, the health care flexible spending account, the dependent care flexible spending account and the health savings account.

GENERAL INFORMATIONQUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)

This section does not apply to the Medicare-eligible post-65 retiree medical options.

The participant cannot assign his own benefits, but a court may assign his benefits in limited situations, such as through a QMCSO.

A QMCSO is a type of court order that gives the participant’s biological or legally adopted child the right to be covered by the participant’s health coverage (including medical, dental, vision, EAP and health care flexible spending account). For example, a QMCSO might be issued after a divorce to make sure the child is covered under one of the parent’s health care plans. The child must meet the plan’s eligibility requirements to be eligible for benefits.

Note: QMCSOs do not apply to grandchildren, nieces, nephews, stepchildren and/or to children of a domestic partner. The court order must satisfy the conditions spelled out under federal law in order to qualify as a QMCSO. Copies of these QMCSO procedures are available without charge at qocenter.com or by calling the Benefits Center.

SUBROGATION RIGHTS (RECOVERY OF BENEFITS PAID)

The following is a very basic explanation of the subrogation and reimbursement rights that apply to the HDHP, PPO, Medicare-eligible PPO and dental options. It is VERY IMPORTANT that the participant contacts the plan administrator and the claims administrator for specific instructions and information if subrogation applies to him.

Note: This section does not apply to coverage under the Kaiser HMO or to vision, EAP or Flexible Spending Plan benefits, or to the Medicare-eligible post-65 retiree medical options.

Subrogation applies if the plan pays medical expenses that should instead be paid by a third party such as an insurance company or another responsible party.

Medical, Dental, Vision, Employee Assistance Plan (EAP) and Flexible Spending Plan (FSP)

http://qocenter.com

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AS USED IN THIS SECTION:

• “The participant” and “his” means the participant and/or his covered dependent.

• A “third party” can be:

– Anyone who may be responsible in any way for the participant’s condition;

– Any liability insurance or other insurance that covers the participant or a third party; or

– The participant’s own uninsured motorist insurance, underinsured motorist insurance, no-fault insurance or school insurance.

• A “third party” excludes:

– Phillips 66 and any other entity that is a sponsoring employer of the plan.

• A “condition” includes an injury, illness, sickness or other similar condition.

The plan’s rights of subrogation and recovery are described below:

• The plan may pay (or owe) benefits relating to a condition for which the participant may be entitled to compensation from a third party. This compensation may include entitlement to payments by that third party to or on behalf of the participant. If this occurs, the plan is subrogated to all of the participant’s rights against, claims against and partial or full recoveries from that third party, up to the amount paid (or owed) by the plan. This is true regardless of whether the participant has been fully compensated or “made whole” for the condition.

• In addition, if the participant receives a full or partial recovery from a third party relating to a condition, the plan is entitled to an independent right of immediate and first reimbursement from that recovery (before the participant or anyone else is paid anything from that recovery), up to the amount paid (or owed) by the plan for that condition. This is true regardless of whether the participant has been fully compensated or “made whole” for that condition, regardless of fault or negligence, and regardless of how he obtained that recovery from the third party (for example, by a settlement agreement, court order or otherwise). The “make whole” doctrine does not apply.

• The participant will be responsible for payment of the legal fees associated with his rights of recovery against a third party. The plan’s rights of subrogation and reimbursement apply to all amounts that the participant recovers (rather than the amounts remaining after payment of any legal fees and costs). This is true even if, for example, the “common fund” doctrine provides otherwise. The plan’s rights of reimbursement and subrogation apply to the first monies that the participant is paid or receives, or to which he becomes entitled, without deductions of any type, including costs or attorney’s fees that he incurs in order to obtain a payment from a third party with respect to a condition. The “common fund” doctrine does not apply.

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• The plan may require, before paying any benefits, that the participant does anything that may be necessary or helpful related to the plan’s rights described in this section, including signing (or obtaining signatures on) relevant documents. If the covered dependent with the condition is a minor child, the child’s parent or guardian must sign the required documents on behalf of the child. However, the plan shall have rights to reimbursement and subrogation regardless of whether these documents are signed and provided to the plan. The participant must not do anything to prejudice (or harm) the plan’s rights to reimbursement and subrogation. He must cooperate with the plan. If the participant fails to comply with any plan requirement, the plan may withhold benefits, services, payment or credits that otherwise may be due under the plan.

• The participant must promptly notify (within 45 days of the filing of a claim against any party for damages resulting from a third party accident) the plan administrator of the possibility of obtaining a recovery from a third party for a condition for which the plan has provided benefits (or may be responsible for providing benefits). This is true regardless of whether that recovery may be obtained by a settlement agreement, court order or otherwise. The participant must not agree to a settlement regarding that condition without first obtaining the written consent of the Plan Administrator or its designee.

If the participant settles a claim with a third party in a way that results in the plan being reimbursed less than the amount of plan benefits related to a condition, or in any way that relieves the third party of future liability for medical costs, the plan may refuse to pay additional benefits for that condition unless the plan administrator previously approved the settlement in writing.

The plan may enforce its subrogation and reimbursement rights in any of the following ways:

• The plan may require the participant to make a claim against any insurance coverage under which he may be entitled to a recovery for a condition.

• The plan may intervene in any legal action the participant brings against a third party related to a condition.

• The plan may bring a legal action against (i) the participant, (ii) the attorney for the participant or anyone else, and (iii) any trust (or any other party) holding any proceeds recovered by or with respect to the participant.

The plan shall have a lien on all amounts recovered related to a condition for which it pays (or may owe) benefits, up to the amount of the plan obligations. This is true regardless of whether the amounts recovered are obtained by a settlement agreement, court order or otherwise. The lien applies to a recovery from a third party as defined by the plan. The plan may seek relief from anyone who receives settlement proceeds or amounts collected from judgments related to the condition. This relief may include, but is not limited to, the imposition of a constructive trust and/or an equitable lien.

If the participant or any other person covered under the plan accepts payment from the plan or has plan benefits paid on his behalf, that person does so subject to the provisions of the plan, including the provisions described in this Subrogation rights (recovery of benefits paid) section.

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The employer, the plan, the plan administrator and the claims administrator also are entitled to recover any amounts paid under the plan that exceed amounts actually owed under the plan. These excess plan payments may be recovered from the participant, any other person with respect to whom the payments were made, the person who received the benefit payment, any insurance companies, and any other organization or any other beneficiary of the plan. The employer, the plan, the plan administrator and/or the claims administrator also may, at its option, deduct the amount of any excess plan payments from any subsequent plan benefits payable to, or on behalf of, the participant, his spouse, his domestic partner or his dependent, as applicable. The Plan Administrator and/or the claims administrator have the authority and discretion to interpret the plan’s subrogation and recovery provisions.

RIGHT OF RECOVERY

For medical, dental and vision benefits

If the participant is paid more than he should have been paid or reimbursed for a medical (including prescription drug or mental health/substance abuse), dental or vision claim, or if a claim is paid for ineligible expenses or ineligible dependents, the claims administrator may deduct the overpayment from future claims payments due to the participant under the plan or require the return of the overpayment.

For Flexible Spending Plan reimbursements

If the participant is reimbursed more than he should have been from his Health Care Flexible Spending Account and/or Dependent Care Flexible Spending Account, the claims administrator may deduct the overpayment from future reimbursements or request reimbursement from him directly. Overpayments not returned will be treated as a taxable distribution.

COBRA CONTINUATION COVERAGE

COBRA continuation coverage does not apply to the Medicare-eligible post-65 retiree medical options.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows qualified beneficiaries to continue medical, dental, vision, the Employee Assistance Plan (EAP) and Health Care Flexible Spending Account (HCFSA) coverage if that coverage is lost due to a qualifying event.

There is more information on qualifying events and qualified beneficiaries beginning on page N-14.

Note: Under the Flexible Spending Plan, COBRA is available for the HCFSA only. It is not available for the Dependent Care Flexible Spending Account (DCFSA) or for before-tax premium payments. HCFSA COBRA is also not available to domestic partners and their children.



HOW COBRA WORKSCOBRA applies to health care coverage — including medical, dental, vision, prescription drugs and mental health and substance abuse. COBRA also applies to EAP and HCFSA contributions and reimbursements.

Notification and enrollment

• A qualified beneficiary loses coverage due to a qualifying event (see pages N-14 and N-15).

• The plan is notified. – The company notifies the plan if the participant’s employment ends, his hours are

reduced or in the event of his death. – The participant or the qualified beneficiary must notify the Benefits Center for all

other qualifying events within 65 days of the event.

• The COBRA Administrator sends a COBRA Enrollment Notice to the person who lost coverage.

• The participant or the qualified beneficiary must elect COBRA within 65 days* to obtain coverage. – Generally, each person can make his own election, except: – Only the employee can make an HCFSA COBRA election.

• COBRA cannot be elected if either of the above deadlines is missed.

* The 65-day period begins on the date of the qualifying event or the date of the COBRA Enrollment Notice, if later.

COBRA coverage options for medical, dental, vision and EAP

• At first, the participant can enroll only in his current medical, dental and vision coverage. For example, if he is in the HDHP option, he must enroll in the HDHP option through COBRA.

• If the participant has other dependents he wishes to cover under his medical, dental or vision coverage, he can also enroll them when he makes his COBRA elections.

• Once the participant has enrolled, he can change to a different medical, dental or vision option or add dependents during annual benefits enrollment or following a qualified change in status event as described on page N-18.

• If the participant elects EAP COBRA coverage, it would cover all eligible dependents that were eligible for the EAP before coverage was lost.

• If the participant elects EAP COBRA coverage and wants it to continue, he does not need to do anything during annual benefits enrollment. His coverage will remain in effect as long as he is eligible and continues to make required payments.

• The participant can cancel coverage for himself and/or his dependents at any time.

• The participant may be allowed to enroll in COBRA medical coverage under this plan and in a group health plan of a different employer or in Medicare; however, some additional provisions will apply. See page N-19 for details. (This does not apply to COBRA dental or EAP coverage.)

(continued)

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COBRA coverage options for the Flexible Spending Plan HCFSA

Because the participant forfeits any unused HCFSA contributions, electing HCFSA COBRA allows him to exhaust his contributions to avoid or reduce the amount of any forfeiture.

• The participant can continue contributing the same amount to his HCFSA through the end of the calendar year in which coverage ended. – The participant will make contributions on an after-tax basis. – Any eligible health care expenses incurred during the time the participant is making

HCFSA COBRA contributions are eligible to be reimbursed through his HCFSA.

• If the participant does not elect to continue his HCFSA through COBRA, he can be reimbursed only for expenses incurred through the end of the month in which coverage ended.

Length of COBRA coverage for medical, dental, vision and EAP

COBRA for medical, dental, vision and/or EAP coverage can continue for up to:

• 18 months if the qualifying event was: – Termination of employment with the company (for reasons other than gross

misconduct); – A reduction in the number of work hours, if there is a loss of coverage under the

plan; or – Failing to return to active employment with the company following a family medical

leave of absence (FMLA).

• 29 months if a qualified beneficiary: – Is disabled at the time the participant’s work hours are reduced or he leaves the

company, or if he becomes disabled within the first 60 days of an 18-month COBRA period; or

– Qualifies because the qualifying event was the participant’s termination of employment or reduction in hours; and

– Notifies the COBRA Administrator within 65 days of the determination of disability by the Social Security Administration before the end of the 18-month period.

This extra time is not automatic. See page N-16 to see what the participant must do if he wants this extended coverage.

• 36 months for all other qualifying events.

COBRA coverage will never last longer than 36 months, even if there is a second qualifying event. For example, if the participant and his spouse are in an 18-month COBRA period and they divorce, the participant’s spouse’s COBRA period can be extended for up to 18 more months (up to a total of 36 months) — but not beyond the 36-month total.

Cost of coverage • All contributions for HCFSA COBRA coverage are made on an after-tax basis.

• For medical (including prescription drug and mental health/substance abuse), dental, vision and/or EAP COBRA coverage: – The participant pays 100% of the cost of coverage, plus a 2% administrative fee. – If coverage is extended due to disability, the participant pays 150% of the cost of

coverage for months 19 – 29. – Contributions for coverage are made on an after-tax basis.

(continued)



When COBRA ends

Provided the participant continues to make required COBRA contributions on time, COBRA coverage will continue until:

• For HCFSA COBRA coverage — The end of the calendar year in which coverage ended.

• For medical, dental, vision and/or EAP COBRA coverage — The earlier of: – The end of the 18-, 29- or 36-month continuation period, as applicable. – When one of the events shown in the When COBRA coverage ends section occurs.

See page N-21.

QUALIFYING EVENTSA qualifying event leads to a loss of plan coverage. Qualifying events are listed below.

For the participant

The participant becomes a qualified beneficiary and is entitled to elect COBRA coverage if he loses coverage because his:

• Hours of employment are reduced;

• Employment ends for any reason other than his gross misconduct; or

• Employment ends because he fails to return to work following a family medical leave of absence (FMLA).

For the participant’s dependent

The participant’s dependent becomes a qualified beneficiary and is entitled to elect COBRA if the participant loses medical, dental, vision or EAP coverage because:

• His coverage ends due to:

– His termination of employment;

– A reduction in the number of hours he is employed, if there is a loss of coverage under the plan; or

– His failure to return to active employment following an FMLA leave;

• His enrollment in Medicare (Part A, Part B or both);

• He gets divorced or obtains a legal separation;

• His domestic partner no longer qualifies as an eligible domestic partner;

• His spouse, dependent child, stepchild or the child of his domestic partner no longer qualifies as an eligible dependent; or

• He dies.

FOR A DOMESTIC PARTNER …

A domestic partner and/or a domestic partner’s child must be enrolled in the medical, dental or vision coverage or covered by the EAP at the time of the qualifying event. If they were not enrolled or covered, they cannot elect COBRA.

In addition, domestic partners and their children are not allowed to elect HCFSA COBRA coverage.

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NOT RETURNING TO WORK FOLLOWING A FAMILY MEDICAL LEAVE OF ABSENCE (FMLA)

If the participant takes an FMLA leave and does not return to work at the end of the leave, he and his dependents will be entitled to elect COBRA medical, dental, vision and/or EAP coverage if:

• The participant and his dependents were covered under the plan on the day before the FMLA leave began (or became covered during the leave); and

• The participant and his dependents will lose plan coverage within 18 months due to the participant not returning to work.

Participants should contact the Benefits Center for more information.

QUALIFIED BENEFICIARIESFor HCFSA COBRA, the participant is the qualified beneficiary.

For COBRA medical, dental, vision and EAP coverage, qualified beneficiaries include:

• The participant and/or any covered dependents who were enrolled in the plan and lost coverage due to a qualifying event.

• Children born to, fostered by, adopted by, or placed for adoption with the participant or any qualified beneficiary during the COBRA continuation period.

– That child will be considered a qualified beneficiary as long as the participant is a qualified beneficiary and has elected COBRA continuation coverage for himself.

– The child’s COBRA coverage begins when the child is enrolled in the participant’s coverage, and lasts for as long as COBRA lasts for the participant’s other family members.

– The child must satisfy the otherwise applicable requirements, such as age, to be an eligible dependent (see the dependent eligibility information in the separate Employee Medical, Retiree Medical, Employee Dental, Employee Vision, and/or Employee Assistance Plan chapters).

– Be sure to check with the COBRA Administrator before adding a new dependent to ensure the dependent is eligible.

• A child covered under a Qualified Medical Child Support Order (QMCSO).

– The participant’s child who is receiving benefits under a QMCSO received during the participant’s period of employment with the company has the same COBRA rights as any of his other eligible dependent children.

• Domestic partners and their children, if they were covered under the applicable plan prior to a qualifying event.

Note: Each qualified beneficiary can make his own independent COBRA medical, dental, vision and EAP election.



DISABILITY EXTENSION OF COBRA COVERAGEThe participant and his qualified beneficiaries may be eligible to extend 18-month medical, dental, vision and/or EAP COBRA coverage for up to an additional 11 months (for a total of 29 months) if:

• The Social Security Administration (SSA) determines that the participant or qualified beneficiary is disabled:

– At the time his work hours are reduced or he leaves the company; or

– Within the first 60 days of COBRA coverage; and

• The disability continues throughout the COBRA continuation period.

To be eligible for this 11-month extension:

• The participant or qualified beneficiary must notify the COBRA Administrator of the disability within 65 days of the date the disability is determined, his work hours are reduced or he terminates employment with the company, whichever is later.

• This notification must be before the end of the original 18-month COBRA continuation period.

If the participant or qualified beneficiary misses either of these deadlines, COBRA coverage cannot be extended.

The extension of COBRA coverage applies to all of the qualified beneficiaries in the participant’s family, even those family members who are not disabled, if the COBRA Administrator is notified by the above deadlines.

The COBRA enrollment materials will include more information about disability extensions.

If the participant or qualified beneficiary is subsequently determined by the SSA to no longer be disabled, he must notify the COBRA Administrator.

SECOND QUALIFYING EVENTSThe participant’s spouse, domestic partner, dependent children or domestic partner’s dependent children can extend medical, dental, vision and/or EAP COBRA coverage for up to a total of 36 months if one of the following qualifying events occurs during the initial 18- or 29-month COBRA coverage period, as applicable, following the participant’s termination of employment or reduction of hours:

• The participant and his spouse divorce or legally separate or his domestic partnership ends.

• The participant’s dependent child no longer meets the eligibility requirements for benefit coverage.

• The participant dies.

These events will be considered a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the plan if the first qualifying event had not occurred. This extension is not available if the covered employee becomes enrolled in Medicare.

The COBRA Administrator must be notified of the second qualifying event within 65 days of the later of the second qualifying event or the date the qualified beneficiary would lose coverage as a result of the second qualifying event (if it had occurred while the qualified beneficiary was still covered under the plan) in order for coverage to be extended.

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CHANGING COBRA COVERAGEThe participant and/or his/her qualified beneficiaries may be eligible to change COBRA coverage under certain circumstances.

For COBRA medical, dental, vision and EAP coverage

• The participant or qualified beneficiary can cancel coverage at any time.

• The participant or qualified beneficiary can change coverage elections each year during annual benefits enrollment.

• If the participant or qualified beneficiary has a qualified change in status event, he may be able to make changes at other times.

For HCFSA COBRA coverage

The participant can cancel his contributions at any time, but he cannot change his contribution amount.

Unless the participant cancels coverage, his contributions will continue in the same amount through the end of the calendar year in which he terminates employment with the company.

Changing COBRA elections midyear

This section applies to COBRA medical, dental and vision coverage only.

Most of the time, the participant or qualified beneficiary cannot change enrollment elections until the next annual benefits enrollment. However, if he has a qualified change in status event as described in this section, he may be permitted or required to:

• Enroll in COBRA medical, dental and vision coverage; or

• Change the dependents covered under the plan.

The new coverage election must be consistent with the qualified change in status event.

The following are very important deadlines:

• A newborn child, newly placed foster child, newly adopted child or child placed for adoption as a new dependent must be ADDED within 90 days. If the participant or qualified beneficiary misses this deadline, the new child will be covered for the first 31 calendar days only, and he must wait until the next annual benefits enrollment to add the child to coverage. This applies even if the participant or qualified beneficiary already has You + two or more coverage for his other dependents.

• A new dependent (OTHER THAN a newborn child, a newly placed foster child, a newly adopted child or a child placed for adoption) must be ADDED within 30 days. If the participant or qualified beneficiary misses this deadline, he must wait until the next annual benefits enrollment. This applies even if the participant or qualified beneficiary already has You + two or more coverage for his other dependents.

• A dependent who is no longer eligible must be REMOVED within 30 days. If the ineligible dependent is not removed from coverage and the plan pays any medical, dental or vision claims for this dependent, the participant or qualified beneficiary will have to pay that money back to the plan.



To make changes, participants should contact the Benefits Center.

Qualified change in status events

The following are the qualified change in status events that allow, or require, changes to COBRA elections:

• Marriage, divorce, legal separation or annulment.

• An individual covered under the plan as a domestic partner no longer qualifies as a “domestic partner” (as that term is defined in the Glossary).

• The death of a dependent.

• The addition of a child through birth, foster placement, adoption or placement for adoption.

• A Qualified Medical Child Support Order that requires the participant to provide medical or dental coverage for a child (see page N-8).

• A change in employment status for the participant or his dependent.

• A change in work schedule for the participant or his dependent that changes coverage eligibility.

• A change in the participant’s dependent’s status.

• The participant and/or his eligible dependents become eligible or lose eligibility for Medicare.

• The participant and/or his dependents become entitled to COBRA.

• The taking of or return from a leave of absence under FMLA or USERRA.

• The participant or his dependents have a significant change in benefits or costs, such as benefits from another employer, etc.

The Plan Administrator shall have the exclusive authority to determine if the participant or qualified beneficiary is entitled to revoke an existing election as a result of a qualified change in status event or a change in the cost or coverage, as applicable, and its determination shall bind all persons. For questions about qualified change in status events, participants should contact the Benefits Center.

HIPAA special enrollment

HIPAA special enrollment applies to COBRA medical coverage only.

HIPAA special enrollment provides additional options when the participant has a qualified change in status event. It applies to the participant’s dependents if:

• The participant did not enroll a dependent in COBRA earlier because the dependent had other medical coverage, and:


– An employer stops contributing toward the cost of coverage.

• The participant gains a dependent due to marriage, birth, foster placement, adoption or placement for adoption.

• The participant or his dependent becomes eligible for premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP). Note that the participant has 60 days instead of 30 days to change his coverage in this case.

Special enrollment does not always apply. For example, it would not apply if the participant’s dependent lost other coverage for non-payment of premiums. The participant should contact the Benefits Center for more information about HIPAA special enrollment.

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ENROLLED IN COBRA COVERAGE AND IN ANOTHER COMPANY’S PLAN OR MEDICARE

This section applies to continued medical COBRA coverage only. It does not apply to dental or vision coverage or the Flexible Spending Plan’s Health Care Flexible Spending Account (HCFSA) participation.

The participant may enroll in both COBRA continuation coverage in the medical benefit provided under the plan and in group health coverage under another employer’s plan. However:

• If the participant elects COBRA continuation coverage under the Phillips 66 plan first and then becomes covered (enrolled) in Phillips 66’s or another employer’s group health plan (but only after any applicable pre-existing condition exclusions of that other plan have been exhausted or satisfied) or enrolls in Medicare (Part A, Part B or both), the company reserves the right to cancel the participant’s COBRA continuation coverage. This rule does not apply if you are enrolled in the company’s Medicare-eligible post-65 retiree medical options. In addition, the participant must notify the COBRA Administrator when the qualified beneficiary becomes covered under another group health plan or enrolls in Medicare (Part A, Part B or both). The Plan Administrator may require repayment to the plan of all benefits paid after the coverage termination date, regardless of whether and when the participant provides notice to the COBRA Administrator of commencement of other group health plan coverage.

• If the participant elects coverage under another employer’s group health plan first and then enrolls in COBRA continuation coverage under the Phillips 66 plan, he may have both coverage — if the participant is willing to pay for both plans. If the participant elects to continue both COBRA under the Phillips 66 plan and coverage under the other group health plan, then the other group health plan will be the primary plan for coordination of benefits.

• If the participant is enrolled in Medicare (Part A, Part B or both) prior to electing COBRA continuation coverage under the plan, Medicare coverage will be primary while the participant is enrolled in COBRA continuation coverage. In this case, when the participant completes the COBRA election process, he must indicate if any qualified beneficiary is enrolled in Medicare (Part A, Part B or both) and, if so, the date of the Medicare enrollment.

• If the participant is enrolled in Medicare (Part A, Part B or both) due to turning age 65 prior to or during COBRA continuation coverage under the Medical Plan, he can delay enrollment in the Medicare-eligible post-65 retiree medical options until the end of COBRA continuation coverage.



PAYING FOR COBRA COVERAGEThe participant will contribute the same amount for HCFSA coverage that he was contributing to the plan before his coverage ended. Unless the participant cancels his HCFSA coverage, his contributions continue for the remainder of that calendar year.

The amount the participant or qualified beneficiary pays for COBRA medical, dental, vision and EAP coverage is shown below.

For … The cost is …

18-month or 36-month COBRA coverage

102% of the full cost of coverage — that is both the employee/retiree and employer costs to provide the benefit, plus a 2% administrative fee

Disability extension from 18 to 29 months

150% of the full cost of coverage during months 19 through 29 (the extension period)

The amount due each month will be provided in the COBRA election notice. The cost for medical, dental, vision and/or EAP coverage may change from time to time during the period of COBRA continuation coverage. Payments must be sent to the COBRA Administrator.

• First payment — The first payment must be made within 45 days after the date of the COBRA election. This payment must cover the cost of coverage from the date the participant lost coverage up to the time he makes the payment, even if he had no claims during that time period.

• Remaining monthly payments — The payment for each month’s coverage is due on the first day of the month. There will be a grace period of 30 days to make monthly payments. If the participant or qualified beneficiary makes a monthly payment later than it’s due date but within the 30-day grace period, coverage under the plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the monthly payment is received.

Monthly payments can be made either by check or automatic deductions from a bank account. The COBRA enrollment materials will contain detailed information about payment methods.

If the participant or qualified beneficiary does not make payments as required, he will lose all COBRA rights under the plan, and claims for expenses incurred after coverage ends will not be paid by the plan.

Checks that are returned unpaid by a bank for any reason will result in untimely payment and cancellation of coverage. Partial payments will not be accepted and will be treated as non-payment, which will result in cancellation of coverage.

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WHEN COBRA COVERAGE ENDSCOBRA coverage for the HCFSA ends on the earlier of:

• December 31 of the calendar year in which the qualifying event took place.

• The date the participant fails to timely pay the full monthly COBRA contribution.

COBRA coverage for medical, dental, vision and EAP ends on the earliest of the following dates:

• The date the covered person first becomes covered under another group health plan (but only after any pre-existing condition exclusions of that other plan for the qualified beneficiary have been exhausted or satisfied).*

• The date the covered person is first enrolled in Medicare benefits under Part A, Part B or both.*

• The date the company stops providing any group health plan or EAP coverage.

• The date the covered person fails to timely pay the full monthly COBRA contribution for coverage.

• If coverage was extended to 29 months due to disability, the date the disabled person is no longer disabled (as determined by the Social Security Administration).

• The date coverage is terminated for any reason for which the plan would terminate coverage for a non-COBRA participant.

• The end of the applicable 18-, 29- or 36-month period.

• The date on which the covered person submits a fraudulent claim.

* This applies only to medical and dental COBRA coverage and only if the coverage under the other group health plan or Medicare entitlement begins after the date that COBRA continuation coverage is elected under this plan. Participants should contact the COBRA Administrator for information.

The COBRA Administrator must be notified when a qualified beneficiary becomes covered under another group health plan or becomes enrolled in Medicare.

QUESTIONS REGARDING COBRAQuestions regarding the plan or COBRA rights should be addressed to the COBRA Administrator or the Benefits Center.

For more information about rights under ERISA, including COBRA, HIPAA and other laws affecting group health plans, participants should contact the nearest regional or district office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) or visit the EBSA website at dol.gov/ebsa. (Addresses and phone numbers of regional and district EBSA offices are available through EBSA’s website.)

USERRA CONTINUATION COVERAGE

This information applies only to Phillips 66 employee medical, dental, vision and EAP benefits and to the Phillips 66 Flexible Spending Plan’s Health Care Flexible Spending Account (HCFSA) (collectively referred to as the plan in this section), to the extent the participant is enrolled in the benefits provided under the plan at the time this section becomes applicable to him.

Under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), the company must offer the participant a temporary extension of health coverage under the plan for him and his covered dependents at group rates in certain instances where coverage would not otherwise be available under the plan.

http://dol.gov/ebsa



Note: Under USERRA, unlike COBRA, dependents do not have a separate election right.

To the extent a participant is covered under the plan and is placed on a military leave of absence (up to 12 months), he will automatically continue coverage at the same rates as active employees. No election is required. If the participant is covered under the plan and his military leave of absence ends with the company (his employment ends), but he is still serving in the uniformed services, he can elect military absence COBRA continuation coverage (USERRA continuation coverage) until the earlier of 24 months or the date he fails to apply for or returns to employment as an employee of the company. HCFSA participation can continue only until the end of the calendar year of the participant’s employment end date. The participant (or his authorized representative) may elect to continue his coverage under the plan for himself and his covered dependents by making an election with the COBRA Administrator and by paying the applicable cost for coverage. The election must be made within 65 days of the later of the date of the COBRA Enrollment Notice or the date the coverage ends.

If the participant fails to make an election or does not make payment within the required timeframe, he will lose his USERRA continuation rights under the plan, except in the event that his failure to give advanced notice of service was excused under USERRA because it was impossible, unreasonable or precluded by military necessity. In that case, the plan will reinstate the participant’s coverage retroactively upon his election to continue coverage and payment of all unpaid amounts due.

USERRA continuation coverage cost is 102% of the full cost of coverage (including both employer and employee costs). Payments must be sent to the COBRA Administrator.

• The participant must make his first payment within 45 days after the date of his election. This payment must cover his costs up to the time he makes payment.

• Thereafter, the cost for each month’s coverage is due on the first day of the month. The participant will be given a grace period of 30 days to make these subsequent monthly payments. However, if he makes a monthly payment later than its due date but during the grace period, his coverage under the plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the monthly payment is received within the 30-day grace period.

If the participant elects to continue coverage under USERRA, the USERRA continuation coverage may be continued for up to 24 months. However, coverage will end earlier if one of the following events takes place:

• The participant fails to make a payment within the required timeframe;

• The participant fails to return to work within the time required under USERRA following the completion of his service in the uniformed services; or

• The participant loses his rights under USERRA as a result of a dishonorable discharge or other undesirable conduct specified in USERRA.

COBRA and USERRA continuation coverage are concurrent for the first 18 months. This means that both COBRA and USERRA continuation coverage begin when the participant’s military leave of absence with the company ends (his employment ends), and he is still serving in the uniformed services. However, COBRA coverage terminates at the end of 18 months and USERRA continuation coverage terminates at the end of 24 months, unless coverage is terminated earlier due to non-payment of costs or another event described earlier.

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The participant must apply for employment or return to employment within the period required under USERRA for benefit reinstatement. If he cancelled plan coverage while on military leave of absence, it will be reinstated after he returns to work. If he returns to work from a military leave of absence during the same calendar year, he will be re-enrolled automatically in the same coverage options that he had before the leave began. If the participant returns to work from a military leave of absence in a different year, he can elect new coverage options.

HIPAA PRIVACY RULES

This information applies only to Phillips 66 medical, dental, vision and EAP benefits and to the Phillips 66 Flexible Spending Plan’s Health Care Flexible Spending Account (HCFSA) (collectively referred to as the plan in this section).

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATIONThe plan will use protected health information (PHI) to the extent of and in accordance with the uses and disclosures permitted by the privacy standards under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the plan will use and disclose PHI for purposes related to health care treatment, payment for health care and health care operations. PHI is information that may identify the participant and that relates to (a) the participant’s past, present, or future physical or mental health or condition or (b) the past, present or future payment for the participant’s health care.

Payment includes activities undertaken by the plan to obtain premiums or determine or fulfill its responsibility for coverage and provision of plan benefits that relate to an individual to whom health care is provided. These activities may include, but are not limited to, the following:

• Determination of eligibility, coverage and cost-sharing amounts (for example, cost of a benefit, plan maximums and copays determined for an individual’s claim);

• Coordination of benefits;

• Adjudication of health benefit claims (including appeals under the claims and appeals procedures and other payment disputes);

• Subrogation of health benefit claims;

• Establishing employee and retiree contributions;

• Risk-adjusting amounts due based on enrollee health status (looked at in aggregate and not individually) and demographic characteristics;

• Billing, collection activities and related health care data processing;

• Claims management and related health care data processing, including auditing payments, investigating and resolving payment disputes and responding to participant inquiries about payments;

• Obtaining payment under a contract for reinsurance (including stop-loss and excess of loss insurance);

• Medical necessity reviews or reviews of appropriateness of care or justification of charges;

• Utilization review, including pre-certification, pre-authorization, concurrent review and retrospective review;

• Disclosure to consumer reporting agencies related to the collection of premiums or reimbursement (the following PHI may be disclosed for payment purposes: name and address, date of birth, Social Security number, payment history, account number and name and address of provider and/or health plan); and

• Reimbursement to the plan.



Health care operations may include, but are not limited to, the following activities:

• Quality assessment;

• Population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, disease management, contacting health care providers and patients with information about treatment alternatives and related functions;

• Rating provider and plan performance, including accreditation, certification, licensing or credentialing activities;

• Underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing or placing a contract for reinsurance of risk relating to health care claims (including stop-loss insurance and excess of loss insurance);

• Conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse detection and compliance programs;

• Business planning and development, such as conducting cost-management and planning-related analyses related to managing and operating the plan, including formulary development and administration, development or improvement of payment methods or coverage policies;

• Business management and general administrative activities of the plan, including, but not limited to:

– Management activities relating to the implementation of and compliance with HIPAA’s administrative simplification requirements, also known as privacy requirements; or

– Customer service, including the provision of data analyses for the Plan Sponsors, policyholders or other customers;

• Resolution of internal grievances; and

• Due diligence in connection with the sale or transfer of assets to a potential successor in interest.

The plan will use and disclose PHI as required by law and as permitted by authorization of the participant or beneficiary

With an authorization by the participant or beneficiary (that is, the participant or his covered dependent), the plan will disclose PHI to whatever entity is set forth in the authorization, including a customer service representative, disability plans, reciprocal benefit plans and Workers’ Compensation insurers for purposes related to administration of those plans and programs.

A plan representative can assist participants and beneficiaries with an aspect of a claim he may have under the plan only if the participant or beneficiary provides the representative with written permission. The plan representative may request that the participant completes and signs an Authorization for Release of Information. In the authorization, the participant will give the representative permission to interface with the plan and third-party administrator on his behalf. The plan representative will not handle disputes with providers; therefore, authorization forms will not be accepted except under rare and limited circumstances.

For purposes of this section, Phillips 66 Company is the Plan Sponsor

The plan will disclose PHI to the Plan Sponsor only upon receipt of a certification from the Plan Sponsor that the plan document has been amended to incorporate the following provisions, of which the Plan Sponsor has provided such certification.

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With respect to PHI, the Plan Sponsor agrees to certain conditions

The Plan Sponsor agrees to:

• Not use or further disclose PHI other than as permitted or required by the plan document or as required by law;

• Not use genetic information for underwriting purposes in compliance with the Genetic Information Nondiscrimination Act of 2008 (GINA);

• Ensure that any agents, including a subcontractor, to whom the Plan Sponsor provides PHI received from the plan, agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to such PHI;

• Not use or disclose PHI for employment-related actions and decisions unless authorized by a participant or beneficiary or a personal representative of the participant or beneficiary;

• Not use or disclose PHI in connection with any other benefit or employee benefit plan of the Plan Sponsor unless authorized by the participant, beneficiary or his respective personal representative, unless such plan is part of the organized health care arrangement of which the plan is a part, as described below;

• Report to the plan any PHI use or disclosure of which it becomes aware, if such use or disclosure is inconsistent with the permitted uses or disclosures;

• Make PHI available to the participant, beneficiary or his personal representative in accordance with HIPAA’s access requirements;

• Make PHI available for amendment and incorporate any amendments to PHI in accordance with HIPAA;

• Make available the information required to provide an accounting of disclosures;

• Make internal practices, books and records relating to the use and disclosure of PHI received from the plan available to the HHS Secretary for purposes of determining the plan’s compliance with HIPAA;

• If feasible, return or destroy all PHI received from the plan that the Plan Sponsor still maintains in any form and retain no copies of such PHI when no longer needed for the purpose for which disclosure was made (or if return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction infeasible); and

• Notify individuals or the HHS Secretary, as necessary, of a breach of unprotected PHI within 60 days of discovery in accordance with HIPAA. Notices will contain a description of the breach (what happened, date of the breach and date of discovery; a list of the types of information involved; suggested steps for the individual’s protection; a description of the investigation, mitigation and protection for the future; and contact procedures to obtain more information).

Adequate separation between the plan and the Plan Sponsor must be maintained

In accordance with and to the extent permitted under HIPAA, only the following employees or classes of employees may be given access to PHI:

For medical, dental, vision coverage and the Flexible Spending Plan HCFSA:

• Senior Vice President, Human Resources, Communication & Public Affairs.

• Manager, Total Rewards.

• Staff designated by the Manager, Total Rewards.

• Manager, HR Operations.

• Staff designated by the Manager, HR Operations.

• Mail & Document Services Staff of Corporate Information Services.

• Documents & Records Management Staff of Corporate Information Services.



• Manager, Health Services.

• Staff designated by Manager, Health Services.

• Employee Benefits Counsel.

• Employee Benefits Counsel legal and administrative assistant(s).

For the Employee Assistance Plan:

• Plan Administrator.

• Staff designated by the Plan Administrator.

• Manager, Health Services.

• Staff designated by Manager, Health Services.

• Employee Benefits Counsel.

• Employee Benefits Counsel legal and administrative assistant(s).

Limitations of PHI access and disclosure

The persons described in the previous section may have access to, and use and disclose, PHI for plan administration functions that the Plan Sponsor performs for the plan only to the extent permitted under HIPAA. If the persons named above do not comply with the rules for use and disclosure of PHI, the Plan Sponsor shall provide a mechanism for resolving issues of noncompliance, including disciplinary action up to and including termination of employment.

Organized health care association

The Phillips 66 Medical and Dental Assistance Plan, the Phillips 66 Flexible Spending Plan and the Phillips 66 Employee Assistance Plan have been designated as part of an organized health care association in order to share certain PHI related to treatment, payment and health care operations under the respective plans, lifetime maximums, deductibles and disenrollment from one plan and enrollment to another plan due to open enrollment, relocation or similar circumstances.

HIPAA security requirements applicable to electronic PHI

The Plan Sponsor will:

• Implement safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of electronic PHI that it creates, receives, maintains or transmits on behalf of the plan;

• Ensure that the adequate separation between the plan and Plan Sponsor, with respect to electronic PHI, is supported by reasonable and appropriate security measures;

• Ensure that any agent, including a subcontractor, to whom it provides electronic PHI agrees to implement the provisions of HIPAA and the Health Information Technology for Economic and Clinical Health Act (HITECH); and

• Report to the plan any security incident of which it becomes aware concerning electronic PHI.

For more information regarding HIPAA Privacy and the plan, participants should contact HR Connections or see hr.phillips66.com.

GENETIC INFORMATION NONDISCRIMINATION ACT

The medical and dental benefit options do not collect or use genetic information, including family medical history, to determine eligibility for enrollment or for underwriting purposes. These plans do not require genetic testing and will not use genetic information to determine premium or contribution amounts.


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CLAIMS AND APPEALS PROCEDURES

Note: Except for appeals related to eligibility to participate in the plan, the information in this section does not apply to the Kaiser HMO or Cigna Global Health option. It also does not apply to the Medicare-eligible post-65 retiree medical options. Each claims administrator has its own procedures, which are explained in a separate certificate provided by the claims administrator.

Each of the health and welfare chapters (Employee Medical, Retiree Medical, Employee Dental, Employee Vision, Flexible Spending Plan and Employee Assistance Plan) describe what the participant must do in order to file a claim for benefits under that plan.

For the Flexible Spending Plan (FSP), this Claims and appeals procedures section applies only to the Health Care Flexible Spending Account and the Dependent Care Flexible Spending Account.

This section will explain what to do if a claim is denied. Throughout this section, “the participant” means the participant or anyone else duly authorized to work on his behalf.

All claims and appeals are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision. Decisions regarding hiring, compensation, termination, promotion, or similar matters with respect to anyone involved in claims or appeals determinations are not made based on the likelihood that the individual will support the denial of benefits.

AN AUTHORIZED REPRESENTATIVE IS …

A person authorized to file claims or appeals on the participant’s behalf. For this person to be considered an authorized representative, one of the following requirements must be satisfied:

• The participant has given express written consent for the person to represent his interests.

• The person is authorized by law to give consent for the participant (e.g., parent of a minor, legal guardian, foster parent, power of attorney).

• For pre-service and urgent claims, the person may be:

– The participant’s immediate family member (e.g., spouse, parent, child, sibling);

– The participant’s primary caregiver; or

– The participant’s health care professional who knows his medical condition (e.g., the participant’s treating physician).

• For outpatient concurrent claims, the person may be:

– The participant’s immediate family member (e.g., spouse, parent, child, sibling); or

– The participant’s primary caregiver.

• For inpatient concurrent claims, the person may be a health care professional who knows the participant’s medical condition (e.g., the participant’s treating physician).

In no event does the appointment of an authorized representative constitute an assignment of benefits under the plan. Additionally, an authorized representative is not a beneficiary under the plan.



MAKING A DECISION ON CLAIMSIn general, the claims administrator must notify the participant of its decision regarding a claim within the timeframes shown below.

Deadlines for decisions on benefit claims

Medical, dental, vision, FSP and EAP claims

The type of claim is determined by the urgency and timing of the health care service involved. The rules for claims and appeals vary depending on the type of claim involved.

Urgent claims and pre-service claims

(Applies to HDHP option, PPO option, the Medicare-eligible PPO option, dental benefits under the Medical and Dental Assistance Plan and to the Employee Assistance Plan)

• An urgent claim is a pre-service claim where delaying a decision on the claim until the usual deadline: – Could seriously jeopardize the participant’s life or health or his ability to

regain maximum function; or – Would, in the opinion of a physician who knows the participant’s medical

condition, subject him to severe and unmanageable pain.

The plan will treat a claim as an urgent claim if the physician or dentist treating the participant advises the plan that the claim satisfies the urgent criteria. Whether a claim meets the urgent criteria is determined at the time the claim is being considered.

• A pre-service claim is a claim for a benefit that is required to be preapproved before the service is received in order to get the maximum plan benefit. This includes such things as required pre-certification, case management or utilization review and requests to extend a course of treatment that was previously preapproved.

Post-service claims

(Applies to HDHP option, PPO option, the Medicare-eligible PPO option, dental and vision benefits under the Medical and Dental Assistance Plan and to the Flexible Spending Plan)

A post-service claim is a claim for a benefit that is not required to be preapproved before the service is received in order to get the maximum plan benefit. Most claims under the HDHP option, PPO option, the Medicare-eligible PPO option and dental benefit and all claims under the vision benefit and Flexible Spending Plan are post-service claims.

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In general, the claims administrator must notify the participant of its decision on a claim within the following timeframes:

For this type of claim: Initial determination will be made:

Urgent claims As soon as possible after the claim is received, but not longer than 72 hours.

(See the following paragraph for extension rules.)

Pre-service claims Within a reasonable time after the claim is received, but not longer than 15 days.

(See the second following paragraph for extension rules.)

Post-service claims Within a reasonable time after the claim is received, but not longer than 30 days.

(See the second following paragraph for extension rules.)

The deadline for a decision on an urgent claim may be extended if the participant does not provide the claims administrator with all the necessary information to make a decision on the claim. The claims administrator will notify the participant of the specific information needed to complete the claim within 24 hours after receiving the claim. The participant will have a reasonable period of time (not less than 48 hours) to provide the information. The claims administrator will notify the participant of its decision as soon as possible, but not later than 48 hours after it receives the requested information (or 48 hours after the deadline for the participant to provide the information, if earlier).

The deadline for a decision on a pre-service claim or post-service claim may be extended for up to 15 days, if special circumstances beyond the control of the plan exist. If the claims administrator needs to extend the deadline, the participant will be notified verbally or in writing before the initial determination deadline. The notice will tell the participant why the extension is necessary and when the claims administrator expects to make the decision on the claim. If an extension is necessary because the participant did not provide all the information necessary to make a decision on his claim, the notice will specifically describe the required information,

and he will have at least 45 days after receipt of the notice to provide that information. The deadline for a decision will be extended by the length of time that passes between the date the participant is notified that more information is needed and the date that the claims administrator receives the participant’s response to the request for more information.

Extensions and terminations of preapproved benefits

If an ongoing course of treatment has been preapproved as an urgent claim or other pre-service claim, some special deadlines apply if:

• The participant must obtain an extension of the approved benefit; or

• The plan determines that the benefit should no longer be continued or should be for a shorter course of treatment than earlier expected.

If a participant makes an urgent claim that is a request to extend a previously approved course of treatment, the claims administrator must notify him of its decision within 24 hours after the request is received. This rule applies only if the participant requests the extension at least 24 hours before the end of the previously approved course of treatment. Otherwise the request will be treated like any other new urgent or other pre-service claim.



For medical and EAP claims, the participant may elect to proceed with an expedited external review that takes place at the same time as his appeal. Please see Expedited external review on page N-42 for more information.

If the claims administrator determines that payments for a previously approved course of treatment should be stopped before the scheduled end of that approved treatment, the claims administrator must give the participant a notice (which will be treated as a claim denial) and give him adequate time to appeal. The participant will receive a determination on the appeal before the plan stops paying benefits for that treatment. While the appeals process must be followed, the claims administrator may give the participant only a reasonable period of time to appeal the denial, rather than the standard 180 days.

Special rules for medical, dental and EAP urgent and pre-service claims

Improperly filed claims

If the participant tries to file an urgent claim or other pre-service claim and he does not file the claim as required by these claims procedures, the claims administrator will notify him that he did not file the claim properly and will tell him how to file it properly. The participant may be notified orally, in which case he may request a written notice.

The participant will only be notified if:

• He made the improper claim to someone at Phillips 66 who customarily handles benefit matters, to the claims administrator, or to a case management or utilization review or similar company that provides services to the plan; and

• The improper claim included his name, the specific medical condition or symptom, and the specific proposed treatment, service or product for which he is seeking approval.

If the participant meets these requirements, he will be notified that he did not file the claim properly as soon as possible, but not later than 24 hours after the improperly filed urgent claim is received, or five days after any other improperly filed pre-service claim is received.

Incomplete urgent claims

If the participant files an urgent claim properly but does not provide the claims administrator with all the necessary information to make a decision on the claim, the claims administrator will notify him of the specific information needed to complete his claim within 24 hours after receiving the claim. The participant will have a reasonable period of time (not less than 48 hours) to provide the information. The claims administrator will notify the participant of its decision as soon as possible, but not later than 48 hours after it receives the requested information (or 48 hours after the deadline for him to provide the information, if earlier).

WRITTEN APPROVAL NOTICES

In general, the plan is not required to give the participant a written notice if a claim is approved. However, the plan must give the participant a written or electronic notice by the deadlines indicated in this section if an urgent or other pre-service claim is approved.

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Denials of claims

If the denied claim is a medical or EAP urgent claim, the notice may be given to the participant orally first, followed by written or electronic notice within three days.

If all or part of the participant’s claim is denied, he will be given a written or electronic notice that will include:

• The specific reason(s) for the denial, including information to identify the claim involved with a description of the plan’s standard used for denying the claim, if applicable;

• The date of service, the health care provider, the claim amount (if applicable), and the availability of the diagnosis and treatment codes (if applicable) with corresponding meanings of such codes (upon request);

• References to each of the specific provision(s) of the plan on which the denial is based;

• A description of any additional material or information the participant must provide in order for his claim to be approved, and an explanation of why that material or information is necessary;

• If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to the participant free of charge upon request;

• If the claim denial was based on medical necessity, experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment for applying the exclusion or limit to the participant’s circumstances, or a statement that such an explanation will be provided to him free of charge upon request (not applicable to the Basic and Comprehensive vision options);

• A statement that the participant is entitled, upon request, to see all documents, records and other information relevant to his claim for benefits, and also that he is entitled to get free copies of that information;

• An explanation of the appeals procedures, and, if applicable, any voluntary external review including time limits that apply;

• A statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman;

• The availability of the claim denial in another language, as necessary;

• A statement of the participant’s rights to file a lawsuit in federal court under ERISA section 502(a), if his claim is denied on final appeal; and

• If the participant’s denied claim was a medical or EAP urgent claim, a description of the expedited appeals procedure that applies to urgent claims.



HOW TO FILE AN APPEAL

Appeals must be filed within very specific timeframes. If the deadlines shown here are missed, the participant CANNOT appeal. The deadlines are:

• 180 days for the first level of appeal.

• 90 days for the second level of appeal (the 90 days start after the first appeal denial is received), except for the Basic and Comprehensive vision benefit options.

• 60 days (the 60 days start after the first appeal denial is received) for the second level of appeal for the Basic and Comprehensive vision benefit options.

If all or part of the participant’s claim is denied, he can appeal that denial. The goal of the appeals process is to ensure the participant has a full and fair review of his appeal. Pending the outcome of a medical or EAP concurrent claim or urgent claim appeal, benefits for an ongoing course of treatment will not be reduced or terminated pending the outcome of the appeal. It is possible that the participant may also elect to have an expedited appeals process or an expedited external review. Depending on the type of claim, the participant may have up to two levels of appeal, plus an external review.

SPECIAL RULE FOR URGENT APPEALS

There is only one level of review for this type of appeal. Medical, dental and EAP urgent appeals do not have to be in writing; urgent appeals can be made orally. In addition, all communications between the participant and the plan for an urgent appeal can be conducted by telephone, facsimile or other available expedited method of communication. Contact the Claims Administrator for urgent appeals.

For medical and EAP urgent claim appeals, the participant can request an expedited external review to run concurrently with the appeals process. For more information about external reviews, see page N-39.

If a prescription drug appeal is urgent (that is, the participant’s health is in serious jeopardy or, in the opinion of his doctor, he will experience pain that cannot be adequately controlled while he waits for a decision on the appeal), the participant or his authorized representative may request an expedited appeal by calling CVS Caremark Customer Care at (888) 208-9634 or by faxing the appeal to (866) 443-1172.

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Except for urgent claim appeals, the appeal must be made in writing and sent to the appropriate appeals administrator as shown below. Start with the first level appeals administrator when the claim is first denied.

Type of benefitAppeals administrator — first level and urgent appeals

Appeals administrator — second level appeals

Medical, prescription drug and mental health/substance abuse benefits

Eligibility to participate in the plan

All employee and retiree medical benefit options

N/A (only one level of appeal is provided, and it is with the appeals administrator shown at right)

Phillips 66 Plan Administrator Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK 74003-6670

(918) 977-6009Eligibility for a disabled child to participate in the plan


Aetna, Inc. or BlueCross BlueShield of Texas at the address shown below

Medical benefits


Medical Claims Administrator Aetna, Inc. National Account CRT P.O. Box 14463 Lexington, KY 40512

(855) 267-4184

Medical Claims Administrator BlueCross BlueShield of Texas P.O. Box 660044 Dallas, TX 75266-0044

(855) 594-4233



Medical Claims Administrator Aetna P.O. Box 14463 Lexington, KY 40512

(866) 259-4450 (phone) (859) 425-3379 (fax)

Medical Claims Administrator BlueCross BlueShield of Texas P.O. Box 660044 Dallas, TX 75266-0044

(855) 594-4233

Medical Claims Administrator Aetna P.O. Box 14463 Lexington, KY 40512

(866) 259-4450 (phone) (859) 425-3379 (fax)

BlueCross BlueShield of Texas Attn: Second Level Appeal Review P.O. Box 660044 Dallas, TX 75266-0044

(855) 594-4233 (phone) (877) 361-7646 (fax)

(continued)





Medical, prescription drug and mental health/substance abuse benefits (continued)

Outpatient prescription drugs


CVS Caremark Appeals Department, MC109 P.O. Box 52084 Phoenix, AZ 85072-2084

Fax: (866) 443-1172


(918) 977-6009

Dental benefits


Employee dental



(918) 977-6009

Eligibility for a disabled child to participate in the plan

Employee dental

MetLife, at the address shown below

Dental benefits

Employee dental

MetLife Dental Claims P.O. Box 981282 El Paso, TX 79998-1282

(855) 837-6381

Vision benefits


Employee vision



(918) 977-6009

Vision benefits

Employee vision

VSP Member Appeals 3333 Quality Drive Rancho Cordova, CA 95670

(800) 877-7195

VSP Member Appeals 3333 Quality Drive Rancho Cordova, CA 95670

(800) 877-7195

(continued)

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Employee Assistance Plan (EAP) benefits




(918) 977-6009

EAP benefits Aetna Behavioral Health 151 Farmington Ave, RSAA Hartford, CT 06156

(855) 812-9333 or (844) 766-7351

Aetna Behavioral Health 151 Farmington Ave, RSAA Hartford, CT 06156

(855) 812-9333 or (844) 766-7351

Flexible Spending Plan benefits




(918) 977-6009

Health Care Flexible Spending Account (HCFSA) or Dependent Care Flexible Spending Account (DCFSA) claims for benefits

WageWorks Claims Appeals Board P.O. Box 991 Mequon, WI 53092-0991

Or fax to: (877) 220-3248



The participant should indicate in large letters at the top of the letter that the letter is an appeal. In the appeal, he may:

• Include written comments, documents, records and other information relating to the claim, whether or not those materials were submitted with his initial claim.

• Request to see and receive free copies of all documents, records and other information relevant to the claim.

By filing an appeal, the participant is consenting to the release of relevant health information for claims processing purposes. The participant or the covered dependent may also be required to have an exam, or have an autopsy performed in the event of death. The participant may also have to sign an authorization for release of relevant medical or dental records. No personnel decisions will be made against the participant based on the outcomes of this review and appeals process.

Review of denied claim on appeal

The appropriate appeals administrator will reconsider any denied claim that the participant appeals by the deadline. The appropriate appeals administrator must consider all information provided by the participant, even if this information was not submitted or considered in the original claim decision. For medical, dental, vision, FSP, EAP and disability appeals, the review will not defer to the original claim denial and will not be made by the person who made the original claim denial or a subordinate of that person.

Prior to issuing a denial of an appeal, the appeals administrator will provide the participant, free of charge, any new or additional evidence or rationale considered, relied upon or generated in connection with the claim. If the participant chooses to respond or rebut this new evidence, he must do so prior to the deadline for the final determination.

If the claim denial is based on a medical judgment, the appeals administrator must get advice from a health care professional who has training and experience in the area of medicine. This professional cannot be a person who was consulted in connection with the original claim decision (or a subordinate of the person who was consulted in the original claim). Upon request, the participant will be provided with the names of any medical or vocational experts who were consulted in connection with the claim denial, even if the advice was not relied upon in making the denial.

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Denials of appeals

If all or part of the participant’s claim is denied on appeal, he will be given a written or electronic notice that will include:

• The specific reason(s) for the denial;

• References to the specific provision(s) of the plan on which the denial is based;

• For medical and EAP claims only, if any internal rule, guideline or protocol was used in denying the claim on appeal, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim on appeal and that a copy will be provided to the participant free of charge upon request;

• If the medical, dental, FSP, EAP or disability claim denial on appeal was based on medical necessity, experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment for applying the exclusion or limit, as applied to the participant’s circumstances, or a statement that such an explanation will be provided to him free of charge upon request;

• A statement that the participant is entitled, upon request, to see all documents, records and other information relevant to his claim for benefits, and also that he is entitled to receive free copies of that information;

• A statement describing any further appeal procedures and, if applicable, any voluntary external review offered by the plan, including any applicable deadlines, and the participant’s right to obtain further information about such procedures;

• For medical and EAP claims, a statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman;

• The availability of the claim denial in another language, as necessary;

• A statement of the participant’s right to file a lawsuit in federal court under ERISA section 502(a) (for medical, dental and EAP claims that qualify for a second level of appeal, the statement would apply only if his claim is denied on final appeal); and

• The following statement: “The participant and the plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact the local U.S. Department of Labor Office and the state insurance regulatory agency.”

Second level appeal to appeals administrator

This section does not apply to urgent claims or claims relating to eligibility to participate in the plan (other than appeals of a disabled child’s eligibility to participate).

If the first level appeals administrator denies the participant’s claim on appeal, he can make a second, and final, appeal to the second level appeals administrator.

All the rules for the first level appeal will apply to the final appeal, except for the following changes in deadlines:

• The participant will have a reasonable period of time, not to exceed 90 days, to make his final appeal after he receives the first appeal denial. Final appeals for the Basic and Comprehensive vision benefit options must be filed within 60 days, rather than 90 days.

• All appeal deadlines that were measured from the date of the participant’s first appeal will now be measured from the date his second appeal is filed with the appeals administrator.

In a final appeal, the health care professional reviewing the appeal will be different than the health care professional who reviewed the first level appeal.



Deadlines for decisions on appeals

The appropriate appeals administrator must make its decision on the participant’s appeal within the following timeframes:

For this type of appeal … The timeframe for a final determination is …

Pre-service appeal Within 15 days

Post-service appeal (does not apply to the EAP) Within 30 days

Sometimes, the appeals administrator may need additional time or information to decide the claim. If this happens, it will let the participant know in writing. It will also tell him why the extension is needed. If the extension is needed because the participant did not provide all the information necessary to make a decision on his appeal:

• The notice will specifically describe the required information;

• The participant will be given a reasonable period of time, not to exceed 45 days, to provide that information, and

• The time to respond to the appeal will be tolled until he provides the requested information.

The appeals administrator’s decision is final

The appeals administrator that makes the final appeals decision acts as a fiduciary under ERISA and has the full discretion and authority to:

• Make final determinations of all questions relating to eligibility for any plan benefit and to interpret the plan for that purpose; and

• Make final and binding grants or denials of benefits under the plan.

Benefits under the plan will be paid only if the appropriate appeals administrator decides in its sole discretion that the applicant is entitled to benefits. The determination of the appropriate appeals administrator on appeal will be final and binding.

The participant must exhaust all administrative remedies under the plan. If the participant has gone through the appeals process and still believes he is entitled to a plan benefit, he may file a civil action under section 502(a) of ERISA to recover benefits due under the terms of the plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan. ANY CIVIL ACTION MUST BE FILED WITHIN TWO YEARS FROM THE DATE OF THE APPEALS ADMINISTRATOR’S FINAL DECISION ON APPEAL.

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External review

External reviews apply to medical and EAP claims only.

Availability of external review

If, after exhausting the two levels of appeal,* the participant is not satisfied with the final determination and his claim involves medical judgment, as determined by the independent review organization (IRO), or rescission of coverage, he may choose to participate in the voluntary external review process.

The participant must request the external review within four months after being notified of the denied appeal. If there is not a corresponding date that is four months after receipt of the denied appeal, the external review request must be filed by the first day of the fifth month following receipt of the notice. For example: The participant receives his final appeal denial from the plan on October 30. The deadline in this situation would be March 1 because February 30 (the actual four-month deadline) does not exist. For urgent claim appeals and concurrent claim appeals, the participant can request the external review to run concurrently with the appeals process.

* The participant has the right to request an external review prior to the exhaustion of the full appeals process available if the plan does not follow Department of Labor guidelines.

Preliminary review

Within five days of receiving the request for external review, the Plan Administrator will conduct a preliminary review. The Plan Administrator will review whether:

• The participant is eligible for external review;

• The denied claim or appeal does not relate to plan eligibility;

• The participant or his eligible dependent is covered under the plan;

• The participant or his eligible dependent was provided with all information required to process the claim; and

• The participant or his eligible dependent has completed all internal plan appeals processes.

Within one day of completing the preliminary review, the Plan Administrator will notify the participant in writing whether his request for the external review is approved or denied. If the participant’s request is complete but not eligible for external review, the notice will state the reasons for his ineligibility. If the participant’s request is denied, the Plan Administrator will include reasons for the denial, including if and why his request was incomplete and a deadline for supplying the information to make the request complete.



Independent Review Organization (IRO)

If the participant’s external review request is approved, the Plan Administrator will assign his request to an IRO. The IRO will then provide the participant with a notice regarding whether his external review request is eligible for review and whether it is accepted. The notice will also inform the participant that the IRO will accept additional information in writing within 10 business days following receipt of the notice and will consider relevant additional information in its external review.

The Plan Administrator will provide the IRO with all the documents and information considered in denying the claim. If the Plan Administrator does not provide this information to the IRO within five business days, the IRO may stop its review and reverse the Plan Administrator’s decision. The IRO will notify the participant and the Plan Administrator within one business day if there is a decision to reverse.

If the participant provides additional information to the IRO within 10 business days following receipt of the IRO’s initial notice, the IRO is required to share this information with the Plan Administrator within one business day. The Plan Administrator, in light of this new information, may choose to reconsider or reverse the denial, which will stop the external review process. If the Plan Administrator reverses the denial, it will provide written notice to the participant and the IRO within one business day.

If the Plan Administrator does not reverse the denial, the IRO will review all the documents and information it receives without giving any weight to the plan’s earlier conclusions or decisions.

The IRO must complete its review and send notice to both the participant and the Plan Administrator within 45 days. The IRO’s notice will include the following information:

• A general description of the reason for the external review request, including information sufficient to identify the claim. This includes the date(s) of service, the provider, claim amount (if applicable), diagnosis and treatment codes (and their corresponding meanings) and the reason for the prior denial;

• The date the IRO received the assignment to conduct the external review, and the date of the IRO’s decision;

• References to the evidence or documentation considered in reaching the decision, including specific coverage provisions and evidence-based standards;

• A discussion of the principal reason(s) for the IRO’s decision, including the rationale for its decision and any evidence-based standards relied on in making the decision;

• A statement that the IRO’s determination is binding unless other remedies are available to the participant (or the plan) under state or federal law; and

• A statement disclosing the availability and contact information for any applicable office of health insurance consumer assistance or ombudsman.

Final decision

The decision made by the IRO is the final decision. If the IRO’s decision reverses the plan’s decision, the plan must immediately provide coverage or payment for the claim.

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Summary of timeline

Step in external review process Timeframe

Request for external review after exhausting appeals process* must be made within:

Four months after receipt of benefits denial notice

The Plan Administrator must review the participant’s request within:

Five business days following receipt of external review request

The Plan Administrator must notify the participant of the preliminary review decision within:

One business day after completion of preliminary review

The Plan Administrator must provide all information to the IRO within:

Five business days of assignment of the IRO

The participant can provide additional information to the IRO within:

Ten business days following receipt of notice from the IRO

The IRO forwards any additional information submitted by the participant to the Plan Administrator within:

One business day of receipt

If the Plan Administrator reverses its denial and provides coverage, notice must be sent to the participant and the IRO within:

One business day of decision

The IRO must notify the participant and the Plan Administrator of its decision within:

45 days after receipt of request for review

* For an urgent claim or concurrent claim, or if the plan has not followed Department of Labor guidelines, the participant may request an external review prior to completion of the full appeals process.



Expedited external review

The participant can request an expedited external review if his claim denial involves:

• A medical condition that would cause serious jeopardy to his life or health or his ability to regain maximum function if he was forced to abide by the timeframe of the appeals process; or

• Admission, availability of care, continued stay or an emergency health care item or service and he has not been discharged from the medical facility.

The preliminary review will take place immediately upon receiving the external review request. The Plan Administrator will send the participant a notice whether his request is approved or denied.

Once the participant’s request is accepted, the Plan Administrator will send all necessary documents and information considered in making the benefits denial to the assigned IRO. The documents and information will be provided electronically, by telephone, fax or any other expeditious method available.

The IRO will consider the documents and information received to the extent the information or documents are available and the IRO considers them appropriate. The IRO will provide notice of its final external review decision as expeditiously as the participant’s medical condition or circumstances require but not more than 72 hours after the IRO receives the expedited external review request. If the final external review decision is not in writing, the IRO must provide written confirmation of the decision to the participant and the Plan Administrator within 48 hours after the date the IRO provided the non-written notice of final external review decision.

FRAUDULENT CLAIMSThe plan has the right to recover any amounts paid by the plan with respect to fraudulent claims or expenses and may take legal action against the participant. Upon determining that a fraudulent claim has been submitted, the plan has the right to permanently terminate the coverage provided for the participant and his dependents under the plan, and the Plan Administrator has the authority to take any actions it deems appropriate to remedy such violations, including pursuing legal action or equitable remedies to recover any payments made by the plan to any party, regardless of when the fraudulent claim occurred or was discovered. Such action will not preclude the company from taking other appropriate action. If medical, dental or EAP coverage is terminated retroactively, the participant will be given a written 30-calendar day notice prior to the retroactive termination of coverage.

The participant will have the right to appeal the decision by following the appeals process that applies to the specific benefit being terminated.

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ERISA PLAN INFORMATIONThe plans listed below are governed by a federal law, ERISA, and are subject to its provisions.

Phillips 66 Medical and Dental Assistance Plan(Includes medical, dental and vision benefits)

Plan name Phillips 66 Medical and Dental Assistance Plan

Type of plan Medical and hospital care health and welfare plan. Also includes retail prescription drugs, home delivery prescription drugs, dental and vision coverage.

Plan number 501

Plan year and fiscal records

January 1 – December 31

Plan funding and sources of contributions

The HDHP option, PPO option, the Medicare-eligible PPO option and the dental benefit under the plan are self-insured by Phillips 66 Company. Any participant contributions are separately accounted for from Phillips 66 Company’s general assets. All expenses and charges are paid from participant contributions and Phillips 66 Company’s general assets.

The Kaiser HMO, the Medicare-eligible post-65 retiree medical options and vision benefits are provided pursuant to insurance contracts.

Plan Medical Director Chief Medical Officer for Phillips 66 Company

Group numbers Aetna Medical: 838938 BlueCross BlueShield of Texas: 0116443, 0116444 CVS Caremark: RX1048 MetLife Dental: 308880 VSP Vision: 30041732

Phillips 66 Employee Assistance Plan(Commonly referred to as the EAP)

Plan name Phillips 66 Employee Assistance Plan

Type of plan Employee assistance welfare benefit plan

Plan number 506




Benefits under the plan are provided at no cost to employees

Plan Medical Director Chief Medical Officer of Phillips 66 Company

(continued)



Phillips 66 Flexible Spending Plan(Commonly referred to as the FSP)

Plan name Phillips 66 Flexible Spending Plan

Type of plan Cafeteria plan under Section 125 of the Code

• The health care flexible spending account (HCFSA) is intended to qualify as a self-insured medical reimbursement plan, as defined in Code Section 105(h)(6), and the medical care expenses reimbursed under the HCFSA are intended to be eligible for exclusion from the participating employee’s gross income under Code section 105(b).

• The dependent care flexible spending account (DCFSA) is intended to qualify as a dependent care assistance program, as defined in Code section 129(d), and the dependent care expenses reimbursed under the DCFSA are intended to be eligible for exclusion from the participating employee’s gross income under Code section 129(a).

• The HCFSA component and the DCFSA component of the plan are separate plans for purposes of administration and for all reporting and nondiscrimination requirements imposed by Code sections 105 and 129. The HCFSA component is also a separate plan for purposes of applicable provisions of ERISA and COBRA.

• The FSP provides for the payment of employee premiums with respect to the Medical and Dental Assistance Plan on a before-tax basis, as permitted under Code section 125.

• The health savings account (HSA) feature is available to participants enrolled in the Phillips 66 Medical and Dental Assistance Plan’s HDHP option, and enables them to make contributions to an HSA and receive company contributions to an HSA, on a before-tax basis, as permitted under Code section 223.

Plan number 504



(continued)

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Health Care Flexible Spending and Dependent Care Flexible Spending Accounts:

• The company accounts for employee monthly contributions and uses them to pay claims on the accounts.

• The company pays the expenses of administering the plan. These payments are offset by any employee contributions that are forfeited under the use or lose rule and by any uncashed benefit checks.

• Any remaining funds after paying claims and administrative expenses will be distributed to current plan participants on a per capita basis after June 30 following the plan year.

Before-Tax Premium Payments:

• The company accounts for employee premium contributions and uses them to pay claims for self-insured medical and dental coverage or for premiums for insured medical and dental coverage.

Health Savings Account (HSA) Contributions:

• Before-tax employee contributions: These contributions are forwarded regularly to the account trustee for the HSA accounts.

• Company contributions: These contributions are forwarded to the account trustee for the HSA accounts once a year in a lump sum and upon eligibility for a new participant.

Group number FSA Plan: 30151



Life, accident and disability plansThis section contains additional information that applies to:

• The Phillips 66 Group Life Insurance Plan — life, occupational accidental death (OAD), accidental death and dismemberment (AD&D) and Emergency Responders benefits; and

• The Phillips 66 Disability Plan — short-term disability (STD) and long-term disability (LTD) benefits.

FOR SHORT-TERM DISABILITY BENEFITS

The Plan Administrator listed on page N-4 has the power to make all determinations regarding its administration and to construe and interpret the terms of the plan whenever necessary to carry out its intent and purpose and to facilitate its administration.

RIGHT OF RECOVERYIf the plan pays more than it should have for a claim, it has the right to recover the overpaid amounts.

FOR SHORT-TERM DISABILITY (STD) BENEFITSIf it is determined that the Phillips 66 Disability Plan has paid more short-term disability benefits than should have been paid under the terms of the plan, or the plan has paid short-term disability benefits based upon a falsified claim or falsified information, the plan retains the right to recover all overpayments from the eligible employee, his estate or the person to whom payments were made.

Either the claims administrator or the Plan Administrator may:

• Deduct the amount of such overpayment from any subsequent benefits payable to the eligible employee or from other present or future amounts payable under the plan; or

• Recover such amount by any other method that the claims administrator or Plan Administrator shall determine.

At the discretion of the Plan Administrator, the eligible employee may be suspended from participation in the plan for the remainder of the current plan year or all future plan years for failure to repay any overpayments or for falsifying a claim for short-term disability benefits, including the falsification of any supporting documentation.

FOR LONG-TERM DISABILITY (LTD) BENEFITSThe Phillips 66 Disability Plan’s long-term disability benefits insurer has the right to recover any amount it determines to be an overpayment under the plan, and the participant has the obligation to return any such amount. The insurer’s rights and the participant’s obligations in this regard are set forth in the reimbursement agreement the participant is required to sign when he becomes eligible for long-term disability benefits under the plan. The reimbursement agreement:

• Confirms that the participant will repay all overpayments; and

• Authorizes the insurer to obtain any information relating to any of the items listed under If the participant receives other disability income or benefits in the Long-Term Disability chapter.

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An overpayment occurs when the insurer determines that the total amount paid by the insurer on the participant’s disability claim is more than the total of the long-term disability benefits due under the plan. This includes overpayments resulting from:

• Retroactive awards received from sources listed in the If the participant receives other disability income or benefits in the Long-Term Disability chapter;

• Fraud; or

• Any error the insurer makes in processing the disability claim.

The overpayment equals the amount the insurer paid in excess of the amount the insurer should have paid under the terms of the plan.

The participant has a right to appeal any overpayment recovery.

An overpayment also occurs when payment is made by the insurer under this plan when the payment should have been made under another plan. In that case, the insurer may recover the payment from one or more of the following:

• Any other insurance company;

• Any other organization; or

• Any person to or for whom payment was made.

In the case of a recovery from a source other than this plan, the insurer’s overpayment recovery will not be more than the amount of the overpayment recovered.

The insurer may, at its option, recover the overpayment by:

• Reducing or offsetting against any future benefits payable under this plan to the participant or his survivors;

• Stopping future benefit payments under this plan (including the minimum benefit) which would otherwise be due under this plan. Plan benefit payments may continue when the overpayment has been recovered; or

• Demanding an immediate refund of the overpayment from the participant.

PAYMENTS TO A MINOR OR LEGALLY INCOMPETENT PERSONThe claims administrator may authorize payments under the Group Life Insurance Plan to a conservator, guardian or other individual who is legally responsible for the management of the estate of a minor or legally incompetent person. If the beneficiary is a minor, the claims administrator will pay benefits as directed by the right legal entity working on behalf of the minor.

USERRA COVERAGE

This information applies only to Phillips 66 employee life insurance and accidental death & dismemberment insurance benefits, to the extent the participant is enrolled in the benefits provided under the plan at the time this section becomes applicable to him.

Under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), the company offers the participant a temporary extension of employee life insurance and accidental death & dismemberment insurance benefits under the plan at group rates for the participant and his covered dependents in certain instances where coverage would not otherwise be available under the plan.



For information regarding his rights under USERRA, the participant should contact:


(918) 977-6009

CLAIMS AND APPEALS PROCEDURESThe Employee Life, Accidental Death & Dismemberment, Emergency Responders Insurance, Short-Term Disability and Long-Term Disability chapters explain what the participant or his beneficiary(ies) needs to do in order to file a claim for plan benefits.

This section will explain what to do if a claim is denied. Throughout this section, “the participant” generally means the participant, his beneficiary or anyone else duly authorized to work on his behalf.


A person authorized to file claims or appeals on the participant’s behalf. For this person to be considered the participant’s authorized representative, one of the following requirements must be satisfied:

• The participant has given express written consent for the person to represent his interests; or


REQUIRED INFORMATION AND CONSENTS

When filing a claim or appeal, the participant, his beneficiaries and/or his covered dependents consent to:

• The release of any information the claims administrator or appeals administrator requests to parties who need the information for claims processing purposes; and

• The release of medical or dental information (in a form that prevents individual identification) to Phillips 66 for use in occupational health activities and financial analysis, to the extent permitted by applicable law.

In considering a claim or appeal, the claims administrator or appeals administrator has the right to:

• Require examination of the participant and his covered dependents when and as often as required;

• Have an autopsy performed in the event of death, when permitted by state law; and

• Review a physician’s or dentist’s statement of treatment, study models, pre- and post-treatment X-rays and any additional evidence deemed necessary to make a decision.

No personnel decisions will be made against the participant based on the outcomes of the claims and appeals process.

All claims and appeals for STD, LTD and AD&D benefits are adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision. Decisions regarding hiring, compensation, termination, promotion, or similar matters with respect to anyone involved in claims or appeals determinations are not made based on the likelihood that the individual will support the denial of benefits.

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IF A CLAIM IS DENIEDIn general, the claims administrator must notify the participant of its decision regarding his claim within the following timeframes:

For this type of claim: Initial determination will be made:

STD, LTD and AD&D (with disability claim)

Within a reasonable time after the claim is received, but not longer than 45 days.

(See the paragraph below for extension rules.)

Life, Emergency Responders and AD&D (without disability claim)

Within a reasonable time after the claim is received, but not longer than 90 days.

(See the paragraph below for extension rules.)

Sometimes, the claims administrator may need more time or information to make a determination regarding the claim (up to 60 more days for disability benefits and up to 90 more days for non-disability benefits). If this happens, the participant will be notified in writing of the need for an extension and why the extension is needed.

If all or part of the claim is denied, the claims administrator will give the participant a written or electronic notice that will include (among other things):

• The specific reason(s) for the denial and the specific plan provisions on which the denial is based.

• A description of any additional material or information the participant must provide in order for his claim to be approved, and an explanation of why that material or information is necessary.

• If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to the participant free of charge upon request (applicable to disability claims only).

• A statement that the participant is entitled, upon request, to see all documents, records and other information relevant to his claim for benefits, and also that he is entitled to get free copies of that information.

• An explanation of the appeals procedures, including time limits that apply.

• A statement of the participant’s right to file a lawsuit in federal court under ERISA section 502(a), if his claim is denied on final appeal.



HOW TO FILE AN APPEAL

APPEALS MUST BE FILED WITHIN:

• 60 days for a life (including OAD) or AD&D (without disability) claim denial.

• 60 days for an Emergency Responders Insurance claim denial.

• 180 days for an AD&D (with disability), STD or LTD claim denial.

If these deadlines are missed, the participant CANNOT appeal and cannot file a lawsuit under ERISA.

If all or part of a claim is denied, the participant can appeal that denial. The goal of the appeals process is to ensure the participant has a full and fair review of his appeal. The appeal must be made in writing and must be sent to the appropriate appeals administrator as shown below.

Type of benefit Appeals administrator

Group life insurance benefits

• Life insurance (basic life, supplemental life, dependent life, Emergency Responders Insurance)

• Occupational Accidental Death (OAD) (recurring seasonal employees)


(800) 206-8826

• Life insurance (travel assistance benefits)

• Occupational Accidental Death (OAD) (regular full-time or part-time employees)


(918) 977-6009

Accidental Death and Dismemberment (AD&D) Zurich American Life Insurance Company P.O. Box 1705 Grand Rapids, MI 49501

(800) 206-8826

Disability benefits

Short-term disability (STD) Manager, HR Operations Adams Building 411 S. Keeler Avenue Bartlesville, OK 74003-6670

(918) 977-6009

Long-term disability (LTD) Benefit Management Services Maitland Claim Office The Hartford P.O. Box 14306 Lexington, KY 40512-4306

(800) 549-6514

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The participant should indicate in large letters at the top of his letter that the letter is an appeal. In the appeal, he may:

• Include written comments, documents, records and other information relating to the claim, whether or not those materials were submitted with his initial claim.

• Request to see and receive free copies of all documents, records and other information relevant to the claim.

If any new or additional evidence is considered, relied upon or generated by (or at the direction of) the Appeals Administrator in deciding an STD, LTD or AD&D appeal, or if any new or additional rationale for denial of such benefits is determined by the Appeals Administrator, the participant will be provided with the new or additional evidence or rationale, as applicable, and be given a reasonable opportunity to respond to such new or additional evidence or rationale.

By filing an appeal, the participant is consenting to the release of relevant health information for claims processing purposes. He may be required to have a medical exam. The participant may also be required to sign an authorization for release of relevant medical or dental records. No personnel decisions will be made against the participant based on the outcomes of this review and appeals process.

The appropriate appeals administrator must make its decision on the participant’s appeal within the following timeframes:

For this type of appeal … The timeframe for a final determination is …

STD, LTD and AD&D (disability) Within a reasonable period of time after the appeal is received, but not longer than 45 days

Life, Emergency Responders and AD&D (without disability)

Within a reasonable period of time after the appeal is received, but not longer than 60 days

The deadline for a decision on an appeal may be extended. If the deadline is extended, the participant will be informed of the extension and the reason for the extension in writing.

For this type of appeal …The timeframe for a final determination may be extended …

STD, LTD and AD&D (disability) Not to exceed 45 days from the initial 45-day determination deadline

Life, Emergency Responders and AD&D (without disability)

Not to exceed 60 days from the initial 60-day determination deadline



If an appeal is denied

If all or part of the participant’s claim is denied on appeal, he will be given a written or electronic notice that will include:

• The specific reason(s) for the denial.

• References to each of the specific provision(s) of the plan on which the denial is based.

• A statement that the participant is entitled, upon request, to see all documents, records and other information relevant to his claim for benefits, and also that he is entitled to receive free copies of that information.

• If any internal rule, guideline or protocol was used in denying the claim, either that specific rule, guideline or protocol or a statement that such a rule, guideline or protocol was used in denying the claim and that a copy will be provided to the participant free of charge upon request (applicable to disability claims only).

• A statement describing any further appeal procedures, including any applicable deadlines, and the participant’s right to obtain further information about such procedures.

• A statement of the participant’s right to file a lawsuit in federal court under ERISA section 502(a).

• The following statement: “The participant and the plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact the local U.S. Department of Labor Office and the state insurance regulatory agency.” (Applicable to disability claims only.)

The appeals administrator’s decision is final

The appeals administrator making the final appeals decision acts as a fiduciary under ERISA and has the full discretion and authority to:

• Make final determinations of all questions relating to eligibility for any plan benefit and to interpret the plan for that purpose; and

• Make final and binding grants or denials of benefits under the plan.

Benefits under the plan will be paid only if the appropriate appeals administrator decides in its sole discretion that the applicant is entitled to benefits. The determination of the appropriate appeals administrator on appeal will be final and binding.

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If the participant has gone through the appeals process and still believes he is entitled to a plan benefit, he may file a civil action under Section 502(a) of ERISA to recover benefits due under the terms of the plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan. Any civil action must be filed within the following time frames:

• For Life (including OAD), AD&D, Emergency Responders and LTD claims, the participant cannot sue in federal court before 60 days after proof of loss was submitted. The suit must be filed within two years* from the date on which proof of loss was required.** Legal action arising under the Travel Assistance provision under the Group Life Insurance Plan shall be barred unless written notice is received by the appeals administrator within one (1) year from the date of the event giving rise to such legal action.

• For STD claims, the participant cannot sue in federal court until the appeal is complete. The suit must be filed within two years from the date of the Plan Administrator’s final decision on appeal.

* If the law of the state in which the participant lives makes the two-year limit void, the action must begin within the shortest time period permitted by law.

** Proof of loss is generally required within 90 days of the date of the event giving rise to the loss, or within 90 days following the completion of the elimination period for LTD claims. Participants should contact the appropriate appeals administrator listed above to determine the date on which proof of loss is required.

A participant must exhaust all administrative remedies under the plan before filing a civil action.

FRAUDULENT CLAIMSIf the participant or someone acting on his behalf has submitted a fraudulent claim to the plan, the plan has the right to recover any amounts paid by the plan with respect to fraudulent claims or expenses and may take legal action against the participant. Upon determining that a fraudulent claim has been submitted, the plan has the right to permanently terminate the coverage provided for the participant and his dependents under the plan, and the Plan Administrator has the authority to take any other actions it deems appropriate to remedy such violations, including pursuing legal action or equitable remedies to recover any payments made by the plan to any party, regardless of when the fraudulent claim was discovered. Such action will not preclude the company from taking other appropriate action.

The participant will have the right to appeal the decision by going through the appeals process that applies to the specific benefit being terminated.



ERISA PLAN INFORMATIONThe plans listed below are governed by a federal law, ERISA, and are subject to its provisions.

Phillips 66 Group Life Insurance Plan (includes Accidental Death and Dismemberment Insurance and Emergency Responders Insurance)

Plan name Phillips 66 Group Life Insurance Plan

Type of plan Welfare benefit plan providing basic life insurance, supplemental life insurance, dependent life insurance, occupational accidental death coverage, accidental death and dismemberment insurance and Emergency Responders Insurance benefits.

Benefits under the plan are provided under the terms and conditions of the plan, and the insurance contracts as determined by the claims administrator. Occupational accidental death benefits for regular full-time and part-time employees are funded through the general assets of the company at no cost to eligible employees. The benefit for regular full-time and part-time employees is taxable income, not grossed up for taxes and not subject to interest for the time between death and payment dates. The insurance contracts providing benefits under this plan are incorporated by reference in the Employee Life, Accidental Death & Dismemberment and Emergency Responders Insurance chapters.

Plan number 502




Except for occupational accidental death (OAD) benefits for regular full-time and part-time employees and travel assistance benefits, benefits are funded through insurance contracts. The costs of basic life, occupational accidental death and travel assistance and Emergency Responders Insurance benefits are paid entirely by the company, with no cost to employees. The costs of supplemental life, dependent life and accidental death and dismemberment insurance benefits are paid entirely by participating employees.

Group numbers Life Insurance (including Accidental Death and Dismemberment (Zurich American Life Insurance Company): CLPEX01066

Emergency Responders Insurance (Zurich American Life Insurance Company): MCB0284886

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Phillips 66 Disability Plan (includes short-term disability benefits and long-term disability benefits)

Plan name Phillips 66 Disability Plan

Type of plan The Phillips 66 Disability Plan is a welfare benefit plan.

LTD benefits are provided under the terms and conditions of the plan and the insurance contract as determined by the claims administrator. The insurance contract providing LTD benefits under the plan is incorporated by reference into the Long-term disability chapter.

Plan number 503




STD benefits are funded through the general assets of the company at no cost to eligible employees.

LTD benefits are funded through an insurance contract. The premium cost is paid entirely by participating employees.

Group numbers STD: Not applicable

LTD (The Hartford): 402337G



Severance Pay PlanThe information in this section applies to the Phillips 66 Severance Pay Plan.

PLAN ADMINISTRATIONFor the Severance Pay Plan, the Plan Administrator is the Manager Total Rewards (or successor) at the address shown below.

Manager, Total Rewards Phillips 66 Company c/o Total Rewards Department P.O. Box 421959 Houston, TX 77242-1959

PHILLIPS 66 BENEFITS COMMITTEE

The Benefits Committee has the power to administer and interpret the Severance Pay Plan, including granting or denying appeals for benefits following the claim denial by the Plan Administrator. All interpretations of the plan, findings of fact and resolutions made by the committee are binding, final and conclusive on all parties.

RIGHT OF RECOVERYIf the plan pays a participant more than it should have, his benefits may be adjusted if:

• The company or its agents or representatives make an error relating to the participant’s eligibility for benefits, calculating benefits or administering the plan; or

• The participant or his beneficiary provides incorrect information (or fails to state a material fact) in an application or claim for benefits or in response to the company’s request for more information.

Any adjustments could mean that the participant or his beneficiary would have to repay part or all of a payment made to him or his beneficiary.

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CLAIMS AND APPEALS PROCEDURESThis section provides information regarding the steps to be taken if a participant has been denied a benefit by the plan. It states “the participant” throughout this section, although it means the participant or anyone else duly authorized to work on his behalf.


A person authorized to file claims or appeals on the participant’s behalf. For this person to be considered the participant’s authorized representative, one of the following requirements must be satisfied:

• The participant has given express written consent for the person to represent his interests; or


HOW TO FILE A CLAIMA participant must file a written claim if he believes he is entitled to benefits under the Severance Pay Plan but did not receive them. Any claim must be presented in writing to the Plan Administrator within 24 months after the participant’s last date of employment with the company.

If a claim is denied in whole or in part by the Plan Administrator, the participant will receive a written notice of the denial within a reasonable period of time, but not later than 90 days after receipt of the claim by the Plan Administrator. If special circumstances require an extension of time for processing, a decision will be made within a reasonable period of time, but in no case later than 180 days after receipt of the claim.

If all or part of the participant’s claim is denied, he will be given written notice that will include:



• A description of any additional material or information the participant must provide in order for his claim to be approved, and an explanation of why that material or information is necessary.

• An explanation of the appeals procedures, including time limits that apply.

• A statement of the participant’s right to file a lawsuit in federal court under ERISA section 502(a), if his claim is denied on appeal.



Review of claim denial

If all or part of the participant’s claim is denied, he can appeal that denial by filing a written request for review with the Benefits Committee within 60 days after the date he received written notice of denial.

The participant has the right to review, free of charge, all pertinent documents, records and other information of the plan that relate to his claim and to submit issues and comments in writing.

The participant’s appeal must be made in writing and sent to the Benefits Committee at the following address:

Benefits Committee Phillips 66 Company P.O. Box 421959 Houston, TX 77242-1959

(832) 765-1877

The participant should indicate in large letters at the top of his letter that the letter is an appeal.

The committee will review the participant’s appeal, make a decision and inform the participant in writing of the decision on appeal within 60 days after the participant files the appeal. If special circumstances require an extension of time for processing, a decision will be made within a reasonable period of time, but in no case later than 120 days after receipt of the participant’s request for review. If the extension of time is due to the participant’s failure to provide information necessary to decide the appeal, the period of time for deciding the appeal will be suspended until the participant responds to the request for additional information.

If all or part of the participant’s claim is denied on appeal, he will be given written notice that will include:



• A statement that the participant is entitled, upon request, to see all documents, records and other information relevant to his claim for benefits, and to get free copies of that information.

• A statement of the participant’s right to file a lawsuit in federal court under section 502(a) of ERISA.

The participant must exhaust his administrative remedies by properly and timely filing a claim for benefits and properly and timely requesting a review on appeal of any complete or partial claim denial before filing suit in a court of law. A decision on a review of a claim denial will be the final decision of the committee. If the participant has gone through the appeals process and still believes he is entitled to a plan benefit, he may file a civil action under section 502(a) of ERISA to recover benefits due under the terms of the plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan. Any civil action must be filed within two years from the date of the Benefit Committee’s final decision on appeal.

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ERISA PLAN INFORMATIONThe plan is governed by a federal law, ERISA, and is subject to its provisions.

Phillips 66 Severance Pay Plan (Commonly referred to as the Severance Pay Plan)

Plan name Phillips 66 Severance Pay Plan

Type of plan Welfare benefit plan

Plan number 507

Plan year and fiscal records January 1 – December 31


The company pays reasonable expenses necessary for the operation of the plan and pays benefits from the general assets of the company. Neither employees nor participants are required or permitted to make contributions to the plan. The plan is not insured.



GlossaryAccidental injury Trauma or damage to a part of the body that occurs as the result of a sudden,

unforeseen external event that occurs by chance and/or from unknown causes and that is not contributed to by disease, sickness or bodily infirmity. An accidental injury does not include:

• Injury incurred while in active, full-time military; and

• Injury incurred while committing a felony or other serious crime or assault.

Active employee An employee who is on the direct U.S. dollar payroll.

Actively at work

For the Life and AD&D options under the Group Life Insurance Plan

At work with the participant’s employer on a day that is one of his employer’s scheduled work days. On that day, the participant must be performing for wage or profit all of the regular duties of his job:

• In the usual way; and

• For his usual number of hours.

The participant is also considered to be actively at work on any regularly scheduled vacation day or holiday only if he was actively at work on the preceding scheduled work day.

Actively at work

For the LTD benefit

Performing all of the regular duties of the participant’s job at a place required by the employer. Includes weekends, vacation, holidays, leaves of absence (excluding leave of absence-Labor Dispute) that are not due to disability as defined for LTD benefits eligibility, and business closures.

Activities of daily living (ADLs)

• Bathing — Washing by sponge bath in either a tub or shower, including getting into or out of the tub or shower with or without equipment or adaptive devices;

• Dressing — Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs;

• Toileting — Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene;

• Transferring — Moving into or out of bed, chair or wheelchair with or without such equipment as canes, quad canes, walkers, crutches, grab bars or other supportive devices — including mechanical or motorized devices;

• Continence — Being able to maintain control of bowel or bladder function; or if unable to maintain control of bowel or bladder functions, being able to perform associated personal hygiene (including caring for catheter or colostomy bag); and

• Eating — Feeding by getting food into a person’s body from a receptacle (such as a plate, cup or table), by a feeding tube or intravenously.

Affiliate A member of the affiliated group, which consists of Phillips 66 and entities of which Phillips 66 has at least a 5% ownership interest. A person, company or other legal entity that is not in the affiliated group is an “unrelated entity.”

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Affiliate providers A network of licensed clinical counselors who contract with the Employee Assistance Plan provider to provide assessment, referral and brief counseling services (45 to 60 minutes per session). These individuals must possess at least a Master’s level degree and may include licensed social workers, professional counselors, marriage and family therapists or psychologists.

Air bag An inflatable, supplemental, passive restraint system installed by the manufacturer of the motor vehicle or its proper replacement parts installed as required by the motor vehicle’s manufacturer’s specifications that inflates upon collision to protect an individual from injury or death. An airbag is not considered a seat belt.

Anesthesia Charges for an anesthetic and its administration.

Annual deductible The amount the participant pays each calendar year before the plan pays benefits. For the HDHP option, the PPO option, the Medicare-eligible PPO option and the dental benefit, the plan defines amounts that apply to the annual deductible.


The maximum amount the participant may pay each calendar year for covered services. The out-of-pocket maximum is the type of amounts defined by the plan that generally apply to the annual deductible. Once the participant reaches his out-of-pocket maximum, the plan pays 100% for most covered services.

Annual pay For basic and supplemental life insurance benefits, pay means base salary and regularly scheduled overtime — excluding shift pay, unscheduled overtime, overtime resulting from the 19/30 work schedule, commissions and bonuses. Base salary is annual pay for determining life insurance benefits.

Appeals Administrator

An entity that processes appeals regarding benefit claims.

Appropriate care and treatment

Medical care and treatment that meet all of the following:

• It is received from a physician whose medical training and clinical experience are suitable for treating the participant’s disability;

• It is necessary to meet the participant’s basic health needs and is of demonstrable medical value;

• It is consistent in type, frequency and duration of treatment with relevant guidelines of national medical, research and health care coverage organizations and governmental agencies;

• It is consistent with the diagnosis of the participant’s condition; and

• Its purpose is to maximize the participant’s medical improvement.

Beneficiary, beneficiary(ies)

The person(s) or entity(ies) the participant designates to receive specific plan benefits in the event of his death.

Biological Child A biological child is a child born to his parents. Such a child is genetically related to its parents.

(continued)



Brand-name drug A prescription drug that is protected by a trademark registration. Brand-name drugs include preferred brand drugs and non-preferred brand drugs.

• Preferred brand drugs (also known as preferred drugs) are included on CVS Caremark’s list of selected brand-name medications that can assist in maintaining quality care for patients, while lowering the plan’s cost for prescription drug benefits. CVS Caremark enlists an independent Pharmacy and Therapeutics Committee to review each drug on the list for safety and effectiveness.

• Non-preferred brand drugs are brand-name drugs that are not on CVS Caremark’s list of preferred drugs.

Claims Administrator

The entity responsible for processing benefit claims and for any other functions as explained in this summary plan description.

COBRA The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law that provides for continuation coverage for employees/retirees and covered dependents who, under certain circumstances, would otherwise lose their group health coverage.

COBRA Administrator

The entity responsible for administering COBRA eligibility and for any other functions as explained in this summary plan description.

Code The Internal Revenue Code of 1986, as amended.

Coinsurance The percentage of a covered expense that the participant is responsible for paying.

Comparable employment level

A new job has a comparable employment level to a current job if it is not lower than one level below the level of the current job. For this purpose, “level” means salary grade level established by the company.

Comparable pay A new job has comparable pay to a current job if weekly base wages or base salary for the new job — including any pay for regularly scheduled overtime, but excluding overtime due to the 19/30 program — are equal to or greater than 80% of the weekly pay for the current job.

Concurrent claim An approved ongoing course of treatment to be provided over a period of time or for a specified number of treatments.

Consultation and X-rays (by a dentist)

Dental services requested by a physician to rule out possible dental problems as a cause of a patient’s medical condition.

Copay (also known as a copayment)

Under the PPO option, a fixed amount the participant pays each time he receives certain services or purchases prescription drugs.

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Corporate event Any of the following events:

• The sale of an asset or assets by the company or by a member of the employer to one or more unrelated entities.

• The sale of stock of an entity that is owned by the company or by a member of the employer to one or more unrelated entities.

• The formation of a joint venture between the company or a member of the employer and one or more unrelated entities.

• The sale of an interest in a joint venture by the company or a member of the employer to one or more unrelated entities.

• The cessation of the company’s role as operator of a joint venture or business, and the commencement of that role by one or more unrelated entities.

• The transfer of a job, function or service formerly performed by employees of the company or a member of the employer to one or more unrelated entities.

Covered accident

For the AD&D options under the Group Life Insurance Plan

An event not otherwise excluded by the insurance contract that results in a bodily injury or death for which the claims administrator determines AD&D benefits are payable.

Covered accident

For Emergency Responders Insurance under the Group Life Insurance Plan

An accident (i.e., an unexpected, unintentional or unforeseeable event or occurrence which happens suddenly and violently and occurs while coverage under the policy is in effect and while the covered person is performing emergency rescue unit duties) not otherwise excluded by the insurance contract that results in an injury or death for which the claims administrator determines Emergency Responder benefits are payable.

Covered expenses Reasonable and customary charges for medically necessary services and supplies that are:

• Recommended by the attending physician; and

• Required in connection with the treatment of accidental bodily injury, disease or pregnancy, or in connection with the care and treatment of a newborn dependent child prior to release from a hospital.

Creditable coverage

Under federal law, health plans may deny coverage for pre-existing conditions only under limited circumstances and for a limited period of time. If a health plan does deny pre-existing condition coverage for the permitted time period, that period may be reduced by periods of prior health coverage, as long as the new coverage starts within 62 days of the date the prior coverage ended.

Creditable prescription drug coverage

Prescription drug coverage that is, on average, at least as good as the Medicare standard prescription drug coverage. This determination of creditable coverage is defined by the Centers for Medicare and Medicaid Services (CMS) and is made by independent actuarial attestation.

(continued)



Custodial care Services — including room, board and other personal assistance — provided primarily to assist a covered individual in the activities of daily living (eating, dressing, bathing, etc.). Custodial care includes, but is not limited to, care rendered to a patient:

• Who is mentally or physically disabled, and such disability is expected to continue and be prolonged indefinitely;

• Who requires a protected, monitored and/or controlled environment; or

• Who is not under active and specific medical, surgical and/or psychiatric treatment that will reduce the disability to the extent necessary to enable the patient to function outside of the protected, monitored and/or controlled environment.

Date of layoff The last day a participant who is laid off is an employee, as reflected by the employment end date recorded in the company’s personnel records.

Disabled, disability

For the Medical and Dental Assistance Plan and the EAP

An otherwise eligible child is permanently and totally disabled if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. An eligible child will not be considered to be permanently and totally disabled unless the participant furnishes proof establishing permanent and total disability. The plan reserves the right to require, at its own expense, an independent medical or psychological evaluation to verify the child’s disabled status.


For COBRA-qualified beneficiaries

The participant qualifies for Social Security disability benefits during the first 60 days of COBRA coverage.


For the Flexible Spending Plan’s Dependent Care Flexible Spending Account

A spouse who is physically or mentally incapable of self-care and has the same principal place of abode as the participant for more than 50% of the current calendar year.


For the dependent life and AD&D options under the Group Life Insurance Plan

The inability to perform activities of a person of like age and gender.


For the STD benefit

A non-occupational illness or injury (see page N-78) that prevents an eligible employee from performing, for a temporary period of time, the regular duties of his job with the company or other normal activities.

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For the LTD benefit

Due to the participant’s accidental bodily injury, sickness, mental illness, substance abuse or pregnancy, the participant is receiving appropriate care and treatment from a physician on a continuing basis, and:

• During the participant’s elimination period and the next 24-month period, he is unable to perform the material duties of his regular job with the company and is unable to earn more than 80% of his pre-disability earnings or indexed pre-disability earnings; or

• After the initial 24-month period, he is unable to earn more than 60% of his indexed pre-disability earnings from any employer in his local economy at any gainful occupation for which he is reasonably qualified, taking into account his training, education, experience and pre-disability earnings.

The participant’s loss of earnings must be a direct result of the sickness, pregnancy or accidental injury. The claims administrator has the sole authority for determining disability. Economic factors, such as, but not limited to, recession, job obsolescence, pay cuts and job-sharing will not be considered in determining whether he meets the loss of earnings test.

If the participant’s job requires a license, “loss of license” for any reason does not, in itself, constitute disability.

Domestic partner

For the Medical and Dental Assistance Plan, the EAP and the Flexible Spending Plan

A person who has demonstrated a commitment to a long-term relationship with the participant. The participant and the domestic partner must meet all of the following requirements:

• They intend to remain each other’s sole domestic partner indefinitely;

• They are both at least 18 years old (or of legal age);

• They are both mentally competent to enter into contracts;

• They are not related by blood;

• They have not been married to each other;

• Neither the participant nor the domestic partner is married to anyone else;

• They have the same principal place of abode for the tax year;

• The domestic partner is a member of the participant’s household for the tax year and intends to remain so indefinitely;

• The participant has provided more than 50% of the domestic partner’s total support for the tax year;

• The relationship does not violate local law; and

• They have lived together for six months before enrolling the domestic partner, are jointly responsible for each other’s welfare and are financially interdependent.

EAP providers • Must meet the criteria to be at least a licensed Master’s Level counselor, years of experience required is driven by state specific license requirements.

• Are not qualified to prescribe or dispense medications; and

• Specialize in one or more workplace issues, performance problems, organizational stresses, substance abuse assessment and issues, or short-term counseling for life concerns.

(continued)



Emergency care Treatment provided in a hospital’s emergency room to evaluate and stabilize a recent and severe medical condition that arises suddenly and, in the judgment of a reasonable person, requires immediate care to avoid:

• Placing the person’s health in serious jeopardy;

• Serious impairment to bodily function;

• Serious dysfunction of a body part or organ; or

• In the case of a pregnant woman, serious jeopardy to the health of the fetus.

Note: Follow-up care after stabilization is not emergency care.

Emergency rescue unit

A unit that conducts training exercises and responds to fires, oil spills, hazardous material events, rescues, medical or bomb scare emergencies and any other emergency rescue unit duties authorized and directed by the company on real estate owned, leased, controlled or under the management of the company or used to conduct the business of the company.

Employee

For the Severance Pay Plan

A person who is on the company’s direct U.S. dollar payroll, for whom the company or its agent issues a Form W-2 to report compensation to the Internal Revenue Service, and who is in a regular full-time or regular part-time employment status on the date of layoff.

The term “employee” shall not include:

• Temporary personnel, intermittent personnel, “leased employees” within the meaning of Internal Revenue Code Section 414(n), and other non-regular employees of the company; or

• A person who is retroactively reclassified as a common-law employee by the Internal Revenue Service or by a court.

Employer


Phillips 66 and the members of its controlled group of corporations as that term is defined in section 414(b) of the Code and entities under common control with Phillips 66 as defined in section 414(c) of the Code.

Employment end date

The last day of an employee’s employment as recorded in the company’s personnel records.

Entitled to Medicare

An individual who:

• Is receiving Medicare benefits; or

• Would receive such benefits if he made application to the Social Security Administration.

ERISA Employee Retirement Income Security Act of 1974, as amended.

Essential duty A duty that:

• Is substantial, not incidental;

• Is fundamental or inherent to the occupation; and

• Cannot be reasonably omitted or changed.

The participant’s ability to work the number of hours in his regularly scheduled workweek is an essential duty.

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Evidence of insurability (EOI), evidence of good health

A statement providing the participant’s medical history. The claims administrator will use this statement to determine his insurability under the applicable plan.

External review A review of a denied claim or appeal by an Independent Review Organization (IRO).

Family and Medical Leave Act (FMLA)

FMLA leave is family or medical leave taken under the terms of the Family and Medical Leave Act of 1993, as amended.

Foster child An individual under the age of 26 who is placed with the participant by an authorized placement agency or by judgment, decree or other order of any court of competent jurisdiction, and who is the participant’s “eligible foster child” for purposes of Code section 152(f)(1)(A)(ii). Under the applicable state law, the maximum age for a foster child may be less than 26.

Full-time student An eligible child (or eligible spouse, for the DCFSA), as defined under the applicable plan, who is enrolled for the number of hours or courses the school considers to be full-time attendance during each of five calendar months during the calendar year in which the taxable year of the covered employee begins. A child (or spouse under the DCFSA) who is attending school only at night is not considered to be a full-time student. However, full-time attendance at school can include some attendance at night as part of a full-time course of study.

General Release of Liability/Release

A waiver and release signed by the participant, or, if the participant is deceased, signed by the participant’s spouse or the representative of the participant’s estate, in a form acceptable to the company, of all claims, whether or not asserted, arising out of or related to the participant’s employment or termination from employment as set forth in the Release.

Generic drug A prescription drug that contains the same active ingredients, in the same dosage form, as the brand-name drug, and is subject to the same U.S. Food and Drug Administration (FDA) standards for quality, strength and purity as its brand-name counterpart.

Some generics are made by the same pharmaceutical firms that produce the brand names. Generally, generic medications cost less because they do not require the same level of sales, marketing research and development expenses associated with brand-name drugs.

Group health plan

For employee and retiree medical

A plan that provides health care coverage and is maintained by an employer.

Group health plan

For the Flexible Spending Plan

When used in connection with special enrollment rights, the term means coverage under a plan that provides health care coverage and is maintained by an employer.

HIPAA The Health Insurance Portability and Accountability Act of 1996, as amended.

(continued)



Home health care agency

An agency or organization that provides a program of home health care and which fully meets one of the following three tests:

• It is approved under Medicare;

• It is established and operated in accordance with the applicable licensing and other laws; or

• It meets all of the following tests: – It has the primary purpose of providing a home health care delivery system

bringing supportive services to the home; – It has a full-time administrator; – It maintains written records of services provided to the patient; – Its staff includes at least one registered nurse (R.N.) or it has nursing care by an

available R.N.; and – Its employees are bonded and it provides malpractice insurance.

Hospice care Care and support services given to a terminally ill person and to the person’s family. An individual who is “terminally ill” has a medical prognosis of 12 months or less to live.

A hospice care agency is an agency that provides counseling and incidental medical services, such as room and board, for a medically ill individual, and that:

• Is approved under any required state or government Certificate of Need;

• Establishes policies governing the provision of hospice care;

• Provides an ongoing quality assurance program, which includes reviews by physicians other than those who own or direct the agency;

• Provides 24-hours-a-day, seven-days-a-week service;

• Is under the direct supervision of a duly qualified physician;

• Has a social service coordinator who is licensed in the area in which it is located;

• Provides hospice services as its main purpose;

• Has a full-time administrator; and

• Maintains written records of services given to the patient established and operated in accordance with any applicable state laws.

A hospice that is part of a hospital will be considered a hospice for the purposes of this plan.

Hospital An institution engaged primarily in providing medical care and treatment of sick and injured persons on an inpatient basis and:

• Is accredited by a reputable health organization; and

• Is approved by a State or Federal agency as a hospital.

Inactive disability status

The participant is in inactive disability status if his status as an employee has not been terminated but he is not performing services due to disability. Exception: “Inactive disability status” shall not include the period of time during which the participant is eligible for short-term disability benefits under the Phillips 66 Disability Plan or successor plan or program.

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Independent Review Organization (IRO)

An entity that conducts independent external reviews of denied claims and appeals under federal external review procedures approved by the National Association of Insurance Commissioners.

Indexed pre-disability earnings

The participant’s pre-disability earnings (as of the day before he begins his elimination period, plus any changes made to his pay during his elimination period). If the participant has been continuously receiving monthly LTD benefits under the plan, each year (on the anniversary of the date his LTD benefit payments began), his pre-disability earnings (not his LTD benefit amount) are adjusted by the lesser of:

• 10%; or

• The current annual percentage increase in the Consumer Price Index (CPI), as published by the U.S. Department of Labor.

Note: This adjustment applies to the participant’s pre-disability earnings and not directly to his LTD benefit amount.

Ineligible dependent

A dependent who does not meet a plan’s dependent eligibility requirements or is otherwise disqualified from eligibility.

Infertility The condition of a presumably healthy covered person who is unable to conceive or produce conception after:

• For a woman who is under 35 years of age: One year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or

• For a woman who is 35 years of age or older: Six months or more of timed, unprotected coitus, or six cycles of artificial insemination.

Injury

For the AD&D option and Emergency Responders Insurance under the Group Life Insurance Plan

A bodily injury directly caused by a covered accident, which is independent of all other causes, and occurs while the individual is enrolled in the plan (insured under the insurance contract) and is not otherwise excluded under the terms of the plan and/or the insurance contract. The following are not considered to be loss resulting from injury:

• Sickness or disease, except pus-forming infection that occurs through an accidental wound; and

• Medical or surgical treatment of a sickness or disease. (Applies to the AD&D option only.)

Institutes of Excellence Network

The claims administrator’s participating network for transplants and transplant-related services, including evaluation and follow-up care. Only hospitals that have exhibited successful clinical outcomes, met quality-of-care standards and agreed to acceptable contractual terms participate in the Institutes of Excellence Network.

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Investigational and/or experimental

A drug, device, procedure or treatment that has:

• Insufficient outcomes data available from controlled clinical trials published in the peer-review literature to prove its safety and effectiveness for the disease or injury involved;

• Not received FDA approval for marketing (if required);

• Been deemed, in writing, to be experimental, investigational or for research purposes by a recognized national medical society, regulatory agency or the treating facility; or

• Not met generally accepted standards of medical practice in the United States.

Layoff, laid off


These terms apply if all the requirements of (1) and (2) below are met and if (3) below does not apply to the termination of employment:

(1) Except as provided in (3) below, the term layoff or laid off applies if:

(a) The company gives the participant notice of layoff;

(b) The participant’s employment is involuntarily terminated with the company and with all members of the employer following such notice of layoff, on a date determined by the company; and

(c) The facts are as described in (i), (ii) or (iii) below:

(i) The participant is not in salary grade level 21 or 22, and the termination of employment is prior to a Change in Control and is caused by a reduction in force, a job elimination, a corporate event or is designated as a layoff by the Chief Executive Officer of Phillips 66; or

(ii) The participant is in salary grade level 21 or 22, and the termination of employment is prior to a Change in Control and is designated as a layoff by the Chief Executive Officer of Phillips 66; or

(iii) The termination of employment is on or after a Change in Control and is either caused by a reduction in force, a job elimination, a corporate event, or designated as a layoff by the Chief Executive Officer of Phillips 66.

(2) For purposes of (1)(c)(i) and (1)(c)(iii) above, in order for the elimination of a job (whether or not the elimination was in connection with a reduction in force) other than the job currently assigned to the participant to constitute causation for the termination of the participant’s employment, the relationship between the job eliminated and the job currently assigned to the participant must be as described in either subparagraph (a) or (b) below:

(a) The job eliminated is not lower than two levels below the level of the job currently assigned to the participant as of the date the job is eliminated, with “level” meaning salary grade levels established by the company; or

(b) The job eliminated has weekly pay that is at least 70% of the weekly pay of the job currently assigned to the participant as of the date the job is eliminated. If the eliminated job is not assigned to an employee at the time of its elimination, the pay shall be the mid-point pay for the salary grade level of the eliminated job.

(definition continued on next page)

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Layoff, laid off


(continued)

(3) Provided, however, whether or not the company has given a participant notice of layoff, the participant’s termination of employment shall not be considered a layoff if any of the following apply:

(a) The participant resigns as of a date prior to the date specified for layoff in the notice of layoff;

(b) The participant’s employment is terminated because he failed to accept, within seven calendar days of the offer, a job offered by an employer at comparable pay, at a comparable employment level, and not in the same geographical area for which he will receive relocation assistance;

(c) The participant’s employment is terminated because he failed to accept, within seven calendar days of the offer, a job offered by an employer at comparable pay, at a comparable employment level and in the same geographical area;

(d) The participant’s employment is terminated because he failed to accept, within seven calendar days of the offer, a transfer job at comparable pay offered by an affiliate that is not an employer made pursuant to a mutual agreement between the company and the affiliate providing for such transfer job offer; or

(e) The participant accepts any transfer job offered by an affiliate that is not an employer made pursuant to a mutual agreement between the company and the affiliate providing for such transfer job offer.

Layoff pay The sum of basic benefits and, if applicable, supplemental benefits the participant is entitled to receive from the Severance Pay Plan.

Leave of absence A direct U.S. dollar payroll status that may allow an employee to continue participation for a limited period of time in certain benefit programs in which he was participating as an active employee prior to going on leave of absence status.

For leaves, refer to the appropriate leave policy for a complete definition.

For a leave of absence-Labor Dispute, the company places an active employee on this leave for the time when he is not working due to a labor dispute. Generally, benefits are not available during a leave of absence-Labor Dispute.

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Legally adopted


For a child (must be under age 18) to be considered the legally adopted son or daughter of the (i) covered employee and/or the covered employee’s eligible spouse or (ii) covered employee’s eligible domestic partner, as applicable, a final order or final decree of adoption has been issued by a court of competent jurisdiction in the United States, and the persons shown as the parents of the adopted child are either the (i) covered employee and/or the covered employee’s spouse or (ii) covered employee’s domestic partner, and the same person(s) are named as parents (with all state statutory parental obligations) in the decree or order evidencing the final adoption.

The parent-child relationship is established when the adoption is effective and final under state law. To be legal, an adoption must be valid under the law of the state where the adoption took place. At least one party to the adoption (either the child or adopting parent) must have been domiciled or actually residing in that jurisdiction at the time of adoption.

Legally adopted

For the dependent life and AD&D options under the Group Life Insurance Plan

Determined in accordance with the provisions of the law of the state in which the participant resides. Includes a child from the date of placement with adopting parents until the date of the legal adoption.

Lifetime maximum

For the Medical and Dental Assistance Plan

The maximum amount payable by the plan for a covered individual throughout his lifetime (cumulative total among all self-insured medical options that covered the person).

Local economy The geographic area surrounding the participant’s place of residence which offers reasonable employment opportunities. It is an area within which it would not be unreasonable for the participant to travel to secure employment. If he moves from the place he resided on the date he became disabled, both his former place of residence and his current place of residence will be looked at in determining local economy.

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Maintenance medication

A prescription drug prescribed for long-term treatment of conditions such as high cholesterol or high blood pressure. Certain maintenance medications may also be considered a preventive prescription drug and, in addition, be subject to those plan provisions. The following categories may include maintenance medications:

• Anti-infectives.

• Autonomic and CNS drugs, neurology and psych.

• Cardiovascular, hypertension and lipids.

• Endocrine therapy.

• Diabetes therapy.

• Musculoskeletal and rheumatology.

• Obstetric and gynecology.

• Urological.

• Ophthalmology.

• Respiratory, allergy and cough and cold.

• Hematinics and electrolytes.

• Gastroenterology.

Drugs on the plan’s maintenance medication list may change, depending upon the following:

• Clinical appropriateness of dispensing the drug in larger quantities (for example, monitoring requirements, methods of administration, etc.);

• Days’ supply limitations (for example, state regulations, stability issues, etc.);

• Supply limitations (for example, product availability, exclusive distribution, drug recall, etc.); and

• Sensitive therapies (for example, extreme psychiatric conditions, etc.).

Marriage Any marriage that is valid in the state or jurisdiction in which the marriage was entered into, regardless of the employee’s place of domicile.

Marriage and family therapist

A person who has completed the necessary education and training to meet the licensing or certification requirements of the governmental body having jurisdiction over such licensing or certification where the person renders services to the participant or dependent.

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Medically necessary

For employee medical and retiree medical

In order to be covered, a service, procedure, supply or treatment must be “medically necessary.” These are health care or dental services and supplies or prescription drugs that a physician or other health care provider recognized by the plan or dental provider, exercising prudent clinical judgment, would give to a patient for the purpose of:

• Preventing;

• Evaluating;

• Diagnosing; or

• Treating: – An illness; – An injury; – A disease; or – Its symptoms.

The provision of the service, supply or prescription drug must be:

• In accordance with generally accepted standards of medical or dental practice;

• Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury or disease;

• Not mostly for the convenience of the patient, physician, other health care provider recognized by the plan or dental provider; and

• No more costly than an alternative service or sequence of services generally considered medically equivalent and at least as likely to produce the same therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.

For these purposes “generally accepted standards or medical or dental practice” means standards that are based on credible scientific evidence published in peer-reviewed literature. They must be generally recognized by the relevant medical or dental community. Otherwise, the standards are consistent with physician or dental specialty society recommendations. They must be consistent with the views of physicians or dentists practicing in relevant clinical areas and any other relevant factors.

Medically necessary

For employee dental

Services that are necessary for the diagnosis and are given at the appropriate level of care. This determination is made by the claims administrator. The fact that a procedure or level of care is prescribed by a dentist does not mean that it is medically necessary or that it is covered under the plan.

In certain circumstances, a medically necessary procedure may be covered partially by the medical option and not the dental benefit. In this circumstance, it may be necessary to submit a claim under both the medical option and the dental benefit. Ultimately, it is the responsibility of the participant and his dentist to determine the appropriate course for dental treatment in any given case, regardless of whether it appears the dental benefit will pay the cost of such care.

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Mental health, mental health condition, mental health disorder

For employee medical and retiree medical

A medically recognized psychological, physiological, nervous or behavioral condition affecting the brain (excluding alcoholism, substance abuse or other addictive behavior) that can be diagnosed and treated by medically recognized and accepted methods. Conditions recognized in the most current American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed. 2013) (DSM-V), or its successor publication, are included in this definition.

Mental illness

For the LTD benefit and STD benefit

A mental disorder as listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. A mental illness may be caused by biological factors or result in physical symptoms or manifestations.

For purposes of the LTD benefit and the STD benefit, mental illness does not include the following mental disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders:

• Mental retardation;

• Pervasive developmental disorders;

• Motor skills disorder;

• Substance-related disorders;

• Delirium, dementia, and amnesic and other cognitive disorders; or

• Narcolepsy and sleep disorders related to a general medical condition.

Motor vehicle A self-propelled, four or more wheeled vehicle not being used as a common carrier, including a:

• Private passenger car, station wagon, van or sport utility vehicle;

• Motor home or camper; or

• Pick-up truck.

“Motor vehicle” does not include farm equipment, snowmobiles, all-terrain vehicles, lawnmowers or any other type of equipment vehicles.

“Common carrier” is a conveyance operated by a concern, other than the company, organized and licensed for the transportation of passengers for hire and operated by that concern. It excludes conveyances hired or used for a sport, gamesmanship, contest, sightseeing, observatory and/or recreational activity, regardless of whether such conveyance is licensed.

Negotiated rate The maximum charge a network provider has agreed to charge for a service or supply covered by the plan.

Network deficiency A situation in which the claims administrator lacks network physicians and hospitals for certain specialties within a provider network.

Network provider A health care provider, hospital or facility in the United States that the claims administrator has designated as part of its provider network for the service or supply being provided. Also known as a “preferred provider.”

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Non-covered expenses

Services, treatments and diagnostic procedures not covered under the plan.

Non-emergency use of an emergency room

Treatment received in a hospital emergency room for a non-emergency while a person is not a full-time inpatient.

Non-network pharmacy

A pharmacy that is not in the CVS Caremark participating pharmacy network.

Non-network provider (also known as non-preferred provider)

A health care provider who has not contracted to furnish services or supplies at a negotiated rate.

Non-network reimbursement rate

For the HDHP option, PPO option and Medicare-eligible PPO option

Non-network benefits under the HDHP option, PPO option and the Medicare-eligible PPO option are paid based on reasonable and customary limits (not applicable to network provider charges). Refer to the Evidence of Coverage (EOC) for information regarding Kaiser HMO.

For a medically necessary service or supply, the reasonable and customary limit is generally the dollar amount that is the lower of:


• Absent a contractual agreement with the claims administrator, 200% of the Medicare Allowable Rate (if established) for the geographic area where the service is furnished.

Medicare allowable rates are established and periodically updated by The Centers for Medicare and Medicaid Services (CMS) for payment for services and supplies provided to Medicare enrollees. The claims administrator updates these revised rates within 180 days of receiving them from CMS.

If a contractual arrangement with the claims administrator is established, the reasonable and customary limit is the rate established in such agreement.

Absent an established Medicare reimbursement rate or contractual arrangement with the claims administrator, the claims administrator maintains and periodically updates data for its use in processing claims. The plan sets the percentile for the reasonable and customary fee. Note: For the HDHP option, the PPO option and the Medicare-eligible PPO option, the claims administrator uses an outside profile data source to ensure that there is adequate profile information to support reasonable and customary benefit determination.

The reasonable and customary limit for a given procedure in a geographic area based on the first three digits of the U.S. Postal Service ZIP codes are all grouped and then ranked. If the volume of charges is not sufficient to produce a statistically valid sample, additional three-digit ZIP codes are grouped; however, the grouping never crosses state lines.


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For the HDHP option, PPO option and Medicare-eligible PPO option

(continued)

For the HDHP option, PPO option and the Medicare-eligible PPO option, in determining the recognized charge for a service or supply that is unusual, not often provided in the area or provided by only a small number of providers in the area, the claims administrator may take into account such factors as the:

• Complexity.

• Duration.

• Degree of skill needed.

• Type of specialty of the provider.

• Range of services or supplies provided by a facility.

• Reasonable and customary charge made by providers in other areas.

• Charge the claims administrator determines to be appropriate based on such factors as the cost of providing the same or similar service or supply and the manner in which the service or supply is made.

• Charge the claims administrator determines to be the reasonable and customary percentage made for that service or supply.

Example of covered charge:

If the provider charges:

And the reasonable and customary charge is:

The plan will recognize:

$50 $55 $50

$60 $55 $55

The plan does NOT cover charges that are over the reasonable and customary limit. In addition, charges that are over the reasonable and customary limit do not count toward satisfying, and are not subject to, any annual deductible or annual out-of-pocket maximum that may apply to the plan.

For the HDHP option, the PPO option and the Medicare-eligible PPO option, in order for the plan to recognize a provider’s fee above the reasonable and customary level as a covered expense, there must be an appeal to the claims administrator that verifies that there was something out of the ordinary that warrants the higher charge.

To find out whether a provider’s charges fall within reasonable and customary limits for a specific service before receiving care, ask the provider for:

• The amount of the charge;

• The numeric code that the provider will assign to the service provided; and

• The provider’s billing office ZIP code.

Call the claims administrator with this information well in advance of receiving the service. The claims administrator will determine whether the charges are within reasonable and customary limits.

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For the dental benefit

The lowest of:

• The dentist’s actual charge for the services or supplies (or if the provider of the service or supplies is not a dentist, such other provider’s actual charge for the services or supplies) (the actual charge); or

• The usual charge by the dentist or other provider of the services or supplies for the same or similar services or supplies (the usual charge); or

• The usual charge of other dentists or other providers in the same geographic area equal to the 90th percentile of charges as determined by MetLife, based on charge information for the same or similar services or supplies maintained in MetLife’s reasonable and customary records (the customary charge). Where MetLife determines that there is inadequate charge information maintained in MetLife’s reasonable and customary charge records for the geographic area in question, the customary charge will be determined based on actuarially sound principles.

Non-occupational accident

For OAD benefits under the Group Life Insurance Plan

An accident that is not considered an occupational accident.

Non-occupational illness or injury

An illness or injury that does not arise out of (or in the course of) any work for profit or result in any way from an illness or injury that does. An illness or injury will be deemed to be non-occupational, regardless of cause, if proof is furnished that the person was covered under any type of Workers’ Compensation law and they are not covered for that illness under such law. For example, a non-occupational illness or injury includes, but is not limited to, the flu, a cold, and physician-directed absences during or after pregnancy.

Normal activities For a dependent, this means the dependent is not confined to a hospital or a place of residence and is able to perform the normal and customary activities of a person of like age and gender.

Notice of layoff A written notice provided by the company to the participant in a form acceptable to the plan administrator stating the date of layoff. Prior to a Change in Control, such notice is a notice of layoff only if approved by:

• The Chief Executive Officer of Phillips 66 in the case of an employee who, on the date the company gives notice of layoff, is in salary grade levels 21 or 22;

• The Senior Vice President, Human Resources, Communications & Public Affairs of Phillips 66 in the case of an employee who, on the date the company gives notice of layoff, is in salary grade levels 19 or 20; or

• The Business Line Human Resources General Manager (HRLT) in the case of an employee who, on the date the company gives notice of layoff, is in salary grade level 18 or below.

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Occupational accident

An accident that occurs while the participant is performing his job duties either at his job site or while traveling on company business (at Phillips 66’s expense).

• The purpose of his business travel must be to further company business, and the trip must involve a company-authorized assignment that requires him to travel.

• Traveling on business starts when the participant leaves from his residence, regular place of employment or other location (whichever occurs last) for the purpose of traveling to the destination of the business trip. The business trip ends when he returns to or arrives at his residence or his regular place of employment (whichever occurs first).

• Everyday travel to and from work and any personal deviation does not qualify as business travel. “Personal deviation” is any travel or activity not reasonably related to the business of the company; or not incidental to the business trip and not at the expense of the company.

Occupational illness or injury

An illness or injury that arises out of (or in the course of) any activity in connection with employment or self-employment, whether or not on a full-time basis, or results in any way from an injury or illness that does.

Occupational therapy

Therapy in which the principal element is some form of productive or creative activity. While similar to physical therapy, occupational therapy focuses on helping an individual develop finer, more delicate movements, such as coordination of the fingers. Such therapy is covered by the plan when it is rendered by a qualified physical therapist or occupational therapist for an appropriate diagnosis as determined by the claims administrator. Occupational therapy for activities to occupy a patient’s time and interest while being treated is not covered by the plan. Occupational therapy also does not include educational training or services designed to develop physical function.

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Other health insurance coverage

The term, as used in connection with the special enrollment rights, means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise) under any hospital or medical policy or certificate, hospital or medical plan contract, or health maintenance organization contract offered by a health insurance issuer. Health insurance coverage includes group health insurance coverage and individual health coverage.

Certain types of coverage are not considered other health insurance coverage, such as:

• Coverage only for accident, or disability income insurance.

• Coverage issued as a supplement to liability insurance.

• Liability insurance.

• Workers’ Compensation or similar insurance.

• Credit-only insurance.

• Coverage for on-site medical clinics.

• Part A, Part B or Part D of Medicare.

• Medicaid, a State child health plan or the Children’s Health Insurance Program.

• Medical and dental care for members and former members of the armed services.

• Medical care program of Indian Health Services or of a Tribal organization.

• Federal Employee Health Benefit Program.

• Peace Corps health plan.

• Public health plan (defined to be a plan of a state, county or other political subdivision).

• Health coverage provided by foreign governments (e.g., Canadian health care system).

Outpatient surgical facility/ambulatory surgical center

A surgery center or hospital outpatient department. Charges for outpatient services and supplies incurred in relation to a surgical procedure performed onsite are covered, provided the procedure:

• Can safely and adequately be performed only in a surgery center or in a hospital; and

• Is not normally performed in the office of a physician or a dentist.

Outpatient services and supplies are furnished by the center/hospital on the day of the procedure. No benefit is paid for charges incurred while the person is confined as a full-time inpatient in a hospital.

Participant An employee/retiree who has satisfied the eligibility and participation requirements specified for a Phillips 66 plan, who has enrolled in or has been automatically enrolled in the plan, and whose participation has not terminated under any applicable provisions of the plan.

Pay Base salary and regularly scheduled overtime, excluding overtime resulting from the 19/30 work schedule.

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Personal leave of absence

The status of an employee who has not been terminated, but is not performing services due to a leave of absence. Exception: “Personal leave of absence” shall not include time during a military leave of absence or leave of absence under the Family and Medical Leave Act.

Physical therapy The treatment of disease and injury by mechanical means, such as exercise, heat, light, hydrotherapy and massage (excludes speech therapy, recreational therapy or rehabilitative swimming lessons), and rendered by a physician or physiotherapist. The physiotherapist must be registered, licensed or recognized in accordance with local licensing authorities.

The services must be prescribed by a physician, and any claim for plan benefits must be accompanied by a physician’s treatment plan outlining type of treatment, frequency and duration. Any change or extension to the treatment plan should be accompanied by an explanation by the physician. The plan may also require periodic updates regarding the treatment plan. Physical therapy does not include educational training or services designed to develop physical function.

Physician

For the Medical and Dental Assistance Plan and the STD benefit

A duly licensed member of a medical profession who:

• Has an M.D. or D.O. degree;

• Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices; and

• Provides medical services that are within the scope of that license or certificate.

This includes a health professional who:

• Is properly licensed or certified to provide medical care under the laws of the jurisdiction where the individual practices;

• Provides medical services that are within the scope of that license or certificate;

• Under applicable insurance law, is considered a “physician” for purposes of this coverage;

• Has the medical training and clinical expertise suitable to treat the patient’s condition;

• Specializes in psychiatry, if the patient’s illness or injury is caused, to any extent, by alcohol abuse, substance abuse or a mental disorder; and

• Is a physician who is not the participant or related to the participant by blood or marriage.

Physician

For the Life and AD&D options under the Group Life Insurance Plan and for the LTD benefit

A person who is:

• A doctor of medicine, osteopathy, psychology or other legally qualified practitioner of a healing art that the claims administrator recognizes or is required to recognize;

• Licensed to practice in the jurisdiction where care is being given;

• Practicing within the scope of that license; and

• Not related to the participant by blood or marriage.

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Physician

For Emergency Responders Insurance under the Group Life Insurance Plan

A legally qualified physician or surgeon other than a physician or surgeon who is related to the participant by blood or marriage.

Placed for adoption, placement for adoption


(Does not apply to domestic partners)

A child (must be available for adoption and under the age of 18) has been placed for adoption with the covered employee in his home, whether or not the adoption has become final, as of the date of either (i) an order by a court of competent jurisdiction in the United States that is issued placing the child in the home of the covered employee for the purpose of legally adopting the child and imposes a legal obligation on the covered employee for partial or total support of the child, or (ii) a legally binding contract between the covered employee and an authorized placement agency that has been signed by both parties and is enforceable in a court of competent jurisdiction (also known as a “placement contract”), which the placement contract places the child in the home of the covered employee for the purpose of legally adopting the child and imparts an obligation on the covered employee for partial or total support of the child.

Post-service claim A claim for a benefit that was not required to be preapproved before the service was received in order to get the maximum plan benefit. Most claims under the medical and dental benefit options will be post-service claims.

Pre-admission testing

Preliminary tests, such as X-rays and laboratory tests, performed prior to admission on a person who is scheduled for inpatient care or outpatient surgery. Pre-admission testing must be:

• Related to the performance of a scheduled surgery that is covered by the plan, and performed prior to, and within seven days of, surgery;

• Ordered by a physician after a condition requiring surgery has been diagnosed and after: – Hospital admission for the surgery has been requested by the physician and

confirmed by the hospital; or – The surgery has been scheduled by the physician, if the surgery is to be

performed on an outpatient basis; and

• Performed in a hospital or a laboratory whose test results are determined to be acceptable by the hospital or outpatient surgical facility/ambulatory surgical center where the surgery is performed.

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Pre-disability earnings

The participant’s base pay, plus regularly scheduled overtime — as determined by the company — and as in effect on the day before he began his elimination period. Pre-disability earnings may include:

• Any pay increases the participant receives during the elimination period; and

• Contributions the participant makes through a salary reduction agreement with the company to any of the following: – A Code Section 401(k) plan; – An executive nonqualified deferred compensation arrangement; and – Amounts contributed under a Code Section 125 plan.

Pre-disability earnings do not include:

• Overtime resulting from the 19/30 work schedule.

• Awards and bonuses.

• Contributions made by the company on the participant’s behalf to any deferred compensation arrangement or pension plan.

• Holiday pay for hourly employees at the refineries.

• Any other compensation.

Pre-existing condition

An injury or illness for which a person has received treatment or services or has taken prescription drug medication during the three months before coverage is effective. There is no pre-existing condition benefit limitation under the medical options.

Premium pay Pay above the normal pay for regular work hours, such as holiday pay, upgrade pay, callout pay, unscheduled overtime and shift differentials.

Pre-service claim A claim for a benefit that is required to be preapproved before the service is received in order to get the maximum plan benefit. This includes such things as required pre-certification, case management or utilization review, and requests to extend a course of treatment that was previously preapproved.

Preventive medical care

A medical examination or service given by a provider when it is not in connection with a diagnosis, monitoring or treatment of a suspected or identified disease or injury. “Not in connection” means the participant has never been treated, diagnosed or suspected to have the identified disease or condition for which the provider is giving the examination or service. Preventive medical care also refers to services based on the preventive medical care guidelines followed by the claims administrator. These guidelines may be based on recommendations from nationally recognized organizations, such as the U.S. Preventive Services Task Force.

Preventive prescription drugs

Prescription drug medications that help avoid or prevent reoccurrence of an illness or condition. Medications within a category may change periodically. The claims administrator sets preventive prescription drug medications clinical dispensing guidelines. Certain preventive prescription drugs may also be considered a maintenance medication and, in addition, be subject to those plan provisions.

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Primary care physician (PCP)

A physician responsible for coordinating all care for an individual patient — from providing direct care services to referring the patient to specialists and hospital care when necessary.

Private automobile A four-wheeled, private passenger car, station wagon, pickup truck, van or jeep-type automobile which is not being used as a conveyance which is organized and licensed for the transportation of passengers.

Professional counselor

A person who has completed the necessary education and training to meet the licensing or certification requirements of the governmental body having jurisdiction over such credentialing where the person renders services to a patient.

Psychiatrist A physician who specializes in the prevention, diagnosis, and treatment of mental illness and substance abuse disorders. A psychiatrist:

• Must be licensed to practice psychiatry in the state in which his practice is located;

• Must receive additional training and serve a supervised residency in his specialty;

• May also have additional training in a psychiatric specialty, such as child and adolescent psychiatry, geriatric psychiatry, and/or psychoanalysis; and

• May prescribe medication.

Psychologist A person who is:

• Licensed or certified as a clinical psychologist by the appropriate governmental authority having jurisdiction over such licensing or certification in the jurisdiction where the person renders service to the patient; or

• A member or fellow of the American Psychological Association if there is no licensing or certification in the jurisdiction where the person renders service to the patient.

Reasonable and customary (R&C)

For the Flexible Spending Plan

The dollar amount that is the lower of the provider’s charge or the prevailing charge for the same service among providers in the same geographic area is the reasonable and customary amount.

Recurring seasonal employee

A recurring seasonal employee of Phillips 66 employed at Stony Island who is not terminated at the end of the performance of his seasonal duties.

Referral The process of increasing client awareness of various available resource systems as well as expediting transfer of the client to the appropriate resource.

Regular job The material duties the participant regularly performs for the company that provides his pre-disability earnings.

Rehabilitation program

• A return to full-time or part-time active employment by the participant in an attempt to enable him to resume gainful employment or service in an occupation for which he is reasonably qualified taking into account his training, experience and past earnings; or

• Participating in vocational training or physical therapy deemed appropriate by one of the claims administrator’s rehabilitation coordinators.

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Relocation assistance

Reimbursement to the participant by the company of moving expenses under the company’s current relocation policy.

Reserve National Guard Service

Includes:

• Attending or en route to or from any active duty training of less than sixty (60) days;

• Attending or en route to or from a service school of any duration;

• Taking part in any authorized inactive duty training; or

• Taking part as a unit member in a parade or exhibition authorized by official orders.

Resident alien The participant is a resident alien as of the first date he is or may be treated as a resident alien as defined by the IRS. Generally, he must satisfy either the “green card test” or the “substantial presence test” to be treated as a resident alien. For more information, see IRS Publication 519 “U.S. Tax Guide for Aliens.”

Residential treatment center

An institution specifically licensed as a residential treatment facility by applicable state and federal laws to provide for mental health residential treatment programs, and accredited by one of the following for the services provided:

• The American Osteopathic Association’s Healthcare Facilities Accreditation Program (HFAP)

• The Committee on Accreditation of Rehabilitation Facilities (CARF)

• The Council on Accreditation (COA)

• The Joint Commission (TJC)

Residential Treatment Facility (Center) Services (RTCS) are provided to individuals who require 24-hour treatment and supervision in a safe therapeutic environment. RTCS is a 24-hours-a-day/seven-days-a-week facility-based level of care. RTCS provides therapeutic intervention and specialized programming in a controlled environment that includes a high degree of supervision and structure to individuals with severe and persistent psychiatric disorders. RTCS addresses the identified problems through a wide range of diagnostic and treatment services, as well as through training in basic skills, such as social skills and activities of daily living that cannot be provided in a community setting. The services are provided in the context of a comprehensive, multidisciplinary and individualized treatment plan that is frequently reviewed and updated based on the individual’s clinical status and response to treatment. This level of care requires at least weekly physician visits. This treatment primarily provides social, psychosocial and rehabilitative training, and focus on family or caregiver reintegration. Active family/significant involvement through family therapy is a key element of treatment and is strongly encouraged unless contraindicated. Discharge planning should begin at admission, including plans for reintegration into the home and community.


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Residential treatment center

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Residential Treatment Programs treating mental disorders must meet the following criteria:

• Behavioral health provider actively on duty 24 hours per day, 7 days a week.

• Medical director is a physician.

• Patient treated by a psychiatrist at least once a week.

Residential Treatment Programs treating chemical dependency must meet the following criteria:

• Behavioral Health provider or an appropriately state certified professional actively on duty during the day, and evening therapeutic programming.

• Medical director is a physician.

• RN must by onsite 24 hours per day, 7 days a week.

• Residential care must be provided under direct supervision of a physician.

A residential treatment center that is part of a hospital will be considered to be a residential treatment center for the purposes of this program.

Room and board charges

Covered charges at a semiprivate room rate (if a facility only has private rooms, the billed charge is allowed), excluding physician services or intensive nursing care. Room and board charges include:

• All charges for medical care and treatment that are made by a hospital at a daily or weekly rate for room and board; and

• Other hospital services and supplies that are regularly charged by the hospital as a condition of occupancy of the class of accommodations occupied.

Same geographical area

A new job is considered in the same geographical area as a current job if the distance between the participant’s primary residence, as of the date notice of layoff is given, and the location of the new job is no more than 50 miles greater than the distance between the participant’s primary residence, as of the date notice of layoff is given, and the location of the current job. For this purpose, the 50-mile provision is determined by reference to Code section 217(c)(1)(A) or a successor Code section and final regulations pertaining to that Code section as in effect on the date of layoff. Such 50-mile provision will be adjusted if and to the extent the 50-mile provision in Code section 217(c)(1)(A) or a successor Code section is adjusted.

School School includes elementary schools, junior and senior high schools, colleges, universities, and technical, trade and mechanical schools that maintain a regular faculty and curriculum and have a regularly enrolled body of pupils or students in attendance at the place where its educational activities are regularly carried on. It does not include on-the-job training courses, correspondence schools and night schools.

Seat belt An unaltered belt, lap restraint or lap and shoulder restraint installed by the manufacturer of the motor vehicle or proper replacement parts installed as required by the motor vehicle’s manufacturer’s specifications, or a child restraint device that meets the standard of the National Safety Council and is properly secured and used in accordance with applicable state law and installed according to the recommendations of its manufacturer for children of like age and weight.

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Service area The geographic area, as determined by the claims administrator, in which preferred (network) providers for the plan are located.

Service in the uniformed services

The performance of duty on a voluntary or involuntary basis in the uniformed services under competent authority, including:

• Active duty.

• Active duty for training.

• Initial active duty for training.

• Full-time National Guard duty.

• A period for which a person is absent from employment for an examination to determine his/her fitness to perform any of these duties.

• A period for which a person is absent from employment to perform certain funeral honors duty.

• Certain duty and training by intermittent disaster relief personnel for the Public Health Service.

Sheltered workshop A school operated by certain tax-exempt organizations, a state, a U.S. possession, a political subdivision of a state or possession, the United States or the District of Columbia, that provides special instruction or training designed to alleviate the individual’s disability.

Skilled nursing care Physician-prescribed procedures or activities requiring the presence of, or administration by, a licensed, trained medical provider (including registered nurses, licensed practical nurses and licensed vocational nurses). The procedures or activities must be reasonable and necessary for treatment and care of a disease or injury.

Services may include (but are not limited to) administration of prescribed treatments and medication, observation and assessment of an unstable patient’s condition, or providing instructions for self-management of treatment. Services do not include custodial care, transportation, therapy (infusion, physical, occupational and speech), services by a certified or licensed social worker or a person who usually lives with the participant or a family member.

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Skilled nursing facility

A facility approved by Medicare as a skilled nursing facility. If not approved by Medicare, the facility may be covered, provided it:

• Is operated in accordance with the applicable laws of the jurisdiction in which it is located;

• Is operated under the applicable licensing and other laws;

• Is under the supervision of a licensed physician or registered graduate nurse (R.N.) who is devoted to full-time supervision;

• Is regularly engaged in providing room and board and continuously provides 24-hours-a-day skilled nursing care of sick and injured persons at the patient’s expense during the convalescent stage of an injury or sickness;

• Maintains a daily medical record of each patient who is under the care of a physician; and

• Is not, other than incidentally, a home for the aged, the blind or the deaf, a hotel, a domiciliary care home, a maternity home or a home for alcoholics or drug addicts or the mentally ill.

A skilled nursing facility that is part of a hospital will be considered a skilled nursing facility for the purposes of this plan.

Social worker A person who:

• Is licensed or certified as a social worker by the appropriate governmental agency having jurisdiction over such licensing or certification in the jurisdiction where the person renders service; or

• Is a member of the Academy of Certified Social Workers of the National Association of Social Workers, if there is no licensing or certification in the jurisdiction where such person renders services.

Solid organ Organs — including the heart, lungs, kidneys, pancreas, intestines and liver. The National Medical Excellence and United Resource Networks programs are designed to help arrange covered care for solid organ and tissue transplants — including heart, lung, liver, kidney, pancreas, peripheral stem cell and bone marrow transplants.

Spinal manipulation (also chiropractic)

Services that adjust spinal disorders; includes manipulative (adjustive) treatment or other physical treatment of any condition caused by or related to biomechanical or nerve conduction disorders of the spine.

Spouse One of the parties of a marriage that is valid in the state or jurisdiction in which the marriage was entered into, regardless of the employee’s place of domicile.

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STD absence Absences due solely to an employee’s sickness, physical examinations or treatment due to a disability and/or non-occupational illness or injury during such period of time as the employee would have otherwise been performing regularly scheduled work. STD absences also include physician-directed absences during or after a pregnancy which begin the date the physician determines the employee is no longer able to work and ends when the physician releases the employee to return to work. STD absences do not include routine wellness examinations.

Any absences that might otherwise be considered STD absences, but that occur during or extend into such period of time when the employee is absent due to a paid or unpaid absence (e.g., vacation, community service, etc.), any paid or unpaid leave of absence, or a leave of absence-Labor Dispute, are not covered by this plan.

Substance abuse

For the Medical and Dental Assistance Plan

The physiological and psychological abuse of, or addiction to, a controlled drug or substance, or to alcohol. Dependence upon tobacco, nicotine and caffeine are not included in this definition.

Substance abuse

For the LTD benefit

The pattern of pathological use of alcohol or other psychoactive drugs and substances characterized by:

• Impairments in social and/or occupational functioning;

• Debilitating physical condition;

• Inability to abstain from or reduce consumption of the substance; or

• The need for daily substance use to maintain adequate functioning.

Substance includes alcohol and drugs but excludes tobacco and caffeine.

Successor employer One or more unrelated entity(ies) that:

• Purchases assets from the company or from a member of the employer; or

• Subsequently purchases assets from a successor employer as defined in the item above where such subsequent purchase is in connection with a corporate event; or

• Purchases stock of an entity from the company or from a member of the employer; or

• Forms a joint venture with the company or with a member of the employer; or

• Purchases an interest in a joint venture from the company or a member of the employer; or

• Assumes the role of operator of a joint venture or business for which the company had been the operator just prior to that assumption; or

• Provides service to the employer that was formerly provided by employees of the company or a member of the employer; and

• Offers employment to one or more participants in connection with a corporate event.

For purposes of this definition “unrelated entity” means a person, company or other legal entity that is not in the affiliated group.

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Support

For the Medical and Dental Assistance Plan, the Flexible Spending Plan and the EAP

Refers to providing more than one-half support of an individual’s total support. To make this determination, the participant must compare the amount of support he provides with the amount of support the other individual receives from all sources, including Social Security, welfare payments and the support the individual supplies for himself.

Support includes items and services such as food, shelter, clothing, medical and dental care and education. For an eligible child who is a full-time student, scholarships received for study at a school are excluded from the support test. For an eligible child who is disabled, income received for the performance of services at a sheltered workshop are excluded from the support test, provided the:

• Availability of medical care is the main reason the disabled child is at the workshop; and

• Income comes solely from activities at the workshop that are incidental to medical care.

If the participant believes he might provide more than one-half of an individual’s support, he should use the support worksheet in IRS Publication 501 “Exemptions, Standard Deduction and Filing Information.”

Support

For the Group Life Insurance Plan

Refers to providing more than one-half support of an individual’s total support. To make this determination, the participant must compare the amount of support he provides with the amount of support the other individual receives from all sources, including Social Security, welfare payments and the support the individual supplies for himself.

Terminally ill Certified by a physician as having a life expectancy, due to illness, of 24 months or less.

Transitional duty A position that has less than the full-time work schedule the participant had prior to his disability, or does not have all of the duties of the job he had prior to his disability, and that has been approved by his supervisor, Phillips 66 health services and local HR and has been made available to him.

Uniformed services The Armed Forces, the Army National Guard and the Air National Guard when engaged in active duty for training, inactive duty for training, or full-time National Guard duty (i.e., pursuant to order issued under United States federal law), the commissioned corps of the Public Health Service, and any other category of persons designated by the president in time of war or national emergency.

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Urgent care Services that are medically necessary and immediately required because of a sudden illness, injury or condition that:

• Is severe enough to require prompt medical attention to avoid serious deterioration of the participant’s health;

• Includes a condition which would subject the participant to severe pain that could not be adequately managed without urgent care or treatment;

• Does not require the level of care provided in the emergency room of a hospital; and

• Requires immediate outpatient medical care that cannot be postponed until the participant’s physician becomes reasonably available.

Urgent claim A medical or dental pre-service claim in a situation where delaying a decision on the claim until the usual deadline:

• Could seriously jeopardize the participant‘s life or health or his ability to regain maximum function; or

• Would, in the opinion of a physician who knows the participant’s medical condition, subject him to severe and unmanageable pain.

The plan will treat a claim as an urgent claim if the physician or dentist treating the participant advises the plan that the claim satisfies the urgent criteria.

USERRA The Uniformed Services Employment and Reemployment Rights Act of 1994, as amended. This is a federal act that provides for continuation of medical and dental coverage, the Flexible Spending Plan’s health care flexible spending account and the Employee Assistance Plan for employees and covered dependents who, under certain circumstances related to uniformed service, would otherwise lose their group health coverage.

Phillips 66 also offers employee life insurance and accidental death & dismemberment insurance benefits, to the extent a participant is enrolled in the benefits provided under the plan at the time USERRA becomes applicable to him.

U.S. expatriate (expat)

An employee on the direct U.S. dollar payroll working for the company outside the United States on a temporary assignment and designated by the company as a U.S. expatriate.

Valid beneficiary designation

For the Group Life Insurance Plan and Emergency Responders

A claims administrator-approved form for the applicable plan that is completed either online at resources.hewitt.com/phillips66 or when the required information is given by phone to the Benefits Center.

Walk-in clinic Health care facilities, typically staffed by nurse practitioners and/or physician assistants, which also have a physician on call during all hours of operation and provide limited primary care for unscheduled, non-emergency illnesses and injuries. Walk-in clinics are not designed to be an alternative for primary care providers, but rather offer a quick alternative for common ailments such as strep throat, seasonal allergies and certain immunizations administered within the scope of the clinic’s license.

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http://resources.hewitt.com/phillips66



Weekly pay, week’s pay

If a participant is a salaried employee, the participant’s weekly pay is equal to the participant’s regular monthly base salary rate at the date of layoff, including any pay for regularly scheduled overtime but excluding overtime due to the 19/30 program, divided by 4.3333. A participant’s regular monthly base salary rate shall not include bonuses, variable pay or other special or premium pay.

If a participant is an hourly-paid employee, the participant’s weekly pay is equal to the participant’s regular base pay rate for the participant’s regularly scheduled workweek, including any pay for regularly scheduled overtime but excluding overtime due to the 19/30 program, as of the date of layoff. A participant’s regular base pay rate shall not include shift differentials, temporary or irregular overtime payments, bonuses, variable pay, or any other special or premium pay.

Further, weekly pay shall be determined without regard to reduction for base military pay received while on military leave and without regard to reductions for state-paid disability payments or workers’ compensation payments.

Work days • For nonexempt employees: Regularly scheduled working days.

• For exempt employees: Days that they are normally and regularly expected to work.

Workplace modification

For the LTD benefit

A change in the participant‘s work environment, or in the way a job is performed, to allow him to perform, while disabled, the essential duties of his job.

Workweek • For nonexempt employees: The average number of regularly scheduled hours in a period of seven consecutive days during which the employee is regularly scheduled to be at work.

• For exempt employees: The average number of regularly scheduled hours in a period of seven consecutive days during which the employee is regularly expected to work.

Years of service

For the STD benefit

The number of full years of an employee’s continuous service completed during the calendar year in which the benefits are requested, as determined by the earlier of the employee’s service award entry date (SAED) or vacation eligibility date (VED). An experienced exempt or non-exempt hire may have an earlier VED due to recognized related experience. (See the U.S. Service Recognition Policy.)

Years of service


The full years of recognized continuous service, from the participant’s Service Award Entry Date (SAED), or from the participant’s Severance Service Date (SSD) if applicable, to the date of layoff, with the SAED, SSD and the years of recognized continuous service determined under the Service Recognition Policy of the company. However, after the participant has reached his first anniversary date, the participant’s service will be recognized up to the anniversary date (if such date is after the participant’s date of layoff) in the calendar year in which the participant is laid off.

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EMPLOYEE MEDICAL Summary of Material Modifications

This is a summary of material modifications (“SMM”) to the medical benefit provided under

the Phillips 66 Medical and Dental Assistance Plan (“Plan”). This SMM, the “Medical”

chapter and “Other Information” chapter of the Phillips 66 Health and Well-Being Handbook

(“Handbook”) together serve as the summary plan description (“SPD”) for employee medical

benefits provided under the Plan. The SMM, when combined with the “Medical” chapter and

“Other Information” chapter of the Handbook, summarizes the Plan’s employee medical benefit,

including amendments through January 1, 2019, and advises you of a change to your SPD.

Please read this SMM in conjunction with the Handbook.

UPoint (formerly Your Benefit Resources or YBR) Web Address Change

• Your Benefit Resources (YBR) website has changed to UPoint and all information related to benefit elections can be viewed at https://digital.alight.com/phillips66

Blue Cross Blue Shield of Texas (“BCBS”) and Aetna Coverage Change

• BCBS is the medical carrier for all employees whose home address on record with the Company is within the State of Texas

– Employees whose home address on record with the Company is within the State of Texas and who were previously covered by Aetna, transition from Aetna to BCBS effective January 1, 2019

Kaiser HMO Coverage Option — Washington

• Kaiser HMO is a medical coverage option for all employees whose home address on record with the Company is within a Kaiser service area in the State of Washington

Infertility Benefit Change — HDHP option and PPO option

• Infertility benefits increase to:

– $20,000 lifetime maximum for medical coverage

– $10,000 lifetime maximum for prescription drug coverage

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Occupational Therapy, Physical Therapy, Speech Therapy Change — HDHP option and PPO option

• Occupational therapy, physical therapy and speech therapy are subject to a combined annual maximum of 120 visits

• Speech therapy for birth defects and autism are not subject to the above visit limitation

Prescription Drug Benefit Change — HDHP option and PPO option

• Mail order is required after:

– 2 retail fills of non-specialty maintenance prescriptions

– 1 retail fill of a specialty prescription

• As an alternative to the above, a 90-day supply can be obtained at a CVS Pharmacy through its Maintenance Choice program

Prescription Drug Benefit Change — HDHP option

• Brand preventive prescription drugs:

– Participant pays 20% ($150 maximum at retail; $300 maximum by mail order)

– No deductible

Prescription Drug Benefit Change — PPO option

• Preferred Brand prescription drugs:

– Participant pays 35% ($150 maximum at retail; $300 maximum at mail)

– No deductible

• Non-preferred Brand prescription drugs:


– No deductible

Employee Portion of Monthly Premium Change

Medical benefit Employee only

Employee + spouse/domestic

partnerEmployee + child(ren)

Employee + family

HDHP option $ 60.00 $ 128.00 $ 128.00 $ 177.00

PPO option $ 144.00 $ 314.00 $ 314.00 $ 434.00

Kaiser (CA only) $ 133.76 $ 282.19 $ 282.19 $ 390.70

Kaiser (WA only) $ 138.42 $ 292.12 $ 292.12 $ 404.79


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COBRA Monthly Medical Premium Change

Medical benefit Employee only



Employee + family

HDHP option $ 443.65 $ 962.73 $ 962.73 $ 1,330.96

PPO option $ 738.87 $ 1,603.35 $ 1,603.35 $ 2,216.62

Kaiser (CA only) $ 683.16 $ 1,441.45 $ 1,441.45 $ 1,994.81

Kaiser (WA only) $ 707.29 $ 1,492.38 $ 1,492.38 $ 2,065.29

Well-Being Program Change

• By completing and submitting the following activities by November 30, 2019, an employee can receive payroll credits of up to a total of $650 in 2019:

– Grand Rounds registration, for which $50 will be received

º Employees enrolled in Grand Rounds prior to January 1, 2019 receive the payroll credit as soon as administratively possible after January 1, 2019

– Submit biometric screening results before November 30, 2019, for which $100 will be received

– Obtain a BMI of less than 30 or consult with a primary care physician, for which $250 will be received

– Complete up to two preventive screenings, for which $50 each will be received

– Complete one company-wide challenge, for which $100 will be received

– Complete one Whil digital training program through Virgin Pulse, for which $50 will be received

• Alight Solutions replaces Wage Works as the Fitness Reimbursement administrator

– To be eligible for Fitness Reimbursement, employees must complete the following well-being program activities:

º Grand Rounds registration, and

º Submit biometric screening results, and

º Obtain a BMI of less than 30 or consult with a primary care physician

– Requests for Fitness Reimbursement must be completed and submitted by November 30 of the applicable calendar year

Receipt of this information does not guarantee eligibility. Please refer to the summary plan description (SPD) and any summaries of material modifications (SMMs) for details, including information regarding eligibility, benefits provided under the plan, when coverage begins and ends, claims procedures and your legal rights. Phillips 66 reserves the right to amend, change or terminate the plan, any underlying contract or any other program, at any time without notice, at its sole discretion, according to the terms of the plan.

P H I L L I P S 6 6 | D E N T A L B - 1

DENTAL Summary of Material Modifications

This is a summary of material modifications (“SMM”) to the dental benefit provided under the

Phillips 66 Medical and Dental Assistance Plan (“Plan”). This SMM, the “Dental” chapter and

“Other Information” chapter of the Phillips 66 Health and Well-Being Handbook (“Handbook”)

together serve as the summary plan description (“SPD”) for dental benefits provided under the

Plan. The SMM, when combined with the “Dental” chapter and “Other Information” chapter of

the Handbook, summarizes the Plan’s dental benefit, including amendments through January 1,

2019, and advises you of a change to your SPD.




Employee Portion of Monthly Dental Premium Change

Dental benefit Employee only



Employee + family

Dental option $7.00 $14.00 $16.00 $23.00

COBRA Monthly Dental Premium Change

Dental benefit Employee only



Employee + family

Dental option $37.54 $75.07 $82.58 $120.11

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P H I L L I P S 6 6 | V I S I O N B - 1

VISION Summary of Material Modifications

This is a summary of material modifications (“SMM”) to the vision benefit provided under the

Phillips 66 Medical and Dental Assistance Plan (“Plan”). This SMM, the “Vision” chapter and

“Other Information” chapter of the Phillips 66 Health and Well-Being Handbook (“Handbook”)

together serve as the summary plan description (“SPD”) for vision benefits provided under the

Plan. The SMM, when combined with the “Vision” chapter and “Other Information” chapter of

the Handbook, summarizes the Plan’s vision benefit, including amendments through January 1,

2019, and advises you of a change to your SPD.




Employee Portion of Monthly Vision Premium — Comprehensive Option Change

Vision benefit Employee only



Employee + family

Comprehensive option

$9.85 $17.90 $17.83 $28.50

COBRA Monthly Vision Premium — Basic Option Change




Employee + family

Basic option $0.82 $1.47 $1.46 $2.33

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VISION Summary of Material Modifications

P H I L L I P S 6 6 | V I S I O N B - 2 2

COBRA Monthly Vision Premium — Comprehensive Option Change




Employee + family

Comprehensive option

$10.05 $18.26 $18.19 $29.07


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FLEXIBLE SPENDING PLANSummary of Material Modifications

This is a summary of material modifications (“SMM”) to the Phillips 66 Flexible Spending Plan

(“Plan”). This SMM, the “Flexible Spending Plan” chapter and “Other Information” chapter of the

Phillips 66 Health and Well-Being Handbook (“Handbook”) together serve as the summary plan

description (“SPD”) for the Plan. The SMM, when combined with the “Flexible Spending Plan”

chapter and “Other Information” chapter of the Handbook, summarizes the Plan’s benefits,





Flexible Spending Account (“FSA”) Expense Reimbursement Change

• Beginning with calendar year 2018 FSA expenses, all requests for reimbursement of FSA expenses incurred during the calendar year must be submitted for reimbursement by March 31 of the following calendar year

Administrator Change

• Alight Solutions replaces Wage Works as the Health Care FSA and Dependent Care FSA administrator

Health Care FSA Contribution Limit Change

• Participants may contribute up to $2,650 annually to their Health Care FSA, with a minimum annual contribution of $120

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FLEXIBLE SPENDING PLAN Summary of Material Modifications

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Health Savings Account (HSA) Change

• A participant can contribute an annual maximum of the following amounts to the HSA under the HDHP option with HSA:

– $3,000 for Employee only coverage

– $6,250 for Employee + spouse/domestic partner coverage

– $6,250 for Employee + child(ren) coverage

– $6,000 for Employee + family

• Participants age 55 or over can contribute an additional $1,000 annually to their HSA

• Company contributions to the Phillips 66-affiliated HSA:

– $500 for Employee only coverage

– $750 for Employee + spouse/domestic partner coverage

– $750 for Employee + child(ren) coverage

– $1,000 for Employee + family

• Bank of America replaces HSA Bank as the administrator for the Phillips 66-affiliated HSA:

– For participants who elected during annual enrollment to transfer their Phillips 66-affiliated HSA from HSA Bank to Bank of America, the transfer is scheduled to occur in January 2019

– For participants who did not elect during annual enrollment to transfer their Phillips 66-affiliated HSA from HSA Bank to Bank of America, their HSA with HSA Bank may be subject to a monthly administrative fee(s)

– All HSA payroll contributions, including the company contribution, on or after Jan. 1, 2019 will be deposited at Bank of America


P H I L L I P S 6 6 | L O N G - T E R M D I S A B I L I T Y B - 1

LONG-TERM DISABILITY Summary of Material Modifications

This is a summary of material modifications (“SMM”) to the long-term disability (“LTD”) benefit

provided under the Phillips 66 Disability Plan (“Plan”). This SMM, the “Long-Term Disability”

chapter and “Other Information” chapter of the Phillips 66 Health and Well-Being Handbook

(“Handbook”) together serve as the summary plan description (“SPD”) for LTD benefits

provided under the Plan. The SMM, when combined with the “Long-Term Disability” chapter

and “Other Information” chapter of the Handbook, summarizes the Plan’s LTD benefit,





Employee Premium Change

• The employee portion of monthly LTD premiums are:

– Basic LTD coverage: $0.662 per $100 of pre-disability earnings

– Enhanced LTD coverage: $0.860 per $100 of pre-disability earnings

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RETIREE MEDICAL Summary of Material Modifications

This is a summary of material modifications (“SMM”) to the retiree medical benefit provided

under the Phillips 66 Medical and Dental Assistance Plan (“Plan”). This SMM, the “Retiree

Medical” chapter and “Other Information” chapter of the Phillips 66 Health and Well-Being

Handbook (“Handbook”) together serve as the summary plan description (“SPD”) for retiree

medical benefits provided under the Plan. The SMM, when combined with the “Retiree

Medical” chapter and “Other Information” chapter of the Handbook, summarizes the Plan’s

retiree medical benefit, including amendments through January 1, 2019, and advises you of

a change to your SPD.




Blue Cross Blue Shield of Texas (“BCBS”) and Aetna Coverage Change

• BCBS is the medical carrier for all retirees whose home address on record with the Company is within the State of Texas

– Retirees whose home address on record with the Company is within the State of Texas and who were previously covered by Aetna, transition from Aetna to BCBS effective January 1, 2019

Kaiser HMO Coverage Option — Washington

• Kaiser HMO is a medical coverage option for all retirees whose home address on record with the Company is within a Kaiser service area in the State of Washington

Infertility Benefit Change — HDHP option and PPO option

• Infertility benefits increase to:

– $20,000 lifetime maximum for medical coverage

– $10,000 lifetime maximum for prescription drug coverage

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Occupational Therapy, Physical Therapy, Speech Therapy Change — HDHP option and PPO option

• Occupational therapy, physical therapy and speech therapy are subject to a combined annual maximum of 120 visits

• Speech therapy for birth defects and autism are not subject to the above visit limitation

Prescription Drug Benefit Change — HDHP option and PPO option

• Mail order is required after:

– 2 retail fills of non-specialty maintenance prescriptions

– 1 retail fill of a specialty prescription

• As an alternative to the above, a 90-day supply can be obtained at a CVS Pharmacy through its Maintenance Choice program

Prescription Drug Benefit Change — HDHP option

• Brand preventive prescription drugs:

– Participant pays 20% ($150 maximum at retail; $300 maximum by mail order)

– No deductible

Prescription Drug Benefit Change — PPO option

• Preferred Brand prescription drugs:


– No deductible

• Non-preferred Brand prescription drugs:


– No deductible


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Retiree Portion of Monthly Premium Change:

Medical benefit

You or spouse only

You + spouse/domestic partner

You + spouse/domestic partner + child(ren)

You or spouse/domestic partner + child(ren)

Child(ren) only

Non-Medicare eligible

HDHP option $ 840.00 $ 1,681.00 $ 1,933.00 $ 1,093.00 $ 252.00

PPO option $ 1,451.00 $ 2,902.00 $ 3,337.00 $ 1,886.00 $ 435.00

Kaiser HMO option (CA only)

$ 1,017.55 $ 2,147.02 $ 2,971.25 $ 2,147.02 $ 1,017.55

Kaiser HMO option (WA only)

$ 1,235.42 $ 2,606.74 $ 3,607.43 $ 2,606.74 $ 1,235.42

Medicare eligible (Under age 65)

PPO option $ 1,160.00 $ 2,321.00 $ 2,669.00 $ 1,509.00 $ 1,160.00

PPO — No Rx option

$ 464.00 $ 928.00 $ 1,067.00 $ 603.00 $ 464.00

Retiree Medical Account (“RMA”) Change

• Effective January 1, 2018, participants who terminate employment with Phillips 66 Company, or a subsidiary or affiliated company, and are eligible for retiree medical benefits under the Plan, may use their RMA credits to pay Phillips 66 COBRA dental premiums and vision premiums under the Plan

• Participants who terminate employment with Phillips 66 Company, or a subsidiary or affiliated company, and are eligible for retiree medical benefits under the Plan, may use their RMA credits to pay Medicare premiums under the Plan

• Participants who terminate employment with Phillips 66 Company, or a subsidiary or affiliated company, and are eligible for retiree medical benefits under the Plan, may use their RMA credits to pay medical premiums for coverage obtained outside of the Plan
