This notice is required by law. No action is required by you.
SUMMARY OF MATERIAL MODIFCATIONS TO THE PHILLIPS 66 EMPLOYEE BENEFITS
HANDBOOK THAT IS THE SUMMARY PLAN DESCRIPTION FOR THE HEALTH AND
WELFARE PLANS OF PHILLIPS 66 COMPANY
Effective May 1, 2012
This is a summary of material modifications (SMM) to the health and welfare plans of Phillips 66 Company. This
document, when combined with the ConocoPhillips Employee Benefits Handbook (which serves as the Summary Plan
Description or SPD) effective January 1, 2012, summarizes the official text of the component plans, including amendments
through May 1, 2012. This SMM is organized to align with the corresponding sections of the SPD.
This document will serve as an SMM to the following plans and component plans which will herein be referenced as the
Phillips 66 Plans:
• Phillips 66 Medical and Dental Assistance Plan
° Phillips 66 Employee Medical Plan (SPD Section B)
° Phillips 66 Employee Dental Plan (SPD Section C)
• Phillips 66 Flexible Spending Plan (SPD Section D)
° Flexible Spending Premium Account
° Health Care Flexible Spending Account
° Dependent Day Care Flexible Spending Account
• Phillips 66 Employee Assistance Plan (SPD Section E)
• Phillips 66 Group Life Insurance Plan
° Phillips 66 Employee Life Insurance (SPD Section F)
° Phillips 66 Accidental Death and Dismemberment Insurance (SPD Section G)
• Phillips 66 Disability Plan
° Phillips 66 Short-Term Disability Plan (SPD Section H)
° Phillips 66 Long-Term Disability Insurance Plan (SPD Section I)
• Phillips 66 Severance Pay Plan (SPD Section K)
As previously communicated, a substantially similar version of the ConocoPhillips Company health & welfare plans
(“Plans”), excluding the ConocoPhillips Long-Term Care Plan, has been established by Phillips 66 Company. Eligible
employees and participants repositioned/transferred to Phillips 66 Company as a result of the spin-off of Phillips 66 from
ConocoPhillips (“Spin-Off ”) and new hires of Phillips 66 Company will receive benefits under these Plans on and after
the effective time of the Spin-Off and effective time of the Phillips 66 Company Plans. The Phillips 66 Company Plans
will be substantially similar with respect to the benefits, rights and features of the ConocoPhillips Company health and
welfare plans, except as otherwise noted in this SMM. Your reposition/transfer related to the Spin-Off, in and of itself, is
not a “change in status” under the Plans and therefore, all elections made under the Plans will remain in place unless another
change in status event occurs.
Changes Throughout the Employee Benefits Handbook
All pages – Effective May 1, 2012, wherever the term “ConocoPhillips” appears, it should be replaced with “Phillips 66” and
wherever the term “ConocoPhillips Company” appears, it should be replaced with “Phillips 66 Company” as the context
dictates.
1
All separate sections of SPD – Employers Participating in the Plan – As of May 1, 2012, the list of the most significant
employers participating in each of the plans should be replaced with:
• Phillips 66 Company
Enrollment – For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its
subsidiaries, as a result of the Spin-Off, unless otherwise noted, employees and dependents will be enrolled in the same
options and levels of coverage in the Phillips 66 Company plans as they were in the ConocoPhillips plans on the transition
date. Changes will not be permitted at the transition unless the plan allows for a change in coverage outside of an annual
enrollment period or a qualified “change in status” occurs per the respective plan provisions.
Additionally, for eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its
subsidiaries, as a result of the Spin-Off, any qualified elections, approvals, assignments or change in coverage following
a qualified “change in status” under the ConocoPhillips Company plans in effect or in process as of the transition date
will be recognized and become effective in the Phillips 66 Company plans on the transition date or, subject to approval,
a later date as applicable; however, such later date will be the same as the effective date would have been under the
ConocoPhillips Company plans.
Long Term Care Insurance Plan – all references and provisions and sections related to the Long Term Care Insurance
Plan are deleted from the Employee Benefits Handbook.
Changes to Contacts Section
Section A – Contacts
The following table reflects changes to the information contained on pages A-2 through A-11
PLAN ADMINISTRATION
For information on:
Ø Eligibility criteria to participate in a
health and welfare plan
Ø Enrollment, changing coverage
Ø Changing personal information
(including dependent information)
Ø Conversion forms and coverage
amounts
Ø Qualified Medical Child Support
Orders (QMSCO)
Ø Accessing HR Express, your logon
ID, password or Web access code
Contact/Address
Benefits Center
7201 Hewitt Associates Center
P.O. Box 563994
Charlotte, NC 28256-3994
Phone/Operating Hours
(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
Web:
Ø Visit hr.phillips66.com to see benefit
plan information
Ø Visit Your Benefits Resources
(YBR) through HR Express (for
active employees only), or at http://
resources.hewitt.com/phillips66
for personal and benefit plan
information and enrollments
Email (via Web for employees):
Phillips 66 Global IT Service Desk
http://gis.phillips66.net/EN/
Americas:
globalservdesk/Pages/Index.aspx
(918) 977-7911 or
(855) 886-7910 (toll-free)
24 hours/day, 365 days/year
2
COBRA ADMINISTRATION
For information on:
Continuing your medical, dental,
Employee Assistance Plan and Flexible
Spending Plan’s Health Care Flexible
Spending Account
Contact/Address
Benefits Center
7201 Hewitt Associates Center
P.O. Box 563994
Charlotte, NC 28256-3994
Phone/Operating Hours
(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
Web:
Ø Visit hr.phillips66.com to see benefit
plan information
Ø Visit Your Benefits Resources (YBR)
at http://resources.hewitt.com/
phillips66 for personal and benefit
plan information and enrollments
CLAIMS AND SERVICES
Contact/Address
Phone/Operating Hours
For information on:
Medical, Prescription Drug, Eyewear, Hearing and Mental Health/Substance Abuse Benefits
You should contact the appropriate parties identified below if you have questions about:
Ø Network providers
Ø Covered and non-covered expenses
Ø ID cards
Ø Claims
Medical Benefits
Aetna, Inc.
(855) 267-4184
HDHP and Primary PPO (uses Aetna
Medical Claims Administrator
8:00 a.m. to 6:00 p.m. Central time,
Choice POS II network) and EPO (uses P.O. Box 981106
Monday - Friday
Aetna Select (Open Access) network)
El Paso, TX 79998-1106
Options
Web: hr.phillips66.com
www.aetnanavigator.com
For solid organ and bone marrow
(877) 212-8811
transplants:
24 hours/day, 365 days/year
National Medical Excellence Program®
Medical Benefits
Traditional Option
Informed Health® Line/Nurseline (to
speak with a registered nurse 24 hours/
day)
United Healthcare
Claims Administrator
P.O. Box 740800
Atlanta, GA 30374-0800
(800) 556-1555
24 hours/day, 365 days/year
(888) 832-0966
8:00 a.m. to 8:00 p.m. Central time,
Monday – Friday
Web: hr.phillips66.com
www.myuhc.com
United Resource Networks
(888) 936-7246
7:00 a.m. to 6:00 p.m. Central time,
Monday – Friday
Informed Health® Line/Nurseline (to
speak with a registered nurse 24 hours/
day)
(800) 556-1555
24 hours/day, 365 days/year
3
For information on:
Health Improvement Programs
Non-Medicare Participants in HDHP,
Primary PPO, EPO and Traditional
Options
Contact/Address
Healthways, Inc.
701 Cool Springs Blvd.
Franklin, TN 37067
Medical, Prescription Drug, Dental,
Mental Health and Substance Abuse
Benefits
Aetna Global Benefits (for U.S.
Inpatriates only)
Aetna Global Benefits
Claims Administrator
P.O. Box 981543
El Paso, TX 79998-1543
Phone/Operating Hours
(888) 324-6067
8:00 a.m. to 8:30 p.m. Central time,
Monday – Friday
8:00 a.m. to 4:30 p.m. Central time,
Saturday
Within the U.S.:
(800) 231-7729
24 hours/day, 365 days/year
Web: hr.phillips66.com
www.aetnaglobalbenefits.com
www.aetnapharmacy.com
Email: agbservice@aetna.com
Prescription Drug Benefits
HDHP, Primary PPO, EPO and
Traditional Options
Medco Health Solutions
Rx Claims Administrator
8111 Royal Ridge Parkway
Irving, TX 75063
Outside the U.S.:
(813) 775-0190 (call collect)
24 hours/day, 365 days/year
Fax:
(800) 475-8751 (toll free)
(813) 775-0625 (direct)
(877) 605-7242
24 hours/day, 365 days/year, except
Thanksgiving and Christmas
For prior authorization:
(800) 753-2851
8:00 a.m. to 9:00 p.m. Eastern time,
Monday – Friday
Web: hr.phillips66.com
www.medco.com
For provider fax instructions:
(888) 327-9791
Eyewear Discount Program
Aetna Vision Discounts
HDHP, Primary PPO and EPO Options Claims Administrator
P.O. Box 981106
El Paso, TX 79998-1106
Web: hr.phillips66.com
www.aetnanavigator.com
(800) 793-8616
7:30 a.m. to 11:00 p.m. Eastern time,
Monday – Saturday
11:00 a.m. to 8:00 p.m. Eastern time,
Sunday
Contact Lens Replacement
(800) 391-5367
8:00 a.m. to 11:00 p.m. Eastern time,
Monday – Saturday
11:00 a.m. to 8:00 p.m. Eastern time,
Sunday
LASIK
(800) 422-6600
8:00 a.m. to 8:00 p.m. Eastern time,
Monday – Friday
Eyewear Discount Program
Traditional Option
EyeMed Vision Care
Eyewear Discount Claims Administrator
4000 Luxottica Place
Mason, OH 45040
Web: hr.phillips66.com
www.eyemedvisioncare.com
4
9:00 a.m. to 5:00 p.m. Eastern time,
Saturday
(Automated telephone location finder
available 24 hours/day)
(866) 559-5252
9:00 a.m. to 8:00 p.m. Eastern time,
Monday – Friday
(Automated telephone information
available 24 hours/day)
For information on:
Hearing Discount Program
HDHP, Primary PPO and EPO
Options
Mental Health and Substance
Abuse Benefits
HDHP, Primary PPO, EPO and
Traditional Options
(See EAP section for EAP contact
information)
Contact/Address
Aetna Hearing Discounts
Claims Administrator
P.O. Box 981106
El Paso, TX 79998-1106
Phone/Operating Hours
HearPO®
(888) 432-7464
8:00 a.m. to 5:00 p.m. Central time,
Monday – Friday
Web: hr.phillips66.com
Hearing Care Solutions
(866) 344-7756
6:00 a.m. to 6:00 p.m. Mountain time,
Monday - Friday
www.aetnanavigator.com
www.hearpo.com
www.hearingcaresolutions.com
ValueOptions, Inc.
Phillips 66 Claims Administrator
P.O. Box 1347
Latham, NY 12110
Within the U.S.:
Web: www.valueoptions.com
(972) 906-2897 (call collect)
24 hours/day, 365 days/year
www.achievesolutions.net/phillips66
(for online self-help resources)
(866) 517-7617
24 hours/day, 365 days/year
Outside the U.S.:
Email: Outside the U.S., email
ValueOptions at:
p66exp@valueoptions.com
Health Maintenance Organization (HMO) Benefits
Contact the HMO
HMO Benefits
HMO Option
See “HMO Claims Administrators” for
contact numbers on page 10
Dental Benefits
Comprehensive Dental and
Preventive Dental Options
MetLife
Dental Claims Administrator
P.O. Box 981282
El Paso, TX 79998-1282
Ø Medical and prescription benefits
Ø Claims
Ø Eyewear discount benefit
Ø Network providers
Ø ID cards
Dental Benefits
Ø Network providers
Ø Covered and non-covered
expenses
Ø Claims
Ø Predeterminations
Flexible Spending Plan
Web: hr.phillips66.com
www.metlife.com/mybenefits
Aetna, Inc.
Health Care Flexible Spending
Account and Dependent Day Care P.O. Box 4000
Flexible Spending Account Benefits Richmond, KY 40476-4000
Ø Reimbursement requests (claims)
Ø Account balance
Ø Eligible expenses
Ø Enrollment changes for streamline
reimbursement option
(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
24 hours/day, 365 days/year
(888) 238-6226
8:00 a.m. to 6:00 p.m. all time zones,
Monday – Friday
Fax: (888) 238-3539
Web: www.aetna.com/fsa
5
For information on:
Disability Benefits
Short-Term Disability Plan
Ø Plan provisions
Contact/Address
Phone/Operating Hours
Phillips 66 HR Connections
P.O. Box 2400
Bartlesville, OK 74005-2400
(855) 480-6634 or (918) 977-7905
8:00 a.m. to 6:00 p.m. Central time,
Monday – Friday, except U.S. Company
holidays
Web: hr.phillips66.com
Online for active employees:
Ø Claim denial or reduction
Ø Employee Health Report
Ø Return to Work Releases
From HR Express under “Express Help,”
select “Contact Us”
Phillips 66 U.S. Benefits Manager,
Center of Excellence
Claims Administrator
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
8:00 a.m. to 5:00 p.m. Central time,
Monday – Friday
Phillips 66 Health Services clinic as noted (855) 480-6634 or (918) 977-7905
8:00 a.m. to 6:00 p.m. Central time,
on back of Employee Health Report
Monday – Friday, except U.S. Company
holidays
or
Contact your local designated Phillips 66
Health Services (medical) representative
Long-Term Disability Plan
Ø Claim filing
Ø Coverage questions
Benefits Center
7201 Hewitt Associates Center
P.O. Box 563994
Charlotte, NC 28256-3994
(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
Web:
Ø Visit hr.phillips66.com to see benefit
plan information
Ø Visit Your Benefits Resources (YBR)
through
HR Express (for active employees
only), or at http://resources.hewitt.
com/phillips66 for personal and
benefit plan information and
enrollments
Ø Questions after claim filing
MetLife
Disability Claims Administrator
P.O. Box 14590
Lexington, KY 40511-4590
6
(800) 638-2242
8:00 a.m. to 11:00 p.m. Eastern time,
Monday – Friday
For information on:
Contact/Address
Phone/Operating Hours
Life and Accidental Death & Dismemberment (AD&D) Insurance
Life Insurance Plan
Ø Claim filing (n/a to OAD)
Ø Coverage questions
Ø Beneficiary designations
Benefits Center
7201 Hewitt Associates Center
P.O. Box 563994
Charlotte, NC 28256-3994
Web:
Ø Visit hr.phillips66.com to see benefit
plan information
Ø Visit Your Benefits Resources (YBR)
through HR Express (for active
employees only), or at
http://resources.hewitt.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
Ø Questions after a claim has
been paid or denied (n/a to
OAD or Travel Assistance)
The Hartford
Phillips 66 Group Life/AD&D Claims
Administrator
P.O. Box 14299
Lexington, KY 40512-4299
(888) 563-1124
8:00 a.m. to 8:00 p.m. Eastern time,
Monday – Friday
Fax: (866) 954-2621
Web: www.thehartfordatwork.com
Ø Portability and conversion coverage
administration (n/a to OAD or
Travel Assistance)
The Hartford
Portability and Conversion Unit
P.O. Box 248108
Cleveland, OH 44124-8108
(877) 320-0484
9:00 a.m. to 5:00 p.m. Eastern time,
Monday – Friday
Fax: (440) 646-9339
Ø Occupational Accidental Death
claim filing
U.S. Benefits Manager
Claims Administrator Phillips 66
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
8:00 a.m. to 5:00 p.m. Central time,
Monday – Friday
Ø Travel assistance (part of the
Basic Life Insurance option)
- Claim filing
- Coverage questions
Europ Assistance USA, Inc.
4330 East West Highway, Suite 1000
Bethesda, MD 20814
Within the U.S. and Canada:
Web: www.europassistance-usa.com
Outside the U.S. and Canada:
(202) 828-5885 (call collect)
(800) 243-6108
24 hours/day, 365 days/year
24 hours/day, 365 days/year
Travel Assistance ID: GLD-09012
7
For information on:
Contact/Address
Phone/Operating Hours
Benefits Center
7201 Hewitt Associates Center
P.O. Box 563994
Charlotte, NC 28256-3994
Web:
Ø Visit hr.phillips66.com to see benefit
plan information
Ø Visit Your Benefits Resources
(YBR) through HR Express (for
active employees only), or at http://
resources.hewitt.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
Accidental Death &
Dismemberment (AD&D) Plan
ØClaim filing
ØCoverage questions
ØBeneficiary designations
ØQuestions after a claim has been The Hartford
Phillips 66 Group Life/AD&D Claims
paid or denied
Administrator
P.O. Box 14299
Hartford, CT 06104-2999
(888) 563-1124
8:00 a.m. to 8:00 p.m. Eastern time,
Monday – Friday
Fax: (866) 954-2621
Web: www.thehartfordatwork.com
ØConversion coverage
administration
The Hartford
Portability and Conversion Unit
P.O. Box 248108
Cleveland, OH 44124-8108
Long-Term Care Insurance – Section deleted
Employee Assistance Plan (EAP)
EAP
ValueOptions, Inc.
Phillips 66 EAP Claims Administrator
Ø Claim filing
P.O. Box 1347
Ø Coverage questions
Latham, NY 12110
(U.S. Inpatriates only: Contact
Aetna Global Benefits for EAP, see
page 4)
Web: www.valueoptions.com
ww.achievesolutions.net/
w
phillips66
(877) 320-0484
9:00 a.m. to 5:00 p.m. Eastern time,
Monday – Friday
Fax: (440) 646-9339
Within the U.S.: (866) 517-7617
24 hours/day, 365 days/year
Outside the U.S.: (972) 906-2897
(NOT a toll-free number)
24 hours/day, 365/year
(for online self-help resources)
Email: Outside the U.S., email
ValueOptions at
p66expat@valueoptions.com
or
Phillips 66 HR Connections
P.O. Box 2400
Bartlesville, OK 74005-2400
Web: hr.phillips66.com
Online for active employees:
From HR Express under “Express Help,”
select “Contact Us”
8
(855) 480-6634 or (918) 977-7905
8:00 a.m. to 6:00 p.m. Central time,
Monday – Friday, except U.S. Company
holidays
HMO CLAIMS ADMINISTRATORS
For information on:
Health Net – CA
Group #: 62651
Contact/Address
Web: www.healthnet.com
Kaiser Permanente – CA
Group #: 101702 (So. Calif.)
Group #: 666 (No. Calif )
Web: www.kaiserpermanente.org
Phone
(800) 522-0088
8:00 a.m. to 6:00 p.m. Pacific time,
Monday – Friday
(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
For the Phillips 66 Severance Pay Plan
For information on:
Ø Plan provisions
Contact/Address
Phillips 66 HR Connections
P.O. Box 2400
Bartlesville, OK 74005-2400
Phone
(855) 480-6634 or (918) 977-7905
8:00 a.m. to 6:00 p.m. Central time,
Monday – Friday, except U.S. Company
holidays
Web: hr.phillips66.com
Online for active employees:
From HR Express under “Express Help,”
select “Contact Us”
Ø Benefit Claims
Plan Administrator
Severance Pay Plan
Phillips 66 Company
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
8:00 a.m. to 5:00 p.m. Central time,
Monday - Friday
Changes to Employee Medical Plan Section
Section B – Employee Medical Plan
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as
a result of the Spin-Off, all enrollment elections and annual and lifetime accumulators for services incurred under the
ConocoPhillips medical plan prior to your transfer will be recognized (e.g., annual deductible, annual out-of-pocket
maximum, treatment visit limits such as chiropractic, etc.).
The provisions providing for an increase to the annual out-of-pocket maximum, inpatient hospitalization per admission
copay and inpatient hospitalization maximum copay, as applicable, for a participant not wearing a seat belt or motorcycle
helmet who is injured in a motor vehicle accident do not apply.
Changes to Employee Dental Plan Section
Section C – Employee Dental Plan
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as
a result of the Spin-Off, all enrollment elections and annual and lifetime accumulators for services incurred under the
ConocoPhillips dental plan prior to your transfer will be recognized (e.g., annual deductible, annual out-of-pocket
maximum, limits on benefits such as orthodontia benefit, etc.).
9
Changes to Flexible Spending Plan Section
Section D – Flexible Spending Plan
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as a
result of the Spin-Off, all enrollment elections and annual accumulators for services incurred and disbursements under
the ConocoPhillips flexible spending plan prior to your transfer will be recognized (e.g., year-to-date contributions, yearto-date disbursements, etc.). Your participation under the plan during 2012 will be treated as if it occurred under a single
plan.
Changes to Employee Assistance Plan Section
Section E – Employee Assistance Plan
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as a
result of the Spin-Off, all services incurred under the ConocoPhillips employee assistance plan prior to your transfer will
be recognized for purposes of applicable limits (e.g., number of face-to-face counseling sessions, etc.).
Changes to Employee Life Insurance Section
Section F – Employee Life Insurance
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as a
result of the Spin-Off, all annual enrollment and beneficiary elections under the ConocoPhillips employee life insurance
will be recognized and evidence of insurability will not be required. Transferred employees and dependents that have
elected to take the accelerated benefit option while under the ConocoPhillips plan will continue to make payments for the
full amount of coverage as long as they remain covered under Phillips 66 Employee Life Insurance. Participants who have
exercised the accelerated benefit option will not be able to increase their coverage level, and the amount received under the
ConocoPhillips Company option will be transferred to Phillips 66 Company.
Changes to Employee Accidental Death & Dismemberment Insurance Section
Section G – Employee Accidental Death & Dismemberment Insurance
For eligible employees, dependents and participants transferred to Phillips 66 Company, or one of its subsidiaries, as a
result of the Spin-Off, all annual enrollment and beneficiary elections under the ConocoPhillips employee accidental
death & dismemberment insurance will be recognized.
Changes to Short-Term Disability Benefits Section
Section H – Short-Term Disability Benefits
For eligible employees transferred to Phillips 66 Company, or one of its subsidiaries, as a result of the Spin-Off,
all accumulators for benefits provided under the ConocoPhillips short-term disability plan, including those used
in determining benefits, will be recognized (e.g., absence benefit accruals, years of service, pay). This includes the
requirement to return to work for at least two consecutive work- weeks without an absence to qualify for the new calendar
year STD absence benefit schedule if the participant was receiving absence benefits at the end of the 2011 calendar year.
Changes to Long-Term Disability Benefits Section
Section I – Long-Term Disability Benefits
For eligible employees transferred to Phillips 66 Company, or one of its subsidiaries, as a result of the Spin-Off, whose date
of disability is prior to their transfer, long-term disability benefits will continue to be provided under the ConocoPhillips
long-term disability plan.
10
Changes to Long-Term Care Insurance Section
Section J – Long-Term Care Insurance
Long-Term Care Insurance Plan - The ConocoPhillips Long-Term Care Insurance Plan will not be adopted by Phillips
66 Company, and therefore Section J of the SPD for the ConocoPhillips Long-Term Care Insurance Plan will be
considered deleted from the Phillips 66 Employee Benefits Handbook.
Changes to Severance Pay Plan Section
Section K – Severance Pay Plan
For eligible employees transferred to Phillips 66 Company, or one of its subsidiaries, as a result of the Spin-Off,
or subsequently hired by Phillips 66 Company with prior service with ConocoPhillips Company recognized, all
accumulators for determining benefits under the ConocoPhillips severance pay plan will be recognized (e.g., severance
service date).
For eligible employees subsequently transferred to a member of the ConocoPhillips control group as a result of the SpinOff, such transfers will not be eligible for severance under the Phillips 66 Severance Pay Plan.
Changes to Other Information/ERISA Section
Section L – Other Information/ERISA
Plan Identification Information
The Primary Employer (also the Plan Sponsor) and Identification Number are:
Phillips 66 Company
411 S. Keeler
Bartlesville, OK 74003
Employer ID#: 37-1652702
Plan Administration
This chart replaces the chart on page L-5
Plan
-
Phillips 66 Medical and Dental Assistance Plan
-
Phillips 66 Flexible Spending Plan (FSP)
-
Phillips 66 Disability Plan
(Including STD and LTD)
-
Phillips 66 Group Life Insurance Plan
(Including Accidental Death and
Dismemberment (AD&D) and Occupational
Accidental Death (OAD))
-
Phillips 66 Employee Assistance Plan
Plan Administrator
Manager, HR Shared Services (or successor)
Phillips 66 Company
Adams Building
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Phillips 66 Severance Pay Plan
Manager, Benefits (or successor)
Phillips 66 Company
Adams Building
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
11
The Agent for Service of Legal Process on page L-6 is now:
General Counsel (or successor)
Phillips 66 Company
600 N. Dairy Ashford, MC-3023
Houston, TX 77079
HIPAA Privacy Rules – the list of employees by title on pages L-30 and L-31 under Adequate Separation Between the
Plan and the Plan Sponsor Must be Maintained is replaced with following:
In accordance with HIPAA, only the following employees or classes of employees may be given access to PHI:
For the medical and dental coverage and the Flexible Spending Plan HCFSA (FSP-HCFSA):
- Vice President, Human Resources;
- Manager, Benefits;
- Health & Welfare Staff designated by the Manager, Benefits;
- Manager, Benefits, HR Shared Services;
- HR Shared Services Staff designated by the Manager, Benefits, HR Shared Services;
- Manager, Compensation;
- Manager, Compensation administrative assistant;
- Manager, HR Shared Services
- Manager, HR Shared Services administrative assistant;
- Mail & Document Services Staff of Corporate Information Services;
- Documents & Records Management Staff of Corporate Information Services;
- Manager, Health Services;
- Manager, Health Services administrative assistant;
- Employee Benefits Counsel; and
- Employee Benefits Counsel legal and administrative assistant(s).
For the Employee Assistance Plan:
- Plan Administrator;
- Manager, Health Services;
- Staff designated by Plan Administrator;
- Employee Benefits Counsel; and
- Employee Benefits Counsel legal and administrative assistant(s).
The section containing Unum’s Notice of Privacy Practices on pages L-32 through L-35 relates to the Long-Term Care
Insurance Plan and is thus deleted.
Claims Administrators and Appeals Administrators
The following table replaces the table on pages L-37 through L-39
12
Type of Benefit
Appeals Administrator – First Level
Medical, Prescription Drug and Mental Health/Substance Abuse Benefits
Eligibility to Participate In the Plan (All N/A (only one level of appeal is provided,
Options)
and it’s with the Appeals Administrator
shown at right)
Eligibility for a disabled child to
The First Level Appeals Administrator for
Participate in the Plan (excludes HMO
your coverage option is shown below
options)
HDHP, Primary PPO and EPO Medical Medical Claims Administrator
Options
Aetna, Inc.
National Account CRT
P.O. Box 14463
Lexington, KY 40512
(855) 267-4184
Traditional Medical Option
Medical Claims Administrator
United Healthcare Appeals
P.O. Box 30432
Salt Lake City, UT 84130-0432
(888) 832-0966
Health Improvement Programs (Disease Healthways, Inc.
Phillips 66 Appeals
Management, Coaching, Well-Being
Assessment, Biometric Screenings)
701 Cool Springs Blvd.
Franklin, TN 37067
Non-Medicare Participants in HDHP,
(888) 324-6067
Primary PPO, EPO and Traditional
Options
Outpatient Prescription Drug
Rx Claims Administrator
Medco Health Solutions
HDHP, Primary PPO, EPO and
8111 Royal Ridge Parkway
Traditional Options
Irving, TX 75063
(877) 605-7242
Mental Health and Substance Abuse
Phillips 66 Appeals
c/o ValueOptions
P.O. Box 1347
Latham, NY 12110
(866) 517-7617
Dental Benefits
Eligibility to Participate in the Plan
N/A (only one level of appeal is provided,
and it’s with the Appeals Administrator
shown at right)
Eligibility for a disabled child to
MetLife, at the address shown below
participate in the Plan
Preventive Dental or Comprehensive
MetLife
Dental options
Dental Claims
P.O. Box 981282
El Paso, TX 79998-1282
(855) 837-6381
Flexible Spending Plan
Eligibility to Participate in the Plan
N/A (only one level of appeal is provided,
and it’s with the Appeals Administrator
shown at right)
Health Care Flexible Spending Account Aetna, Inc.
or Dependent Day Care Flexible
P.O. Box 4000
Spending Account Claims for Benefits
Richmond, KY 40476-4000
(888) 238-6226
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Appeals Administrator – Second Level
Phillips 66 Plan Administrator
Manager, HR Shared Services (HRSS)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Phillips 66 Plan Administrator
Manager, HR Shared Services (HRSS)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Phillips 66 Plan Administrator
Manager, HR Shared Services (HRSS)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Type of Benefit
Employee Assistance Plan
EAP
Eligibility to Participate in the Plan (all
participants)
Disability Benefits
Short-Term Disability (STD)
Long-Term Disability
Appeals Administrator – First Level
Appeals Administrator – Second Level
ValueOptions, Inc.
Phillips 66 Claims
P.O. Box 1347
Latham, NY 12110
(866) 517-7617
N/A (only one level of appeal is provided,
and it’s with the Appeals Administrator
shown at right)
Phillips 66 Plan Administrator
Manager, HR Shared Services (HRSS)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
N/A (only one level of appeal is provided, Phillips 66 Plan Administrator
and it’s with the Appeals Administrator
Manager, HR Shared Services (HRSS)
shown at right)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
N/A (only one level of appeal is provided, MetLife Disability
and it’s with the Appeals Administrator
P.O. Box 14592
shown at right)
Lexington, KY 40511-4592
(800) 243-8786
Life and Accident Insurance Benefits
Life Insurance [including Basic Life,
Supplemental Life, Dependent Life and
Occupational Accidental Death (store
employees only)]
N/A (only one level of appeal is provided, The Hartford
and it’s with the Appeals Administrator
Phillips 66 Group Life/AD&D Claims
shown at right)
Unit
P.O. Box 2999
Hartford, CT 06104-2999
(888) 563-1124
Accidental Death and Dismemberment
N/A (only one level of appeal is provided, The Hartford
Insurance (excluding Travel Assistance)
and it’s with the Appeals Administrator
Group Life/AD&D Claims Unit
shown at right)
P.O. Box 2999
Hartford, CT 06104-2999
(888) 563-1124
Accidental Death and Dismemberment
N/A (only one level of appeal is provided, Phillips 66 Plan Administrator
Insurance – Travel Assistance Only
and it’s with the Appeals Administrator
Manager, HR Shared Services (HRSS)
shown at right)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Occupational Accidental Death Coverage N/A
Phillips 66 Plan Administrator
(non-store employees only)
Manager, HR Shared Services (HRSS)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
Long-Term Care Benefits – Section Deleted
Severance Pay Plan Benefits
Severance Pay Plan
N/A (only one level of appeal is provided, Phillips 66 Severance Pay Plan
and it’s with the Appeals Administrator
Committee
shown at right)
411 S. Keeler Avenue
Bartlesville, OK 74003-6670
(918) 977-6009
ERISA Plan Information
The following table reflects changes to the information contained on pages L-52 through L-55
14
Phillips 66 Medical and Dental Assistance Plan
(Commonly referred to as the Employee Medical Plan and the Employee Dental Plan)
Plan Number
501
Plan Medical Director
General Manager and Chief Medical Officer for Phillips 66 Health Services
Group Numbers
Aetna Medical: 838938
UHC Medical: 743571
Medco Health Solutions, Inc.: PHIL66RX
MetLife Comprehensive Dental: 308880
MetLife Preventive Dental: 308881
Phillips 66 Group Life Insurance Plan (Includes Accidental Death and Dismemberment Insurance)
(These components are commonly referred to as the Life and AD&D Plans)
Plan Number
502
Group Numbers
Life Insurance (The Hartford): 402337
Accidental Death and Dismemberment Insurance (The Hartford): S07584
Phillips 66 Disability Plan (Includes Phillips 66 Short-Term Disability Plan and Phillips 66 Long-Term Disability Plan)
(These component are commonly referred to as the STD Plan and the LTD Plan)
Plan Number
503
Group Number
LTD (MetLife): 148870
Phillips 66 Flexible Spending Plan
(Commonly referred to as the Flexible Spending Plan or FSP)
Plan Number
504
Group Number
FSA Plan: 838939
Limited FSA Plan: 838940
ConocoPhillips Long-Term Care Insurance Plan – section deleted
Phillips 66 Employee Assistance Plan
(Commonly referred to as the Employee Assistance Plan or EAP)
Plan Number
506
Plan Medical Director
General Manager and Chief Medical Officer for Phillips 66 Health Services
Phillips 66 Severance Pay Plan
(Commonly referred to as the Severance Pay Plan)
Plan Number
507
Changes to Glossary Section
Section M – Glossary
No changes.
Changes to Appendix Section
Section N – Appendix
This section is deleted and does not apply to Phillips 66 Company.
This brief description of changes to these plans of Phillips 66 Company is meant to provide general information, but your entitlement to any benefits is governed
by the actual terms and conditions of the Phillips 66 Company plans described herein. Eligibility, benefits, vesting, claims, participant rights, plan administration,
and other provisions are described in Summary Plan Descriptions and other materials furnished to you. The official records will govern if there is conflict between
information shown and the official plan records and documents. The sponsor of these plans reserves the right to amend or terminate a plan at any time, at its sole
discretion, according to the terms of the plan. This document is not intended to modify our “at-will” employment arrangement. Employees have no acquired rights in
the company’s plans and programs, other than as set forth in the official documents.
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