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Supplement to the Conocophillips Retiree Medical – Pre-Age 65 Plan

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Supplement to the Conocophillips Retiree Medical – Pre-Age 65 Plan SUPPLEMENT TO THE CONOCOPHILLIPS RETIREE MEDICAL – PRE-AGE 65 PLAN This supplement is a legally required Summary of Material Modifications (SMM) to the ConocoPhillips Retiree Medical – Pre-Age 65 Plan (“Pre-Age 65 Plan”), a component plan of the ConocoPhillips Retiree Medical and Dental Plan. When combined with the Retiree Benefits Handbook effective January 1, 2021, these documents summarize the terms of the Pre-Age 65 Plan and all amendments related to the Pre-Age 65 Plan through December 31, 2020. The current change is described below with reference to the specific page of the 2021 Retiree Benefits Handbook. Please retain this SMM with your 2021 Retiree Benefits Handbook. Page B-8, the Section titled Dependent Eligibility, in the last paragraph of the left column addressing children, is amended as to eligibility of a disabled dependent age 26 or older to read as follows: You can cover the child/stepchild/domestic partner’s child if he or she is: - Under age 263, or - A disabled dependent over age 26 who was disabled prior to age 26. 3. Your child is considered an eligible dependent up to age 26 regardless of student status, marital status, employment status and/or IRS dependent requirements. Please note, your receipt of this email does not necessarily mean you are eligible for or participating in this plan. To be eligible to participate in a particular plan, you must meet the eligibility requirements outlined for that plan. The Company reserves the right to amend or terminate a plan at any time in its sole discretion. 2021 RETIREE BENEFITS HANDBOOK Effective January 1, 2021 Welcome Welcome to the ConocoPhillips Retiree Benefits Handbook ii Contacts A-1 Retiree Medical – Pre-Age 65 B-1 Retiree Medical – Age 65 and Over C-1 Retiree Dental D-1 Retiree Life Insurance E-1 Retiree Accidental Death & Dismemberment Insurance F-1 Other Information/ERISA G-1 Glossary H-1 Appendix I — Grandfathered Retiree Medical and Dental Insurance Benefit Provisions I-1 Appendix II — Grandfathered Retiree Life Insurance Benefit Provisions J-1 Houston Onsite Medical Clinic Former Employee Plan K-1 This handbook is the Summary Plan Description (SPD) for the ConocoPhillips retiree health and welfare plans. Additionally if you are enrolled in a plan that’s insured and provides you an insurance contract and Certificate of Coverage, that insurance contract and the Certificate of Coverage will be considered a part of the SPD for that insured plan. When you enroll you will receive information about how to access the current cost for most of the plans described in this handbook. That information and any Summaries of Material Modifications that are issued should be maintained with this handbook. If you are enrolled in a plan that’s insured by an insurance contract, sections of this handbook that do not apply to you will be indicated. Some retirees are not eligible to participate in the plans described in this handbook. Receipt of this handbook does not mean you are eligible to participate in all the plans described. To be eligible to participate in a particular plan, you must meet the eligibility requirements outlined for that plan. This handbook does not describe health and welfare benefits for current employees. Every effort has been made to ensure the accuracy of this handbook. If there is any conflict between this handbook and the official plan documents, the official plan documents will control. If an insurance contract exists, it is part of the official plan document and will control. The Appendices of this handbook contains details of certain historical official plan provisions. The Company reserves the right to amend or terminate a plan at any time, in its sole discretion, according to the terms of the plan. 2021 Welcome i Welcome to the ConocoPhillips Retiree Benefits Handbook ConocoPhillips is committed to your overall health and well-being, and we’re pleased to offer a quality, competitive retiree benefits package that provides valuable health care and financial protection for you and your family. But remember, it’s your responsibility to make sure you understand your benefits and use them wisely. This easy-to-use handbook, which features important information about our retiree benefit plans, is designed to help you do just that. ii Welcome 2021 Features to Help You Staying Up to Date Within the handbook, you’ll find features to help increase The benefit information in this handbook will be your understanding of the benefit plan being described. updated from time-to-time, as necessary. When that These features include: happens, you’ll receive a notice of what’s changing • Examples — We’ve included several examples of your and when. Be sure to keep any updates with this benefits at work. As you see your benefits “in action,” handbook for easy access. you’ll get a working understanding of the mechanics of your ConocoPhillips benefit plans and how they might Additional information about your ConocoPhillips apply to you. retiree benefits is available on hr.conocophillips.com. • Icons — The following icons placed throughout the text highlights essential information for you: p Refers you to other sections in the handbook that provide additional information on the subject. c Highlights information of special importance. • Contacts — For easy reference, this chapter, located at the front of the handbook, provides you with the phone numbers, addresses, and websites for benefit plan resources when you have questions or need contact information. • Glossary — Some benefit terms used in this handbook have very specific meanings. These terms are underlined throughout this book, and you’ll find their definitions in the “Glossary” at the end of the handbook. 2021 Welcome iii Welcome 2021 Contacts A Plan Administration A-2 COBRA Administration A-3 Claims and Services A-3 Retiree Medical – Pre-Age 65 A-4 Medical and Prescription Drug A-4 Retiree Medical – Age 65 and Over A-5 Medical Benefits A-5 Retiree Dental A-5 Dental Benefits A-5 Retiree Life, AD&D and Disability Plans A-6 Life Insurance A-6 Accidental Death & Dismemberment (AD&D) Insurance A-7 Disability Benefits A-7 Houston Onsite Medical Clinic Former Employee Plan A-7 = Mobile Accessible 2021 Contacts A-1 Plan Administration For Information on: Contact/Address Phone/Operating Hours Medical Benefits Benefits Center (800) 622-5501 or (718) 354-1344 (Applies for all retirees eligible for P.O. Box 310512 7:00 a.m. to 7:00 p.m. Central time, Retiree Medical Pre-Age 65 Plan) Des Moines, IA 50331-0512 Monday – Friday • Eligibility criteria to participate Web: • Enrollment, changing coverage • Visit hr.conocophillips.com to see benefit • Changing personal information plan information (including dependent information) • Visit http://mybenefits.conocophilllips.com • Payment of premiums for personal and benefit plan information and enrollments • Qualified Medical Child Support Orders (QMCSO) Medical Benefits Web: www.UHCRetiree.com/conocophillips.com (855) 323-1665 (Applies for all retirees eligible for 8:00 a.m. to 8:00 p.m. local time, Retiree Medical Age 65 and Over Plan) Monday – Friday (calls outside of these • Eligibility criteria to participate hours will be routed for after-hours • Enrollment self-service) T T Y/ TDD 711 Fax: (888) 836-3985 Dental Benefits UnitedHealthcare Dental (800) 996-7563 (Applies for all retirees eligible for retiree Attn: M/S CA 124-0152 7:00 a.m. to 10:00 p.m. Central time, medical insurance) P.O. Box 6020 Monday – Friday Cypress, CA 90630-0020 • Eligibility criteria to participate Fax: (844) 608-0601 • Enrollment, changing coverage Web: www.myuhc.com • Changing personal information Email: [email protected] • Payment of premiums Life and Accidental Death & Benefits Center (800) 622-5501 or (718) 354-1344 Dismemberment (AD&D) Insurance P.O. Box 310512 7:00 a.m. to 7:00 p.m. Central time, • Eligibility criteria to participate Des Moines, IA 50331-0512 Monday – Friday • Enrollment, changing coverage Web: • Changing personal information • Visit hr.conocophillips.com to see benefit (including dependent information) plan information • Coverage amounts • Visit http://mybenefits.conocophilllips.com for personal and benefit plan information • Payment of premiums and enrollments A-2 Contacts 2021 COBRA Administration Contacts For Information on: Contact/Address Phone/Operating Hours Continuing your medical benefits Benefits Center (800) 622-5501 or (718) 354-1344 P.O. Box 310512 7:00 a.m. to 7:00 p.m. Central time, Des Moines, IA 50331-0512 Monday – Friday Web: Fax: (515) 343-2246 • Visit hr.conocophillips.com to see benefit plan information • Visit http://mybenefits.conocophilllips.com for personal and benefit plan information and enrollments Claims and Services The Plans described in this Summary Plan Description (SPD) have a Benefits Committee that has delegated certain responsibilities to others, which may include the administration of claims. Contact information provided below identifies others who have been delegated authority to assist you with your participation in the Plans, including the filing of claims. • See the “How to File a Claim” section in each of the health and welfare benefit plan chapters for details on filing a benefit claim. • See the information in this section for the Claims Administrators and their contact information. • See “Claims and Appeals Procedures” for information on how to appeal a denied claim and for the Appeals Administrators’ contact information. p “Claims and Appeals Procedures,” page G-20 • See “Plan Administration” for descriptions of the Benefits Committee’s rights and responsibilities and its contact information. p “Plan Administration,” page G-4 2021 Contacts A-3 Retiree Medical – Pre-Age 65 For Information on: Contact/Address Phone/Operating Hours Medical and Prescription Drug You should contact the appropriate parties identified below if you have questions about: • Network providers • Covered and non-covered expenses (includes mental health/substance use disorder) • ID cards • Claims Medical Benefits Blue Cross and Blue Shield of Texas (800) 343-4709 HDHP and HDHP Base (Blue Choice Medical Claims Administrator 7:00 a.m.
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