CITGO Petroleum Corporation Retiree Reimbursement …

1 CITGO Petroleum Corporation Retiree Reimbursement account plan summary plan Description Effective January 1, 2014 i TABLE OF CONTENTS INTRODUCTION 1 ELIGIBILITY 1 THE Retiree Reimbursement account 4 EMPLOYER CONTRIBUTIONS 5 USING YOUR BENEFIT DOLLARS FROM YOUR RRA 6 REQUESTING Reimbursement FROM YOUR RRA 8 CLAIM DENIALS AND APPEALS 9 ADMINISTRATIVE INFORMATION: ERISA 11 GLOSSARY 16 January 1, 2014 2 Retiree Reimbursement account plan SPD INTRODUCTION CITGO Petroleum Corporation (the Company ) is pleased to provide you with this updated summary plan Description ( summary ), effective January 1, 2014 . This summary describes the primary features of the CITGO Petroleum Retiree Reimbursement account plan ( plan ) for the exclusive benefit of certain retirees who are Medicare-eligible retirees and their eligible Spouses who are on Medicare.

2 The plan became effective January 1, 2013. This summary supersedes the previous summary plan Description, effective January 1, 2013. This summary describes the primary Retiree Reimbursement account ( RRA ) features, but it does not describe the separate coverage provided under the Medicare Supplement or Medicare Advantage insurance programs and certain Dental and Vision insurance programs provided by UnitedHealthcare AARP Medical Products or MetLife, which are provided in connection with Retiree programs, such as the plan . The UnitedHealthCare insurance products are not part of the plan , and the Company does not sponsor any of the UnitedHealthcare AARP Medicare Products or other insurance products available to you. You choose which UnitedHealthcare AARP Medicare Products in which you desire to enroll. This summary has been prepared to explain the provisions of the plan with certain terms defined in the Glossary Section.

3 A summary cannot include all details of the plan document or the administration and operation of the plan . Accordingly, if there is any conflict between this summary and the terms of the plan , the provisions of the actual plan document will control. Please read this summary thoroughly to learn how the plan works. Your RRA is administered by OptumHealth Financial Services, a division of UnitedHealthcare. If you have questions you may contact UnitedHealthcare Retiree Accounts at 877-298-2305 or 877-753-5150 for a dedicated CITGO Retiree tele-sales representative. ELIGIBILITY Retiree who is eligible You are eligible to participate in the plan if you meet all of the following requirements: You are a Retiree of the Company who at the time of retirement met the eligibility criteria for Retiree health coverage as defined by the Company s health plan covering active employees ( Retiree ).

4 You are enrolled in a UnitedHealthcare AARP Medicare Product. Your primary health coverage is Medicare by reason of age (65 or older). Retiree who is not eligible You are not eligible to participate in the plan if you meet any of the following conditions: You are an active employee of the Company or any of its affiliates. January 1, 2014 3 Retiree Reimbursement account plan SPD Your CITGO Retiree health coverage was cancelled as a result of your non-payment of your required contributions. You are retired from the Company but returned to active employment for the Company. You are a Retiree of a related company or any subsidiary or affiliate which has not adopted the plan . You are a non-resident alien. Spouses who are eligible Your eligible Spouse may also participate in the plan . Your Spouse must meet all of the following requirements: His/her employment status is retired.

5 His/her primary health coverage is Medicare by reason of age (65 or older). He/she is enrolled in a UnitedHealthcare AARP Medicare Product. He/she is not a non-resident alien. He/she is not covered by either a health plan or an arrangement similar to the plan available from his/her own employment or retirement from any other employer. Individuals who enter into any civil union, domestic partnership, same-sex marriage or similar arrangement with an eligible Retiree are not entitled to benefits under the plan as a Spouse. When you and your Spouse are both Retirees of the Company Married CITGO couples are each eligible for their own individual RRA account . Termination of coverage Coverage under the plan for you and your covered Spouse, if applicable, will terminate on the earliest of the following dates: The date of your death. The date of the death of your surviving Spouse, if your surviving Spouse was covered under the plan at the time of your death.

6 The date your surviving spouse remarries, if your surviving spouse was covered under the plan at the time of your death. The date you fail to pay health plan contributions for health plan coverage for your eligible dependents that are covered as a non-Medicare eligible Spouse or Child under the pre-65 Retiree benefit program administered by the Company. The date you fail to pay plan contributions for your life insurance benefits administered by the Company. The date you are no longer eligible to participate in the plan . January 1, 2014 4 Retiree Reimbursement account plan SPD The date the plan is terminated. THE Retiree Reimbursement account The RRA is considered a Retiree health Reimbursement arrangement or HRA under Internal Revenue Service guidance. The RRA can accumulate Benefit Dollars credited monthly by the Company while you are eligible to participate.

7 The Benefit Dollars are used to pay Eligible Premium Expenses and any remaining amounts can be used for specified Eligible HealthCare Expenses (described below). The RRA: Allows the Company to credit tax advantaged dollars for you to use for Eligible Premium Expenses associated with the purchase of a UnitedHealthcare AARP Medicare Product. Allows you to use any remaining balance of Benefit Dollars in your account for Eligible Healthcare Expenses or to save any remaining balance for future use. Allows you or your eligible surviving Spouse to access the RRA funds of the other if either of you die while a plan Participant. Allows both you and your eligible Spouse to enroll in the plan and each have an individual account with Benefit Dollars deposited for each of you. Any remaining Benefit Dollars in your RRA will be transferred to your eligible surviving spouse.

8 However, if you are single or your surviving Spouse dies or remarries, the RRA account will be forfeited. Online tool to help you manage your RRA Once you enroll, you can access your RRA online via where you can view your RRA summary , contributions, available balance, claims and obtain forms. January 1, 2014 5 Retiree Reimbursement account plan SPD EMPLOYER CONTRIBUTIONS Your RRA is neither insured nor funded; it is a recordkeeping credit in the books and records of the Company. All reimbursements are paid from the Company s general assets, and no Retiree contributions are permitted or required. This Benefit Dollar amount to be credited to each RRA is determined by the Company. For each month of eligibility of a Retiree or eligible Spouse, Benefit Dollars are credited as follows: Contribution Category Monthly Company Credit of Benefit Dollars Eligible Retiree and/or Eligible Spouse $192 per month of eligibility each *Your eligible Spouse must meet all of the eligibility requirements to participate in the plan .

9 Benefit Dollars will roll over from month-to-month and year-to-year if not used. As of January 1, 2014 , the RRA has a calendar plan Year from January 1 through December 31 of each year. Your RRA will utilize such twelve-month plan Year for purposes of incurring claims and obtaining reimbursements. The plan permits claims incurred during the plan Year to be submitted for Reimbursement during a so-called run-out period, which lasts until 90 days after the end of the plan Year (or March 31, except in Leap Years). During the run-out period, you or your covered Spouse may submit claims for RRA Reimbursement . Claims must be received by UnitedHealthcare by the last day of the run-out period. Any claims received after the end of this run-out period will not be reimbursed. During the plan Year, eligible claim submissions for a particular month are suspended when a sufficient balance does not exist.

10 Claims are reimbursed up to the amount available in the account . Any remaining portion of the Reimbursement request will be held in suspense until the next month. At the end of the plan Year, any remaining suspended claims (if applicable) will not be reimbursed. However, if the account has an unused RRA balance as of the end of the run-out period for the prior plan Year, that unused RRA balance will rollover to be used for the current plan Year. January 1, 2014 6 Retiree Reimbursement account plan SPD These claims submission rules are summarized in the following chart: EVENT DATE Beginning of plan Year January 1 End of plan Year (final day to incur expenses for the current plan Year) December 31 Final filing date during next plan Year for claims incurred in the prior plan Year 90 days after the end of the plan Year (March 31, except in Leap Years) (claims must be received by UHC on or before this date) Date when unused funds (if any) roll over and are available in the account Mid-April of the next plan Year (approximately 10 business days after the final filing date at the end of March) You can keep track of the Benefit Dollars in your RRA account by going online to or by calling UnitedHealthcare Retiree Accounts at 877-298-2305.