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Human Energy. Yours . TM Chevron Open Enrollment Your Action is Required October 20 Through October 31, 2014 Your Health.

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Page 1: Chevron Open Enrollmenthr2.chevron.com/usbenefits/docs/102014PABN_OEUSPayExp_FINAL.pdf · Chevron Open Enrollment ... Open Enrollment Checklist Open enrollment this ... you can make

Human Energy. Yours.TM

Chevron Open EnrollmentYour Action is Required October 20 Through October 31, 2014

Your Health.

Page 2: Chevron Open Enrollmenthr2.chevron.com/usbenefits/docs/102014PABN_OEUSPayExp_FINAL.pdf · Chevron Open Enrollment ... Open Enrollment Checklist Open enrollment this ... you can make

2 | Open Enrollment October 2014

What’s Inside:

This newsletter tells you how to enroll, how to certify your tobacco use status, outlines upcoming changes for 2015, and provides other important information about your benefits. The plan changes described in this newsletter and any changes you make to your coverage during open enrollment become effective January 1, 2015. This newsletter applies to U.S.-payroll expatriate employees on a residential assignment who are eligible for Chevron’s health and welfare benefits.

Page 3 Open Enrollment Checklist

Page 4 Do I Need to Do Anything?

Page 6 How to Enroll

Page 7 More Enrollment Resources

Page 8 How to Certify Your Tobacco Use Status

Page 10 Check Your Dependent’s Information

Page 11 Health Rewards Deadline

Page 12 2015 Medical Costs

Page 13 2015 Plan Changes

Page 19 Good to Know

Page 27 Legally Required Notices

Page 29 Global Choice Contact Information

This newsletter serves as an official summary of material modification (SMM) for the plans referenced herein. Please keep this information with your other plan documents for future reference. This communication provides only certain highlights about changes of benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. There are no vested rights with respect to Chevron health care plans or any company contributions towards the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-represented employees.

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3 | U.S.-Payroll Expatriates

Make sure you have your Benefits Connection PIN if you plan to take action from outside the Chevron network. (See Page 6.)

Understand the tobacco use certification process and requirements. Remember, all employees are required to certify. You must certify between October 20 and October 31, 2014. (See Page 8.)

Check your dependent’s information. Chevron needs your spouse, domestic partner and children’s Social Security Number if enrolled in a Chevron health plan. Learn why on Page 10.

Understand what is changing with your benefits and what you need to do. There are some changes for 2015 that may affect you. It’s important to read this newsletter and review the resources posted at hr2.chevron.com to understand what’s changing and if you need to take action. See Page 13 to learn about plan changes.

Decide if you want (or need) to make other changes. Your 2015 benefit choices and monthly cost for coverage will be available online beginning October 13. Remember, you can’t make changes until October 20, but you can preview the 2015 costs and your available options. The If You Don’t Make Changes section will show what your 2015 coverage will be if you do not take action during open enrollment. On October 13, go to hr2.chevron.com and click the Open Enrollment Preview link to get started.

- If you decide that you don’t want (or need) to make changes, you only need to certify your tobacco use status and don’t need to do anything else to change your plans. But remember to look at the situations on Page 4 and make sure they don’t apply to you.

- If you decide that you do want to make changes, including updating your tobacco use status, you must take action between October 20 and October 31.

Verify your elections. Print your confirmation statement and review your elections and tobacco status certification for accuracy. You’ll also receive a confirmation of your elections in the mail after October 31. If any information is incorrect, call the HR Service Center within 10 days. Keep the statement for your records.

Open Enrollment Checklist

Open enrollment this year is very different; don’t ignore it. All employees (including U.S.-payroll expatriates on a residential assignment) are required to certify your tobacco use status during open enrollment, whether or not you use tobacco. This means you must take action between October 20 and October 31, even if you don’t typically make enrollment choices.

During open enrollment, you can decide to keep the coverage you currently have or make changes, such as adding a dependent to your coverage or enrolling in a flexible spending account plan. If you miss the open enrollment deadline, you generally can’t make any changes until the next enrollment period in the fall of 2015. However, you can make changes to certain benefits outside of the open enrollment period if it’s within the 31-day deadline after a qualifying life event, such as a marriage or birth.

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4 | Open Enrollment October 2014

If any of the situations below apply to you, you are required to take action starting October 20. See Page 6 for general enrollment instructions and Page 8 for more information about how to certify your tobacco use status.

Do I need to do anything?All employees are required to take action this year during open enrollment, October 20 through October 31, 2014.

“I don’t use tobacco.” All employees are required to certify your tobacco use status during open enrollment, October 20 through

October 31, 2014, whether or not you use tobacco. If you fail to certify your tobacco use status by the deadline, you’ll be charged the higher monthly rates for medical and supplemental life insurance coverage for all of 2015, whether or not you use tobacco. See Page 8 to learn more.

“I use tobacco.” All employees are required to certify your tobacco use status during open enrollment, October 20 through

October 31, 2014. If you’ve been thinking about quitting the use of tobacco, there’s still time to commit. See Page 8 to learn more.

“I’m not enrolled in Chevron’s health or life insurance benefits.” Certify your tobacco use status anyway. If you choose not to participate in Chevron health coverage next year, you’re still strongly encouraged to

certify your tobacco use during open enrollment. The tobacco surcharge won’t apply to you if you’re not enrolled. But if you do not take action to certify your tobacco use status during open enrollment, you will be automatically assigned to Tobacco User for all of 2015, whether or not you use tobacco. Your tobacco use status on record as of January 1, 2015, will be used to determine your medical and supplemental life insurance coverage rates for all of 2015 should you experience a life event and need to add coverage during the year. You will not be able to change your tobacco use status until the next open enrollment, even if you experience a life event and add coverage during the year. For this reason, you should still certify your tobacco use status to ensure that you will be charged the most accurate rates if you need to enroll in the future. (See Page 8 to learn more.)

“I’ve had a change to my dependents.” If you need to add or remove a dependent from health coverage for 2015, you must make an election

during open enrollment.

“I want to start Chevron health coverage.” If you want to start Chevron medical, dental or Vision Plus Program coverage for 2015, you must make

an election during open enrollment.

“I want to stop my Chevron health coverage.” If you want to stop Chevron medical, dental or Vision Plus Program coverage for 2015, you must make

an election during open enrollment.

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5 | U.S.-Payroll Expatriates

“I’m enrolled in a flexible spending account this year. I want to participate again in 2015.” Participation in the flexible spending accounts — Health Care Spending Account (HCSA) or Dependent Day Care Spending Account (DCSA) — is the only benefit election that does not carry over from year to year. Remember, you must re-enroll in the flexible spending accounts during open enrollment every year if you want to participate. (See Page 20.)

“I want additional vision coverage.” The voluntary Vision Plus Program provides additional vision coverage beyond the basic vision coverage

already provided. If you want to start (or stop) participating in this program, you must make an election during open enrollment. (See Page 22.)

“I want to change my Voluntary Group Accident Insurance coverage.” If you contribute to this plan on a before-tax basis and you want to increase or decrease the amount of your

coverage, you must make an election during open enrollment.

“I want to change to after-tax health contributions.” Your benefit contributions are automatically deducted from your paycheck on a before-tax basis. But you can

elect to have contributions deducted on an after-tax basis instead by calling the HR Service Center during open enrollment. Read more about before-tax and after-tax contributions at hr2.chevron.com.

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6 | Open Enrollment October 2014

How to Enroll October 20 Through October 31, 2014

HR Service Center1-888-825-5247 (inside the U.S.)610-669-8595 (outside the U.S.)

For quicker service, avoid peak call hours. Peak hours are all day Monday and 9 a.m. to 10 a.m. Pacific time (11 a.m. to noon Central time) on other weekdays.

Representatives AvailableMonday through Friday6 a.m. to 5 p.m. Pacific time8 a.m. to 7 p.m. Central time

OnlineThe website will be open for you to certify your tobacco use status and make other enrollment elections until midnight Pacific time on October 31.

• Go to hr2.chevron.com.• Choose Open Enrollment to get started.

Do You Know Your Benefits Connection PIN?If you access the enrollment website from the Chevron network, you can use the automatic sign-in feature and you don’t need a PIN. But if you plan to certify your tobacco use status or make other open enrollment elections from outside the Chevron network or by phone, you’ll need your PIN. A PIN reminder was mailed to you in September, but if you still don’t know your PIN or can’t find it, you can request a new one online or by calling the HR Service Center. It can take up to two weeks to receive your PIN in the mail, so take action right away if you need it.

Also, register for the Forgot your PIN feature if you haven’t already done so. This feature will allow you to access your account by answering security questions. From the Benefits Connection home page, chose the Personal Information tab, then Login and Site Preferences. If you don’t have this feature enabled, the only way to get a new PIN is through the mail.

By phoneCustomer Service Representatives can take your tobacco use status certification and open enrollment elections by phone until 5 p.m., Pacific time (7 p.m., Central time) on October 31.

Extended HR Service Center HoursTo assist expatriates who work in different time zones around the world, the HR Service Center will be open from 4 a.m. to 6 p.m., Pacific time on October 22 and October 29 during open enrollment.

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7 | U.S.-Payroll Expatriates

The Open Enrollment section at hr2.chevron.com is the place to go to learn more about your benefits, learn more about changes for next year, access links to other tools and resources, certify your tobacco use status and make other enrollment choices online. You can go to this website at work or at home. Here are three resources available at hr2.chevron.com that may be of special interest to you as you are thinking about your benefits for 2015.

Online Videos Watch our new series of online videos, from home or work, on hr2.chevron.com to learn more about:

• How flexible spending account plans work.

• Eight ways to be a smart health care shopper.

• The Patient Protection and Affordable Care Act, which is the law that’s known simply as Health Care Reform.

Summary of Benefits and Coverage (SBC) SBCs provide summary information about your health plans, such as benefits, copayments, deductibles, coinsurance and plan contact information. SBCs for 2015 health plans are available free of charge online at hr2.chevron.com or by calling the HR Service Center at 1-888-825-5247 (inside the U.S.) or 610-669-8595 (outside the U.S.), and selecting option 2.

Summary Plan Description (SPD)Your SPD provides specific details about your Chevron benefits, such as eligibility and covered services. You can get your SPD in two ways:

• Online. Visit hr2.chevron.com and choose the Your Benefits tab.

• By phone. To request a printed copy by mail, contact the HR Service Center at 1-888-825-5247 (inside the U.S.) or 610-669-8595 (outside the U.S.), and selecting option 2.

More Enrollment Resources

It’s not SPAM or PhishingThe HR Service Center manages the administration of your health and welfare benefits and maintains enrollment records for Chevron. For this reason, Chevron may request the HR Service Center to provide information that applies to your personal benefits enrollment situation directly to you at your Chevron email address. The emails come from the Human Resources Service Center mailbox with the email address [email protected]. These emails have been approved by Chevron’s benefits department and can be considered safe. Please note this email box is an outgoing email box, so please don’t send benefits questions to that address. If you have any question about the validity of an email you receive, you’re always encouraged to call the Human Resources Service Center or send an email to the Chevron benefits team at [email protected].

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8 | Open Enrollment October 2014

How to CertifyYou can certify your tobacco use status by calling the HR Service Center (see Page 6) or by going online to Benefits Connection, the same website you use to make open enrollment elections. If you access Benefits Connection, from the Chevron network, you can use the automatic sign-in feature and you don’t need a PIN. But if you need to certify your tobacco use status from outside the Chevron network or by phone, you’ll need your PIN. A PIN reminder was mailed to you in September, but if you still don’t know your PIN or can’t find it, you can request a new one online or by calling the HR Service Center. It can take up to two weeks to receive your PIN in the mail, so take action right away if you need it.

• Go to hr2.chevron.com and click Open Enrollment, then the Certify Tobacco Status button.

• Login to Benefits Connection. Choose the Enroll Today button, then the Make Your Elections Now button.

• From the Make Coverage Elections screen, look for Tobacco Certification and choose Change.

• After you certify your tobacco use status, your Make Coverage Elections screen will be updated according to your certification choice.

Tobacco use can affect your health. And your health is important to your quality of life, your family, your career, and the health of our business. That’s why Chevron announced an important change to medical and supplemental life insurance coverage earlier this year. Starting January 1, 2015, Chevron will establish a tobacco surcharge for medical and supplemental life insurance coverage. This means there will be different monthly rates for this coverage for tobacco and non-tobacco users.

It matters to Chevron that you’re in good health at work and at home. That’s why we offer a variety of wellness programs and resources to encourage and support better health. We hope our employees — tobacco and non-tobacco users alike — take advantage of these opportunities, whether it’s to try to stop using tobacco, participate in exercise programs, or take steps to protect your heart.

How to Certify Your Tobacco Use StatusAll employees (including U.S.-payroll expatriates on a residential assignment) are required to certify their tobacco use status during open enrollment, October 20 through October 31, 2014.

During this year’s open enrollment period, October 20 through October 31, 2014, all U.S.-payroll employees who participate in Chevron medical or supplemental life insurance coverage will be required to certify their tobacco use status. If you fail to follow the steps to certify your tobacco use status during open enrollment, you’ll be charged the higher monthly rates for medical and supplemental life insurance coverage for all of 2015, whether or not you use tobacco. You will not lose your coverage in these plans if you fail to certify, but you will pay the higher rate. If you miss the deadline, you cannot change your tobacco use status until next year’s open enrollment for 2016 benefits.

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9 | U.S.-Payroll Expatriates

Your Certification ChoicesWhen you certify your tobacco use status, you’ll be asked to choose from the status options listed below. Here’s what those choices are and what they mean.

Tobacco UserTobacco use is a personal choice. It’s not our goal to intrude on your personal life and take away that choice. That’s why if you currently use tobacco, you can continue using it. If you’re a tobacco user and don’t intend to stop using tobacco, you’ll pay $25 more each month in 2015 for medical coverage than employees who are not tobacco users. If you participate in Chevron’s Supplemental Life Insurance Plan, you’ll also pay 20 percent more each month in 2015 for that coverage. The higher rates will take effect on January 1, 2015. Your benefit plan and the level of coverage you receive will be the same as non-tobacco users, the only difference will be that you pay a higher monthly cost for your coverage.

Tobacco User, But Will Try to QuitIf you commit to try to stop using tobacco during 2015, we have support resources to help you, and you’ll pay the lower monthly rate too. Go to hr2.chevron.com for resources.

Not a Tobacco UserIf you don’t use tobacco you will not be subject to the higher medical and supplemental life insurance rates in 2015 as long as you certify your tobacco use status during open enrollment, October 20 through October 31. If you fail to meet this deadline, you’ll be charged the higher monthly rates for medical and supplemental life insurance coverage for all of 2015.

Decline to DiscloseYou can choose to decline to disclose your tobacco use status, but you’ll be charged the higher monthly rates for medical and supplemental life insurance coverage for all of 2015, whether or not you use tobacco.

What’s considered tobacco use?You’ll be asked to indicate your tobacco use status only. You don’t have to certify the tobacco use status of your spouse or domestic partner and other dependents for 2015. Any use, regardless of frequency or location, is considered use. This includes daily, occasional or social use. It also includes if it’s used only at your home. Use of the following since July 1, 2014, will be considered tobacco use:

• Tobacco (such as cigarette, pipe, cigar).

• Smokeless tobacco (such as snuff or chewing tobacco).

E-cigarettes do not contain tobacco, so at this time e-cigarettes are not included in the tobacco use definition. However, the Federal Drug Administration is currently reviewing e-cigarettes. We continue to monitor this review and may choose to include e-cigarettes in the tobacco use definition in the future.

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10 | Open Enrollment October 2014

Verify Your Dependents Are Enrolled in Health CoverageIt’s important to confirm during open enrollment that any eligible dependents you expect to be covered under the Global Choice and Dental PPO plans are in fact enrolled. This is especially important if you’ve recently transferred to an expatriate assignment. Remember, if you miss the open enrollment deadline, you generally can’t add any dependents until the next enrollment period in the fall of 2015 (unless you experience a qualifying life event). You can confirm coverage from the Benefits Connection website. Go to the Personal Information tab, then choose Dependents.

Verify Chevron Has Your Dependents’ Social Security NumberThe Patient Protection and Affordable Care Act requires companies like Chevron to annually report Social Security numbers (SSNs) for all dependents enrolled in one of Chevron’s health plans. This requirement starts in early 2016 for coverage effective in 2015. The HR Service Center has updated their systems to ensure we have the data required to satisfy this government reporting requirement. As a result, if you have a life event in the future that triggers a benefit change, you will be required to have all of your dependents’ Social Security numbers on file with the HR Service Center. This includes life events like moving or adding a new dependent to your coverage. If Social Security numbers are missing for your dependent(s), your life event may not process correctly and you could experience a disruption in your coverage.

What do I need to do?While you’re certifying your tobacco use status or making other open enrollment elections, review your dependents listed on Benefits Connection and be sure an SSN is listed for each of your dependents. For your reference this includes all types of dependents, children, spouse and domestic partner. If an SSN is missing, please update your dependent’s record as soon as possible. It’s a good idea to do this now so you don’t have a possible disruption in your coverage during a future life event. You can update your dependent’s information either online from the Personal Information – Dependents screen at the Benefits Connection enrollment website or by phone with the HR Service Center. (See Page 6.) If your dependent does not have an SSN, please contact the HR Service Center by telephone. Certain alternatives, such as Tax Identification Number, may also be entered into our system to satisfy this request.

Your Right to PrivacyPlease note that we respect your right to privacy. Chevron will only use the information collected to comply with plan rules and these specific legal requirements. Chevron does not use or transmit any personal information collected for the purpose of health plan administration except as described in the Notice of Privacy Practices For Health Care Information available online at hr2.chevron.com.

Check your dependent’s information.

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11 | U.S.-Payroll Expatriates

Health Rewards deadline to qualify is October 31, 2014.The choices you make every day about diet, exercise and tobacco matter. Earlier this year, Chevron announced a new health reward opportunity to recognize your personal commitment to get and stay healthy this year. The deadline to qualify for the health reward is almost here.

Each time you choose a healthy lifestyle option and complete a qualifying wellness activity, you’ll earn points. Complete the health questionnaire then earn 250 points before October 31, 2014, to qualify for the health rewards. This year, rewards include a $250 Wellness Credit. You’ll also be entered in a drawing for a chance to win free medical premiums for all of 2015 for you and your eligible dependents.

It’s too late to start some of the long-term qualifying activities, but there may be others that you can still complete before October 31 to receive points.

Go to hr2.chevron.com/wellness and choose the Health Rewards link to review full program details, eligibility requirements, qualifying activities, frequently asked questions or to check your points balance.

How You’ll Receive Your Wellness CreditIf you are enrolled in the Global Choice Plan or have waived Chevron medical coverage, and you meet the requirements to qualify for health rewards, your Wellness Credit will be deposited into your general purpose Health Care Spending Account (HCSA) on January 1, 2015, as long as you’re still eligible. The Wellness Credit can be used for eligible health care expenses you incur between January 1, 2015 and December 31, 2015. Your total HCSA balance, which includes your Wellness Credit, will be available on and after January 1, 2015, on myuhc.com

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12 | Open Enrollment October 2014

Medical Coverage Costs

2015 Global Choice Plan (U.S.-Payroll Expatriate) Costs As you know, Chevron currently shares the monthly cost of coverage — the premium — for your Global Choice Plan. Chevron will continue to share the cost of 2015 coverage with you as indicated below. The company makes a maximum monthly contribution for your Chevron Global Choice coverage and you will pay the difference. Your premium cost for Global Choice coverage will decrease by 8 percent for 2015. The numbers in the chart below show both your monthly cost and the amount Chevron will contribute to your Global Choice coverage in 2015.

Coverage Tier

You Only

You + One Adult

You + Child(ren)

You + Family

Chevron’s Maximum Contribution Amount

$338/month (last year: $368)

$676/month (last year: $736)

$574/month (last year: $626)

$913 /month (last year: $993)

You Contribute

$84/month

$166/month

$141/month

$224/month

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13 | U.S.-Payroll Expatriates

2015 Plan ChangesThis section describes the changes to your health and welfare benefits that take effect on January 1, 2015.

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14 | Open Enrollment October 2014

Prescription Drug ChangesThe changes described in this section take effect on January 1, 2015

Prescription Drug Coverage – Obtained Outside the U.S. (Cigna)Cigna is the insurer for prescription drugs obtained outside the United States. There are no changes to this coverage for 2015. Contact Cigna if you have questions. (See Page 29.)

Prescription Drug Coverage – Obtained Inside the U.S. and Through Mail Order (Prescription Drug Program - Express Scripts)For additional details about the changes described on the following pages, contact Express Scripts Member Services at 1-800-987-8368, or review the documents and links available from hr2.chevron.com. Choose the Open Enrollment link to get started.

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15 | U.S.-Payroll Expatriates

Compound Medications Not Covered Without Prior AuthorizationAccording to the FDA, compounding is the practice in which a licensed pharmacist combines, mixes or alters ingredients in response to a prescription to create a medication tailored to the medical needs of an individual patient. Individual active ingredients within the compound might be FDA approved, but the FDA does not approve the quality, safety and efficacy of a compound with multiple active ingredients. Express Scripts has identified 10 commonly used bulk powder ingredients (if submitted as the primary ingredient) that have limited or no medical studies for topical use. These bulk powders are:

Prescription Drug Out-of-Pocket MaximumFor prescriptions filled in the United States. This maximum generally includes your prescription drug deductible, copayments and coinsurance.

• Gabapentin

• Fluticasone

• Ketoprofen

• Ketamine

• Diclofenac

• Meloxicam

• Haluronic Acid

• Flurbiprofen

• Mometasone

• Nabumetone

Beginning January 1, 2015, if you are using a compound medication in which the primary ingredient is one of the bulk powders listed above, the medication will no longer be covered without a Prior Authorization. Approval for a Prior Authorization will require clinically sound studies proving the efficacy of the medication. Express Scripts recommends that you contact your physician to try a commercially available, FDA-approved alternative. For a few of the powders, there are commercially available products that don’t require a compounded product. Only your medical provider and you can determine a suitable alternative since it is often difficult to determine the condition for which a compounded medication is being prescribed. If you continue to use the affected compounded medications without an approved Prior Authorization, you will pay the full retail price if you refill that prescription starting January 1. Express Scripts will continue to monitor this class of medications closely.

You Only

You + Family

� $1,800

� $3,600

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16 | Open Enrollment October 2014

Abbott (FreeStyle,

Precision)

Abstral

Alvesco

Apidra

Aranesp

Axert

Bayer (Breeze, Contour)

Beconase AQ

BenzaClin Gel Pump

Betaseron

Bravelle

Breo Ellipta

Cetraxal

Cimzia

Duexis

Edarbi/Edarbyclor

Epogen

Euflexxa

Fentora

Flovent Diskus/HFA

Follistim AQ

Fortesta

Frova

Gel-One

Hyalgan

Incivek

Jentadueto

Kadian

Kazano

Levitra

Nesina

Nipro (TRUEtest,

TRUEtrack)

Novolin

NovoLog

Nutropin/Nutropin AQ

Omnaris

Omnitrope

Pancreaze

PegIntron

Pertzye

Proventil HFA

Roche (Accu-Chek)

Saizen

Simponi

Staxyn

Stendra

Subsys

Supartz

Tanzeum

Testim

Testosterone 1% Gel

Teveten HCT

Tev-Tropin

Tradjenta

Ultresa

Veltin

Veramyst

Victoza

Vimovo

Vogelxo

Xeljanz

Xopenex HFA

Zetonna

Zioptan

Zohydro ER

Excluded Medications and Products Effective January 1, 2015

New National Preferred FormularyA formulary is a list of drugs that are covered by your plan. It includes commonly prescribed medications that have been selected based on their clinical effectiveness, safety and opportunities for savings. Effective January 1, 2015, your plan will switch to the National Preferred Formulary. While many of the same drugs will continue to be covered, there are approximately 65 drugs that will no longer be covered. See below for the list of drugs that will no longer be covered. If you continue to use any of these drugs, you will pay the full retail price when you refill that prescription starting January 1. If you are taking one of the drugs that will no longer be covered, Express Scripts will notify you starting in October. You will receive a personalized list of alternatives that are available on the formulary, so you can discuss them with your doctor and change your prescription in advance of January 1.

Is my prescription on the formulary?To determine at any time if a prescription drug is on the formulary you can:

• Call and ask a Patient Care Advocate at Express Scripts to check on the status of the medication.

• Register and login to www.express-scripts.com, click on the Manage Prescriptions tab at the top of the page, then click on Price a Medication.

• Download the Express Scripts mobile app for free, register and then check status of a medication.

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17 | U.S.-Payroll Expatriates

Breast Cancer Risk-Reducing MedicationsIn accordance with the Health Care Reform law, your plan will provide network coverage at 100 percent with no deductible for certain breast cancer risk-reducing medication such as Tamoxifen and Raloxifene. You’re eligible for

the 100 percent coverage if you meet all of the following requirements:

• You are a woman age 35 or older.

• You do not have a prior history of a diagnosis of breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS).

• You are being prescribed tamoxifen or raloxifene for the purpose of primary prevention of invasive breast cancer because you are deemed high risk.

• You are post-menopausal, if prescribed raloxifene (this does not apply to a woman prescribed tamoxifen).

Breast cancer risk-reducing medications that are covered are:

• Generic tamoxifen

• Generic raloxifene

• Brand Soltamox (tamoxifen liquid*)

* Tamoxifen liquid will be covered at 100 percent with no deductible if the prescriber provides information that the patient meets all other criteria and cannot swallow or has difficulty swallowing tamoxifen tablets

Coverage at 100 percent is not automatic. If you meet the eligibility criteria above, you or your provider must request the $0 copayment/coinsurance within 30 days of the prescription being filled (pre- or post-fill). To request the $0 copayment/coinsurance, follow these steps:

• You or your prescriber contacts Express Scripts Customer Service at 1-800-987-8368.

• Customer service will explain the procedure for contacting the Coverage Review Department through mail, fax, or a direct call transfer.

• You will submit your request through mail, fax or telephone.

• Your prescriber is contacted through a fax form to determine if you meet the eligibility criteria.

• Copayment review decision is then made.

• You and your prescriber are notified of decision.

New Prior AuthorizationsThe Prescription Drug Program covers some drugs only if they’re prescribed for certain uses or only up to certain quantity levels. For this reason, some medications must be approved in advance before you can receive plan benefits. The following drugs will require prior authorization effective January 1, 2015:

• Lovaza

• Vescepa (fish oil)

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On the Job Accident Insurance PlanOn-the-Job Accident insurance provides a level of income protection for you and your family members due to death or a covered loss resulting from an on the job accident. Currently, this coverage is automatically provided at no additional cost to eligible employees. The following additional benefits are provided under the plan for covered accidents that occur on and after July 1, 2014:

• Seatbelt/Airbag Benefit: If you die as the result of a covered accident while wearing a properly fastened, original, factory-installed seatbelt, the plan will pay $25,000 to your beneficiary. The plan will pay an additional airbag benefit of $10,000 if the seatbelt benefit is payable and you are positioned in a seat protected by a properly functioning, original, factory-installed supplemental restraint system that inflates on impact. Verification of the actual use of the seat belt and verification that the supplemental restraint system inflated properly upon impact at the time of a covered accident must be provided in accordance with the plan’s requirements.

• Coma Benefit: If you are injured as a result of a covered accident, the plan will pay a monthly benefit of one percent of your principal sum if:

- You are injured and become comatose within 31 days of the date of the covered accident; and

- The coma continues for a period of 31 consecutive days.

The plan pays monthly benefits for as long as you remain comatose due to the injury, up to 11 straight months. Benefits stop at the end of the month during which the earliest of the following occurs:

- You cease to be comatose due to that injury; or

- You die.

• Brain Damage Benefit: The plan will pay a benefit equal to 100 percent of the principal sum if as a result of a covered accident:

- Brain damage begins within 30 days of a covered accident;

- You are hospitalized for at least five days within the first 30 days following the covered accident;

- Brain damage continues for 12 consecutive months; or

- A physician determines the brain damage is permanent, complete and irreversible at the end of the 12-consecutive-month period.

Brain damage means physical damage to the brain which cause the complete inability to perform all the substantial and material functions and activities normal to everyday life.

The amount payable under this benefit will be made in one lump sum during the 12th month following the date of the accident if brain damage continues longer than 12 consecutive months.

• Home Alteration and Vehicle Modification Benefit: If you suffered an accidental dismemberment for which benefits are payable under the plan and, as a direct result, require the use of a wheelchair to be ambulatory, the plan will pay up to $25,000 for alterations to your residence and modifications to your vehicle to make them wheelchair accessible. Such expenses must be incurred incurred within one year after the date of the accident causing such loss.

• Rehabilitation Benefit: If you suffer an accidental loss for which benefits are payable under the plan, the plan will reimburse you up to $25,000 for covered rehabilitative expenses that are incurred within two years after the date of the covered accident.

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Good to Know.Benefit facts and reminders you might want to know as you make enrollment choices.

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You must re-enroll in flexible spending accounts every year; coverage is not automatic. If you want to participate in 2015, you must enroll during open enrollment, even if you’re already participating this year. If you don’t make an election during open enrollment, you will not have coverage during 2015.

The Health Care Spending Account (HCSA) and Dependent Day Care Spending Account (DCSA) are Chevron’s flexible spending account plans. These plans are voluntary options that allow you to pay for certain eligible expenses with before-tax dollars. Each month, you contribute a set amount to your account(s) through before-tax payroll deductions. Then you use the funds in your account(s) to pay for eligible expenses. More information about the HCSA and DCSA plans is available online. You can also watch our video online to learn more about these plans and how they can help you. Go to hr2.chevron.com and choose Open Enrollment to get started.

Health Care Spending Account (HCSA)You can use the HCSA to pay for your (and your eligible dependents’) out-of-pocket health care expenses — like deductibles, office copayments, prescription drug copayments, and contact lens supplies.

The contribution limit for the HCSA for 2015 will remain at $2,250. If you qualify for the Wellness Credit by completing the health questionnaire and earning 250 points before October 31, 2014, Chevron will contribute an additional $250. This will bring your total maximum Health Care Spending Account balance for 2015 to $2,500. See Page 11 for more information about the Wellness Credit deadline and eligibility requirements.

Dependent Day Care Spending Account (DCSA)You can use the DCSA to pay for eligible dependent day care expenses for a qualified dependent — like after-school child care, a licensed child care provider, or school tuition up to kindergarten — so you and your spouse can go to work. The contribution limit for the DCSA is generally $5,000 ($2,500 if married and filing a separate return), subject to other IRS limitations.

Plan Your Contributions CarefullyIf you enroll in the HCSA, DCSA or both for 2015, your account(s) will reimburse eligible expenses you incur from January 1 through December 31, 2015. If you do not use all of your account funds to pay for eligible expenses during this period, money left unspent or unclaimed in your account will be forfeited.

You have until June 30, 2016, to file a claim to be reimbursed for eligible expenses you incurred in 2015. Note that HCSA funds cannot be used for Dependent Day Care Spending Account expenses and DCSA funds cannot be used for Health Care Spending Account expenses. It’s your responsibility to meet the December 31 and June 30 deadlines; be sure to add a reminder to your calendar to help you remember.

Flexible Spending Accounts Help With Health and Day Care Expenses

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21 | U.S.-Payroll Expatriates

A Word About Wellness CreditsIf you qualify for a Wellness Credit by meeting the program requirements by the October 31, 2014, deadline, you don’t need to do anything. (See Page 11 for more details.) Your $250 Wellness Credit will automatically be applied to your HCSA account on January 1 (for use between January 1 and December 31, 2015). You are not required to enroll in the HCSA Plan during open enrollment to receive your Wellness Credit. However, if you want to contribute additional money to the HCSA, you must make an election during open enrollment. Please note you must be a current employee on January 1, 2015, to receive the Wellness Credit. Learn more about the Wellness Credit opportunity on Page 11.

How to Contact UnitedHealthcare (UHC)Contact UHC to check your HCSA or DCSA account balance, submit claims, enroll in HCSA auto reimbursement, sign up for direct deposit, download a claim form or search for eligible expenses.

· Phone: 1-800-654-0079

· Online: www.myuhc.com

Important Reminder for ExpatriatesA special-purpose debit card is provided to HCSA and DCSA participants. The debit card is tied to your account(s). Just swipe your card when you incur an eligible health or dependent day care expense, and the amount is automatically deducted from your account. Please note that the special purpose debit card can only be used for purchases inside the United States. If you incur an expense outside the U.S., you’ll need to submit a claim form (online or by paper) to request reimbursement. You can get a claim form at hr2.chevron.com or by calling UHC directly.

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Basic Vision CoverageIf you’re enrolled in the Chevron Global Choice Plan you are automatically enrolled in the Vision Program for basic vision coverage. VSP is the insurer for the Vision Program and administers your annual eye exam coverage.

As a reminder, the VSP provider network is made up of primarily private-practice vision providers across the United States. All VSP private—practice doctors provide exams and have materials, such as glasses and contacts, available in their office. If you receive covered services outside the U.S., the nonpreferred (out-of-network) level of benefits will apply. If you use a VSP preferred provider while you’re in the U.S., the preferred provider level of benefits will apply.

Chevron’s basic vision coverage includes 100 percent coverage for an annual comprehensive eye exam, including dilation as needed, from a network provider. Contact VSP to understand what’s available.

Vision Plus ProgramThe Vision Plus Program is a voluntary coverage option that provides prescription eyewear coverage for an additional payroll deduction. This is additional coverage for prescription eyewear that goes beyond your basic vision coverage. Any U.S.-payroll employee eligible for Chevron’s health plans can enroll, and you can enroll even if you waive Chevron health coverage. VSP is the insurer for the Vision Plus Program.

• If you are currently enrolled, your coverage will automatically continue in 2015.

• If you want to start (or stop) coverage, you must make an election during open enrollment.

• Go to hr2.chevron.com and click Open Enrollment to review more information about this benefit and what it covers.

An Eye on Your Chevron Vision Coverage

About VSPThe VSP Preferred Provider network is made up of primarily private-practice vision providers across the United States. You still have the option to see an out-of-network provider or a provider outside the United States for exams or to purchase materials if you desire. But note that the out-of-network benefit will apply and you’ll generally have to submit a claim to VSP for reimbursement. VSP also offers Retail Chain Affiliate Providers for added convenience and additional retail locations. These providers are network providers, so network benefits will apply. Retail Chain Affiliate Providers include Visionworks, WisconsinVision, HeartlandVision, Rx Optical and Cohen’s.

We know many employees use Costco for their prescription eyewear. Costco is an out-of-network provider, so out-of-network benefits will apply. Unlike other out-of-network providers, however, Costco can submit your claim to VSP. In addition, out-of-network coverage with Costco includes standard progressive lenses fully covered after a $40 copayment.

If you have questions about your vision coverage, contact VSP at 1-800-877-7195, or go to www.vsp.com/go/chevron.

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23 | U.S.-Payroll Expatriates

The MHSA plan, administered by ValueOptions, provides confidential support for a wide range of personal issues — from everyday challenges to more serious problems. You and your covered dependents have access to support services 24 hours a day for a variety of concerns such as:

• Depression

• Stress and anxiety

• Parenting and family problems

• Relationship difficulties or problems at work

Maintain Your Emotional Health Mental Health and Substance Abuse (MHSA) Plan

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MHSA Basics• You do not need to enroll. This benefit is automatically provided to you, as long as you’re eligible

to participate. And you’re still covered by this plan even if you are not enrolled in a medical plan offered by Chevron.

• Your eligible dependents are covered, if they are enrolled in a medical plan to which Chevron contributes, such as the Global Choice Plan.

• You do not pay a monthly cost for this coverage. Chevron currently pays the full monthly cost for this coverage. However, you do share a portion of the costs if you receive benefits under the plan.

• If you’re enrolled in the Chevron Global Choice Plan or waive Chevron medical coverage, there is no deductible to satisfy.

If you need assistance, you can talk to either ValueOptions, Chevron’s Employee Assistance and WorkLife Services, or both. Contact ValueOptions at 1-800-847-2438. Contact Chevron’s Employee Assistance WorkLife Services at 1-800-860-8205 (CTN 842-3333).

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25 | U.S.-Payroll Expatriates

Reminders About Using Your Global Choice Plan CoverageServices Outside the U.S. All medical services and prescription drugs obtained outside the United States are insured by Cigna.

• Individual providers (such as a doctor), pharmacies and outpatient hospital facilities will generally require payment at the time services are delivered. You’ll need to submit a claim directly to Cigna for reimbursement.

• There are no Cigna networks outside the United States; however Cigna does have a direct settlement agreement with many international providers (physician and hospitals). This means that if you use one of these providers, Cigna can settle your charges directly. Be sure to provide your member ID card when you visit. If Cigna does not have a direct settlement agreement in place, they can, in many cases, arrange for a Guarantee of Payment. You or the provider should contact the 24-hour member services unit at the number on your ID card to make arrangements. Regardless of the direct settlement agreement, you should always obtain a copy of the bill for services rendered and retain it for your records.

• Cigna has more than 185,000 doctors and hospitals with either direct settlement or who are a part of CignaLinks. The CignaLinks program has partnerships with select, regional networks for additional cost savings and ease of access to health care. CignaLinks can also help you understand how health care works in your host country. Contact Cigna for more information about CignaLinks.

• If you need to obtain a prescription when you are outside the United States, Cigna can help you locate a physician. Cigna can also verify if a prescription is available or help you determine the drug equivalency in other countries for your prescription medications.

• If you need to obtain a prescription when you are outside the United States, use your Cigna ID card.

• Mail-order is only available through Express Scripts and only applies to addresses within the United States because medications cannot be shipped overseas. In addition, medications cannot be shipped through Chevron pouch mail.

Cigna ClaimsClaim forms are available on the Cigna website. Claims forms are also available on hr2.chevron.com. Choose the Your Benefits tab and then select the Global Choice (U.S.-Payroll Expatriates) Plan from the page. Use the same Cigna claim form for:

• Medical services inside the U.S.

• Medical services outside the U.S.

• Prescription drugs obtained outside the U.S.

You can submit claim forms and bills by mail, email or fax, or you can submit claims online at CignaEnvoy.com. Keep a copy of your completed claim form and receipts for your records. You can track the status of your claim on CignaEnvoy.com and you can contact Cigna if you have any questions. Cigna offers several options for reimbursement including international direct deposit, checks, electronic funds and wire transfers.

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Services Inside the United States All medical services are insured by Cigna — whether inside or outside the United States. Express Scripts administers your prescription drugs for prescriptions obtained in the United States or by mail-order within the United States.

• The Global Choice Plan uses the Cigna Open Access Plus (OA Plus) network, so you can use any doctor you choose – in or out of the network – although you will generally pay less for your out-of-pocket expenses if you use a network provider. Contact Cigna to find a U.S. provider in the Cigna network.

• If you need to obtain a prescription when you are inside the United States, use your Express Scripts ID card. Your Cigna ID card is only for medical services or when you purchase a prescription outside the U.S.

• Show your Cigna member ID card to your provider for medical services. If they have questions about your coverage they should contact Cigna at the phone number listed on your ID card. Note that if you need to obtain a prescription when you are inside the U.S., use your Express Scripts ID card.

• Covered dependents staying behind in the United States will be issued a card with their own name on it and should always use their own Cigna ID card when receiving medical services.

• If you visit a network provider in the United States, you do not need to submit a claim form for reimbursement. You’ll pay out of your own pocket for your portion of the medical service, if any, when you receive it. Your provider will work directly with Cigna.

• If you visit an out-of-network medical provider in the United States, you will generally need to pay for the service when you receive it, out of your own pocket. Be sure to give your provider a Cigna claim form, then return the claim form with the required copies of receipts and bills to Cigna.

• Mail-order is only available through Express Scripts and only applies to addresses within the United States because medications cannot be shipped overseas. In addition, medications cannot be shipped through Chevron pouch mail.

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Women’s Health and Cancer Rights NoticeTo comply with the Women’s Health and Cancer Rights Act of 1998, Chevron reminds you that all medical plans the company offers cover medically necessary mastectomy and related breast reconstructive surgery, including reconstruction of the breast on which the mastectomy is performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment remedies for physical complications during all stages of the mastectomy, including lymphedema.

Free or Low-Cost Health Coverage to Children and FamiliesTo comply with the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Chevron reminds you that if you are eligible for health coverage from Chevron or another employer, but are unable to afford the monthly premiums, you may qualify for a premium assistance program that some states offer to help pay for your coverage. These states use funds from their Medicaid or Children’s Health Insurance Program (CHIP) programs to help people who are eligible for employer-sponsored health coverage but need assistance with paying their health premiums. This typically applies to households with an annual income under $44,100 for a family of four. For a list of states that participate in premium assistance, go to hr2.chevron.com.

• If you or your dependents are already enrolled in Medicaid or CHIP, and you live in a participating state, contact your state’s Medicaid or CHIP office to find out if premium assistance is available.

• If you or your dependents are not currently enrolled in Medicaid or CHIP but you think you or your dependents might be eligible for either program, contact your state’s Medicaid or CHIP office. You can also call 1-877-Kids-Now or visit www.insurekidsnow.gov to learn how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

Special Enrollment Opportunity

If it’s determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, Chevron is required to allow you and your dependents to enroll in a company-offered plan. To qualify for this special enrollment opportunity, you must be eligible for Chevron coverage but not already enrolled. In addition, you must contact the HR Service Center and request Chevron health coverage within 60 days of being determined eligible for Medicaid or CHIP premium assistance. If you enroll within the 60-day time limit, Medicaid or CHIP will subsidize, or pay for, a portion of the Chevron health plan premium cost.

Legally Required NoticesNo action required by you.

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Mental Health and Substance Abuse Plan (MHSA) is a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act Chevron Corporation believes the Chevron Corporation Mental Health and Substance Abuse Plan (the MHSA Plan) is a grandfathered health plan under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at 1-888-825-5247 (610-669-8595 outside the U.S.). You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.

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Global Choice Contact Information

Claims Administrator

Group Account Numbers

Websites

Talk to Cigna

Talk to Express Scripts

Talk to VSP

Medical ServicesCigna Global Health Benefits (Cigna) (For services obtained globally)

Prescription DrugsCigna Global Health Benefits (Cigna) (For prescriptions obtained outside the U.S.) Express Scripts (For prescriptions obtained inside the U.S. and mail order)

Vision CareVSP Vision Care (VSP) (For services obtained globally)

Cigna 05721A008 Express Scripts 1839VSP 30021085

Cigna: www.CignaEnvoy.comExpress Scripts: www.express-scripts.comVSP: www.vsp.com/go/chevron

Toll-Free Number1-800-828-5822 (U.S. and Canada)

International CallsATT Access Code* + 800-828-5822

Direct Dial Number (collect calls accepted)1-302-797-3871

* AT&T USADirect® access numbers make it convenient to call Cigna. AT&T USADirect® access is available in many countries around the world. If you happen to be on assignment in one of the few countries where it’s not available, please call Cigna collect through the international operator. For a listing of AT&T USADirect® Access numbers, go to www.att.com/esupport/traveler.jsp

Prescription drugs obtained inside the U.S. 1-800-987-8368

Toll-Free Number1-800-877-7195

International Calls1-916-851-5000 Press 0 for operator assistance

Chevron Global Choice Plan (U.S. Payroll Expatriates)Note: Cigna refers to the network as the Open Access Plus (OA Plus) network.

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USPAB102014ACTIVEUSEXPAT

Recycled/Recyclable

© 2014 Chevron Corporation. All rights reserved.

U.S. Pay and Benefits News is published by

Human Resources Communications,

P.O. Box 6041, San Ramon, CA 94583-0741

Save this newsletter for future reference.

Please note: This newsletter applies to U.S.-payroll expatriate employees on a residential assignment who are eligible for Chevron health benefits.

This newsletter serves as an official summary of material modification (SMM) for the plans referenced herein. Please keep this information with your

other plan documents for future reference. This communication provides only certain highlights about changes of benefit provisions. It is not intended

to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will

prevail to the extent permitted by law. There are no vested rights with respect to Chevron health care plans or any company contributions towards the

cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these

plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations

may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering

provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-

represented employees.