Citigroup Inc.
750 Washington Boulevard, 8th Floor
Stamford, CT 06901

52-1568099

Citigroup Inc. and any of its U.S. subsidiaries in which at least an 80% interest is owned

Plans Administration Committee of Citigroup Inc.
c/o Claims and Appeals Management Team
PO Box 1407
Lincolnshire, IL 60069-1407

Fax: 1 (847) 554-1653

Call 1 (800) 881-3938 (ConnectOne). See the For More Information section for detailed instructions, including TDD assistance.

From outside the United States, Puerto Rico and Canada:

Call 1 (469) 220-9600. See the For More Information section for detailed instructions, including TDD assistance.

The Plans are administered by the Plans Administration Committee of Citigroup Inc. through agreements entered into with the Claims Administrators. However, final decisions on the payment of claims rest with the Claims Administrators.

General Counsel
Citigroup Inc.
388 Greenwich St., 15th floor
New York, NY 10013

January 1-December 31

(self-funded In-Network Only Plan, Choice Plan and High Deductible Plan with HSA), including prescription drugs and medical clinics

Citigroup Health Benefit Plan

Plan number 508

(fully insured MetLife PDP and Cigna DHMO)

Citigroup Dental Benefit Plan

Plan number 505

(fully insured Aetna Vision)

Citigroup Vision Benefit Plan

Plan number 533

Citigroup Flexible Benefits Plan

Plan number 512

Citigroup Be Well Program

Plan number 521

Not applicable (DCSA is not subject to ERISA)

Not applicable (TRIP is not subject to ERISA)

Citigroup Supplemental Medical Plans

Plan number 802777

Citigroup Life Insurance Benefits Plan

Plan number 506

Citigroup Business Travel Accident/Medical Plan

Plan number 510

Citigroup Disability Plan

Plan number 530

Call the Citi Benefits Center at ConnectOne at 1 (800) 881-3938. See the For More Information section for detailed instructions, including TDD and international assistance.

Plan number 508

Citigroup Legal Benefits Plan

Plan number 515

The Medical Plan and Dental Plan are funded through insurance contracts, the general assets of Citigroup, or a trust qualified under Section 501(c)(9) of the Code on behalf of the Plans. The cost of medical and dental coverage is shared by Citigroup and the participant.

The following Plans are self-insured, and thus are not subject to state laws:

The following Plans are fully insured and are subject to state laws:

The cost of the Vision Plan, medical spending accounts and Supplemental Medical Plans is provided by employee contributions. Citigroup pays for the Be Well Program. The Vision Plan is funded through an insurance contract. The medical spending accounts and the Be Well Program are funded from the general assets of Citigroup. The Supplemental Medical plans are fully insured and funded through an insurance contract.

Basic Life, Basic AD&D, GUL, Supplemental AD&D and Business Travel Accident/Medical insurance are fully insured. Benefits are provided under insurance contracts between Citigroup and the Claims Administrator. Portions of the Basic Life insurance may be funded under a trust qualified under Section 501(c)(9) of the Code. The Claims Administrator, not Citigroup, is responsible for paying claims. Basic Life, Basic AD&D and Business Travel Accident coverage is provided through employer contributions; GUL and Supplemental AD&D are provided through employee contributions.

STD benefits are paid from the general assets of the Company. STD coverage is provided by Citigroup; no employee contributions are required.

A portion of the LTD benefits are fully insured, and a portion of the benefits are paid from the general assets of the Company. The Claims Administrator, not Citigroup, is responsible for paying claims. LTD coverage is provided through both employer and employee contributions.

Legal Plan benefits are fully insured. The cost of MetLife Legal Plans coverage is provided by employee contributions.

Any refund, rebate, dividend adjustment or other similar payment under any insurance contract entered into between Citigroup and any insurance provider shall be allocated, consistent with the fiduciary obligations imposed by ERISA, to reimburse Citigroup for premiums it has paid or to reduce Plan expenses.