You can search this SPD section by section or click here to create a single searchable document.
Medicare Primary Option
Summary plan description of the Medicare Primary Option as of January 2024
About the Medicare Primary Option
The ExxonMobil Retiree Medical Plan (EMRMP) is comprised of two separate options: the Retiree Medical Plan option and the Medicare Primary Option (MPO). The information described in this document along with the 2024 Evidence of Coverage (EOC), the Summary of Benefits (SOB) and the Schedule of Cost Sharing (SOC) found on Aetna Medicare Website constitute the Summary Plan Description (SPD) for the MPO. If there is a conflict or difference between this SPD and the ExxonMobil Retiree Medical Plan document or the EOC, the ExxonMobil Retiree Medical Plan document or EOC will govern, as applicable.
There are two component parts of the MPO: 1) medical benefits are provided through the Medicare Advantage PPO with an Extended Service Area (ESA) also known as Group Medicare Part C and administered by Aetna; and 2) prescription drug benefits under the Medicare Part D program called Express Scripts Medicare® (Prescription Drug Plan or PDP).
Information sources
When you need information, you may need to contact one or more of the following sources.
Please read carefully:
For copy of the Evidence of Coverage (EOC):
Go to the Aetna Medicare website at ExxonMobil.AetnaMedicare.com. Evidence of coverage can be found under Coverage & benefits tab, in section “Plan Benefits and Star Ratings” or you can request a copy of the EOC by contacting Aetna Member Services at 1-833-595-1012 (TTY: 711).
For claims administration:
Contact Aetna for medical/surgical, behavioral health and substance use disorder claims forms, claims payment and other claims inquiries.
Contact Express Scripts for pharmacy claims forms, claims payment and other claims inquiries.
Aetna:
Refer to the EOC and SOC for those services that may require prior authorization. For claims, either download a copy of the form from ExxonMobil Aetna Medicare website (ExxonMobil.AetnaMedicare.com) or call Member Services and ask for the form. Phone numbers for Member Services are printed on your member ID card. Mail your request for payment together with any bills or receipts to the PO Box address below.
Phone numbers and website:
Aetna Medicare Services:
(1) 833-595-1012 (TTY: 711)
Monday Friday 7 a.m. - 8 p.m. (U.S Central Time)
Except certain holidays
Automated Voice Response Hours: 24 hours a day, 7 days a week
Website: ExxonMobil.AetnaMedicare.com
Address:
Aetna Medicare
P.O. Box 981106
El Paso, TX 79998-1106
Express Scripts:
Express Scripts can provide pharmacy benefits information, including clinical guidelines, benefits pre-determinations, and providers participating in the Express Scripts pharmacy network. Express Scripts also provides prior-authorization review for certain pharmacy services, medications, and equipment. Ask to speak to a Therapeutic Resource Center (TRC) pharmacist for specialized support services.
| Phone Numbers: | Address: |
|---|---|
| Express Scripts Pharmacy: | |
|
Express Scripts Home Delivery Pharmacy |
Home Delivery Pharmacy: |
| For questions regarding Retail Prescriptions: | |
|
Express Scripts |
Direct Reimbursement Claim Form: |
Another way to locate retail network pharmacies and order refills is via the Express Scripts website at www.express-scripts.com.
Direct Reimbursement Claim Form:
Express Scripts
ATTN: Medicare Part D
P.O. Box 14718
Lexington, KY 40512-4718
Direct Reimbursement Claim Forms may also be faxed to:
1-608 741-5483
To visit Express Scripts website: www.express-scripts.com.
Benefits Administration
References to Benefits Administration throughout this SPD pertain to the ExxonMobil Benefits Service Center. Contact the Exxon Mobil Benefits Services Center (EMBSC) for benefits administration information, including enrollment and eligibility inquiries.
Retirees and survivors can enroll/change coverage on the Your Total Rewards portal at digital.alight.com/exxonmobil. If you are unable to access the Internet or need additional information, you may contact:
Phone Numbers:
Retirees and Survivors call:
ExxonMobil Benefits Service Center (EMBSC)
Monday – Friday 8:00 a.m. to 4:00 p.m.
(U.S. Central Time), except certain holidays
Toll-Free: 1-833-776-9966
Address:
ExxonMobil Benefits Service Center
Dept 02694, PO Box 64116, The Woodlands, TX, 77387-4116
ExxonMobil sponsored sites- Access to MPO-related information including claim forms for employees, retirees, survivors, and their family members.
- ExxonMobil Family, the Human Resources Internet Site — Can be accessed by everyone at www.exxonmobilfamily.com.
- ExxonMobil Benefits Service Center (EMBSC) Internet Site — Can be accessed by everyone at Your Total Rewards portal at digital.alight.com/exxonmobil.
ExxonMobil Aetna Medicare website:
Introduction
The Medicare Primary Option (MPO), is an option under the ExxonMobil Retiree Medical Plan for retirees, their eligible spouses and eligible surviving spouses who are also eligible for Medicare. Medical coverage under this option is provided through the Aetna Medicare Plan (PPO) with Extended Service Area (ESA), a type of Medicare Advantage plan which combines the same benefits as Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and extra medical benefits all under one plan, commonly referred to as Medicare Part C. It is designed to work with Medicare Parts A and B and must follow the rules set by Medicare. You must be enrolled in and continue to pay premiums for Medicare Part A and Part B in order to continue your enrollment in the MPO.