Index

About Dental

Eligibility and Enrollment

Dental PPO

Covered Expenses

Exclusions

Payments

Claims

Administrative and ERISA Information

Key Terms

Benefit Summary

Continuation Coverage

Q. Can coverage be continued after eligibility in this Plan ends?

A. Yes. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) entitles you and your covered dependents to extend medical benefits beyond the date your coverage would normally end.

Continuation Coverage Rights Under COBRA

Introduction
You are required to be given the information in this section because you are covered under a group health plan (the Plan). This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This section generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review this SPD or contact ExxonMobil Benefits Administration at the telephone numbers or address listed under Benefits Administration on page 36.

IMPORTANT: "Benefits Administration" references throughout this section change depending on your status. Unless specifically stated otherwise, you should refer to the correct Benefits Administration entity using the list below. The contact information for each of these entities is as shown on page 36.

• Current ExxonMobil employees or their dependents refer to ExxonMobil Benefits Administration/ Health Plan Services; 

• Exxon, or Mobil, or Superior Oil, or ExxonMobil retirees, or their survivors, or their dependents refer to ExxonMobil Benefits Service Center; and 

• Former Exxon or ExxonMobil employees, or retirees, or their survivors, or their dependents, who have elected and are participating through COBRA, refer to ExxonMobil COBRA Administration.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later in this section. After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay the entire cost of COBRA continuation coverage.

An employee will become a qualified beneficiary if the employee loses coverage under the Plan because either one of the following qualifying events happens:

• Hours of employment are reduced; or
• Employment ends for any reason other than the employee's gross misconduct.

The spouse of an employee or retiree, will become a qualified beneficiary if the spouse loses coverage under the Plan because any of the following qualifying events happens:

• The employee or retiree dies;
• The employee's hours of employment are reduced;
• The employee's employment ends for any reason other than his or her gross misconduct;
• The employee or retiree becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• Divorce or legal separation.

Dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

• The parent-employee or parent-retiree dies;
• The parent-employee's hours of employment are reduced;
• The parent-employee's employment ends for any reason other than his or her gross misconduct;
• The parent-employee or parent-retiree becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a dependent child.

Any retiree, retiree's spouse (including surviving spouse) and dependent children, will become qualifying beneficiaries if a proceeding in bankruptcy is filed in respect to Exxon Mobil Corporation, and the bankruptcy results in a loss of coverage.

When is COBRA Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the correct Benefits Administration entity has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee or retiree, or commencement of a proceeding in bankruptcy with respect to the employer, the employer must notify the correct Benefits Administration entity of the qualifying event. See page 36 for the listing of Benefits Administration entities.

You Must Give Notice of Some Qualifying Events
For the other qualifying events (divorce or legal separation of the employee/retiree and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must notify the correct Benefits Administration entity within 60 days after the later the qualifying event occurs or the date you would lose benefits under the Plan. See page 36 for the listing of Benefits Administration entities. Notices of these qualifying events from current employees must be made by logging onto Employee Direct Access (EDA) located on the ExxonMobil Me HR Intranet site. Forms are also available from ExxonMobil Benefits Administration/Health Plan Services for those individuals who do not have access to EDA. Notice is not effective until either an EDA change is made or the properly completed form is received.

How is COBRA Coverage Provided?
Once the correct Benefits Administration entity receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees or retirees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or the reduction of the employee's hours of employment and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability Extension of 18-month Period of Continuation Coverage
If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify ExxonMobil Benefits Administration/ Health Plan Services in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must notify ExxonMobil Benefits Administration/Health Plan Services. See page 36 for the listing of Benefits Administration entities.

You must provide the written determination of disability from the Social Security Administration to the correct benefits Administration entity within 60 days of the latest of the date of the disability determination by  Social Security Administration, the date of the qualifying event or the benefit termination date; and prior to the end of the 18-month COBRA continuation period. See page 36 for the listing of Benefits Administration entities.

Second Qualifying Event Extension of 18-month Period of Continuation Coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the correct Benefits Administration entity. This extension may be available to the spouse and any dependent child receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child. This extension is available only if the qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Cost of COBRA Coverage
A person who elects continuation coverage may be required to pay the group rate premium for their continuation coverage plus a 2% administration fee, if applicable, or 102% of cost to the Plan to maintain the coverage, unless the person is entitled to extended coverage due to disability. If the person becomes entitled to such extended coverage, the person may be required to contribute up to 150% of contributions after the initial 18-month's coverage until coverage ends. A person who elects continuation coverage must pay the required contributions within 45 days from the date coverage is elected, retroactively to the date benefits terminated under the Plan.

If You Have Questions
Questions concerning your plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA Web site at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's Web site.)

Keep Your Plan Informed of Address Changes
In order to protect your family's rights, you should keep the correct Benefits Administration entity informed of any changes in your address as well as the addresses of dependents. You should also keep a copy, for your records, of any notices you send to Benefits Administration.

Benefits Administration:
The following sets out the contact numbers based on your status under the ExxonMobil Dental Plan. It is your responsibility to contact the correct Benefits Administration entity with any required notices and address changes. Failure to notify the correct entity could result in your loss of COBRA rights. If your status is not listed, call ExxonMobil Benefits Administration/Health Plan Services for assistance.

ExxonMobil Dental Plan Contact Information