Index

About Dental

Dental PPO

Covered Expenses

Exclusions

Payments

Claims

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Eligibility and Enrollment

Q. What are the Plan's eligibility requirements?

A. Most U.S. dollar payroll employees of Exxon Mobil Corporation and participating affiliates are eligible for this Plan.

Generally, you are also eligible if:

		You are a regular employee.
		You are an extended part-time employee.
		You are a retiree.
		You are a survivor, which means an eligible dependent of a deceased regular employee or retiree.

You are not eligible if:

		You participate in any other dental plan to which ExxonMobil contributes.
		You fail to make any required contribution toward the cost of the Plan.
		You fail to comply with general administrative requirements including but not limited to enrollment requirements.
		You lost eligibility as described under the Loss of Eligibility section on page 14.

Eligible Dependents

You may also elect coverage for your eligible dependents including:

• Your spouse. When you enroll your spouse for coverage, you may be required to provide proof that you are legally married.
• Your unmarried dependent child(ren) under age 25 who are not employed on a regular, full-time basis. Coverage ends at the end of the month in which they reach age 25. If your situation involves a dependent other than your biological or legally adopted child who lives with you, call Benefits Administration.
• Your totally disabled, unmarried child(ren) incapable of self-sustaining employment by reason of mental retardation, physical handicap, or mental illness due to psychosis or a severe behavioral health disorder that occurred prior to otherwise losing eligibility.
• A dependent child or spouse of a Medicare-eligible retiree enrolled in the ExxonMobil Medicare Supplement Plan.

Note: You can enroll eligible dependents only if you are enrolled in this plan.

Refer to Key Terms for definitions of eligible dependents, dependent child, suspended retiree, spouse, and Qualified Medical Child Support Order.

Suspended Retiree

A person who becomes a retiree due to incapacity within the meaning of the ExxonMobil Disability Plan and who begins long-term disability benefits under that plan, but whose benefits stop because the person is no longer incapacitated is considered a suspended retiree and is not eligible for coverage until the earlier of the date the person:

• Reaches age 55, or
• Begins his or her retirement benefit or receives a lump-sum settlement under the ExxonMobil Pension Plan, at which time the person is again considered a retiree and may enroll.

The family members of a deceased suspended retiree will be eligible for coverage under this Plan only after the occurrence of the earlier of the following:

• The date the suspended retiree would have attained age 55, or
• The date a survivor begins receiving a benefit due to the suspended retiree's accrued benefit from the ExxonMobil Pension Plan.

Special Eligibility Rules

If you or your dependents were participating in either the Comprehensive Medical Plan of Mobil Oil Corporation, the Superior Oil Medical Plan for Pre-1967 Retirees, or the Superior Oil Medical Plan on March 31, 2004, you may elect coverage in the ExxonMobil Dental Plan. In addition, individuals who became an eligible dependent (e.g., birth, marriage) after your retirement date may be eligible for coverage.

A person who otherwise is not a spouse but who as a dependent of a former Mobil employee participated in or received benefits under a Mobil-sponsored plan or program prior to March 1, 2000, is considered an eligible dependent so long as that person's eligibility for coverage as a dependent under a Mobil-sponsored plan would have continued.

Classes of Coverage

You can choose coverage as an:

• Employee or retiree only;
• Employee or retiree and spouse;
• Employee or retiree and child or children; or
• Employee or retiree and family.

There are also classes of coverage for extended part-time employees, surviving spouses and dependents of deceased employees and retirees, and employees on certain leaves of absence. 

For employees on some types of approved leaves of absence, their contribution rate will change from the employee contribution rate to the Leave of Absence contribution rate as shown in the table below.

	Leave of Absence Contribution Rate begins
Type of Leave	Immediately	No later than  after 6 months	No later than  after 12 months
Military (voluntary)	X
Civic Affairs	X
Health / Dependent Care		X
Education		X
Personal			X

Each class of coverage described in this section has its own contribution rate. Employees contribute to the Dental Plan through monthly deductions from their pay on a pre-tax or after-tax basis. Retirees and survivors receiving monthly benefit checks from ExxonMobil pay by deductions from these checks on an after-tax basis. Other retirees or survivors and participants with continuation coverage pay by check or by monthly draft on their bank account.

Double Coverage

No one can be covered by more than one dental plan to which ExxonMobil contributes, so you cannot both enroll as employees (or retirees) and elect coverage for each other as eligible dependents. If you and your spouse work for the company or are both retirees you may both be eligible for coverage. Each of you can be covered as an individual employee (or retiree), or one of you can be the employee (or retiree) and the other can be an eligible dependent. Also, if you have children, each child can only be covered by one of you.

How to Enroll

As a newly hired employee, if you enroll within 31 days of your start date, coverage begins on your first day of employment; however, no benefits are payable for any diagnosis or treatment started prior to becoming a participant.

You can enroll eligible dependents only if you are enrolled in this Plan. You can enroll in the Plan using Employee Direct Access (EDA) located on the ExxonMobil Me HR Intranet site. Enrollment forms are also available from Benefits Administration for those individuals who do not have access to EDA.

Your monthly contributions – what you might think of as premiums – will be paid on a pre-tax basis through the ExxonMobil Pre-Tax Spending Plan, unless you decline this feature when you enroll. Your monthly contributions and coverage option must remain in effect for the entire plan year, unless you experience a change in status. (See the Annual Enrollment and Changing Your Coverage sections.)

You may be requested to provide documents at some future date to prove that the dependents you enrolled were eligible (e.g., marriage license, birth certificate). If you fail to provide such requested documents within 90 days of the request, the dependents will be disenrolled, and you may be asked to repay any benefits that were paid on their behalf from the Plan. In addition, you may be subject to disciplinary action up to and including termination for falsifying company records.

Annual Enrollment
If you are not currently participating in the Plan and would like to, you may elect to enroll yourself and your eligible dependents during Annual Enrollment. Your coverage will always become effective January 1st of the following year. You can enroll/change benefits using Employee Direct Access (EDA) located on the ExxonMobil Me HR Intranet site. If you do not have EDA access, contact Benefits Administration.

Employees will be enrolled in the Pre-Tax Spending Plan to pay monthly contributions on a pre-tax basis unless this feature is declined. This choice is only available during the annual enrollment period or with a change in status. If you pay your monthly contributions on an after-tax basis and would like to continue making contributions on an after-tax basis for the following year, you must elect to do so during each Annual Enrollment. Otherwise, your contributions will be made on a pre-tax basis beginning the first day of the following year. As a retiree, you will pay your monthly contributions on an after-tax basis via payroll deduction (if eligible), check, or bank draft.

Pre-existing Conditions

Any dental diagnosis or treatment started before coverage begins is pre-existing and will not be covered. This provision also applies to your dependents. Here are some examples:

• Your dependent child is undergoing orthodontic work. None of this work is covered if the first appliance is inserted before coverage begins.
• You need full or partial dentures. If the necessary impression is taken before you begin coverage, expenses associated with the dentures are not covered.
• Your dentist diagnoses you with gum disease. If the diagnosis was made prior to your being a covered participant, expenses associated with the treatment of gum disease are not covered.

Pre-existing condition provisions do not apply if you are promoted from a represented job, where you were covered by another plan to which ExxonMobil contributed, to a non-represented job where you are no longer eligible for that plan.

Changing Your Coverage

If you pay your contributions on a pre-tax basis and would like to change your coverage after you are first eligible, you must wait until the next Annual Enrollment, unless you experience one of the following Changes in Status. If you experience a change in status, you must notify Benefits Administration within 31 days of the event (60 days in the case of birth or adoption).

You can enroll/change benefits using Employee Direct Access (EDA) available on the ExxonMobil Me HR Intranet site or by contacting Benefits Administration if you do not have EDA access.

Changes in Status

Changes in status are events that allow you to make changes to your coverage during the plan year. This section explains which events are considered changes in status and what changes you may make as a result. If you have a change in status, you must notify Benefits Administration within 31 days of the event (60 days for birth or adoption). If you do not notify Benefits Administration within 31 days of the event (60 days for birth or adoption) changes to your coverage may be limited.

Changes made to your dental coverage due to a change in status do not automatically adjust your coverage or contributions to other company plans such as medical plans or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes to those plans must be made separately.

Birth or Adoption
If you are a plan participant and you gain a family member through birth or adoption, you may enroll the new eligible dependent in your current coverage. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself, your spouse, and your eligible children. If you plan to be covered as a dependent under your spouse's dental plan, you can cancel your coverage. The enrollment process begins when you notify Benefits Administration of your change in status. Coverage is effective on the date of birth or placement provided you complete the enrollment process within 60 days, even if you have family coverage. If the enrollment of the dependent changes your class of coverage, your coverage cost will be adjusted. If you do not enroll your new dependents within the first 60 days in the case of birth or adoption, you can enroll them later during Annual Enrollment or with another change in status.

Sole Legal Guardianship or Sole Managing Conservatorship
If you (or you and your spouse) become the sole legal guardian or sole managing conservator of a dependent child and the child meets all the requirements of the definition of an eligible dependent, you have 31 days from the date the judgment is officially signed by the judge to enroll the child for coverage. Coverage will be effective as of the date of the signed judgment.

Marriage
If you are enrolled in the Plan, you can enroll your new spouse and his or her eligible children (your stepchildren) for dependent coverage. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself, your new spouse, and your eligible stepchildren. If you plan to be covered as a dependent under your spouse's dental plan, you can cancel your coverage. You must make these changes within 31 days following the date of your marriage or wait until Annual Enrollment or another change in status.

Death of a Spouse
If you are enrolled in the Plan, you can cancel your coverage for you and your dependents. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself and your eligible dependents. You must make these changes within 31 days following the date of death or wait until Annual Enrollment or another change in status.

When a Child is No Longer Eligible
If an enrolled dependent is no longer an eligible dependent (e.g., death, dependent gets married), coverage continues through the end of the month for which you made required contributions. In some cases, continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) may be available. (See page 32 for more details.)

Divorce and Legal Separation
In the case of divorce, if you are enrolled in the Plan, the covered former spouse and any stepchildren are ineligible for dental coverage. You must notify Benefits Administration within 31 days of your divorce. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself and your eligible dependents (your former spouse and stepchildren are not eligible for coverage). Your former spouse and any stepchildren may be eligible for continuation coverage under COBRA. Please see page 32 for more details. In the case of legal separation, different COBRA rules apply, because your spouse and any stepchildren continue to be eligible for coverage under the Plan. If you cancel coverage for your spouse or dependent children due to a legal separation, your dependents will not be eligible for continued health care coverage under COBRA until the divorce.

If You Transfer
If you transfer from one location to another, contact Benefits Administration for assistance to ensure there is no gap in coverage for you or your enrolled dependents. You may add or delete eligible dependents at this time. For more information, call Benefits Administration. See Information Sources at the front of this SPD.

If You Take a Leave of Absence
If you are on an approved leave of absence, you can continue coverage by making required contributions directly to the Plan by check. If you fail to make required contributions, your coverage will end.

If the company should make any payment on your behalf to continue your coverage while you are on leave and you decide not to return to work, you will be required to reimburse the company for required contributions.

If you are on an approved leave of absence and the Leave of Absence contribution rate begins, you may continue your coverage by making your required contribution.

If you were on a leave that meets the requirements of the Family and Medical Leave Act (FMLA) or the Uniformed Services Employment and Reemployment Rights Act (USERRA), and your coverage ended, re-enrollment is subject to FMLA or USERRA requirements. Upon returning from other types of leaves, you will be considered a late entrant subject to all plan provisions.

For more information, call Benefits Administration. See Information Sources at the front of this SPD.

Change in Coverage Costs
If the cost for coverage charged to you significantly increases or decreases during a plan year, you may be able to make a corresponding prospective change in your election, including cancellation of your election. This provision also applies to a significant increase in the dental deductible or co-payment.

Addition or Improvement of an Option
If a new plan option is added or if benefits under the existing option are significantly improved during a plan year, you may be able to cancel your current election in order to make an election for coverage under the new or improved option.

Loss of Option
If the Plan is discontinued, you will be able to elect either to receive coverage under another option providing similar coverage or to drop dental coverage altogether if no similar option is available.

Change In or Loss of Coverage Under Your Spouse's Dental Plan
If your spouse's dental plan experiences a significant increase in coverage costs, or a significant curtailment or loss of coverage that allows the revocation of coverage under that plan, you will be eligible to elect coverage in the Plan. You may also add eligible dependents to your coverage. Notify Benefits Administration within 31 days of the termination of the other coverage. Coverage is effective the first of the month following the date of termination of the other coverage.

Remember, if you make your contributions on a pre-tax basis and you experience any of the events mentioned previously, or if you are newly eligible as a result of a change or loss of coverage under your spouse's dental plan, it is your responsibility to notify Benefits Administration within 31 days of experiencing the event. If you miss the 31-day notification period, you will not be able to make changes until Annual Enrollment or until you experience another Change in Status.

Other Changes That May Effect Your Coverage

If You are a Retiree under Age 65
If you are a retiree under age 65, you and your dependents who are not eligible for Medicare can continue to participate in the Plan. When you (as a retiree) or a covered dependent become eligible for Medicare, Medicare will become the primary plan and benefits will be coordinated.

If You are an Extended Part-Time (Enhanced Non-Regular) Employee
If you terminate employment as an extended part-time employee, you are not eligible to continue to participate in the Plan. You may be eligible to elect continuation coverage for yourself and your eligible dependents under COBRA provisions. See page 32 for details.

If You Work Past Age 65
If you continue to work for ExxonMobil past age 65, although you are eligible for Medicare, your coverage remains in effect and the Plan is your primary plan.

If You or Your Covered Dependents Become Medicare Eligible
When a retiree or a covered eligible dependent become eligible for Medicare, benefits will be coordinated with Medicare.

If You Die
If you die while enrolled, your covered eligible dependents can continue coverage. Their eligibility continues under the Plan with the payment of required contributions for a specified amount of time:

• If you have 15 or more years of benefit service at the time of your death, eligibility continues until your spouse remarries or dies.
• If you have less than 15 years of benefit service, eligibility continues for twice your length of Benefit Service or until the spouse remarries or dies, whichever occurs first.

Children of deceased employees or retirees may continue participation as long as they are an eligible dependent. If your surviving spouse remarries, eligibility for your children also ends. Special rules may apply to dependents of individuals who become retirees due to disability. See Continued Coverage for suspended retirees on page 35.

Eligible dependents of deceased extended part-time employees are not eligible to continue to participate in the Plan. These dependents may be eligible to elect continuation coverage under COBRA provisions. See page 32 for details.

If You Become a Suspended Retiree
If you are a retiree and you would otherwise lose coverage because you have become a suspended retiree under the ExxonMobil Disability Plan (See page 6 for details), you may continue coverage for yourself and all your dependents who were eligible for plan participation before you became a suspended retiree for either 12 or 18 months.
Coverage continues for 12 months from the date coverage would otherwise end if you received transition benefits under the ExxonMobil Disability Plan. However, if you did not receive transition benefits under the ExxonMobil Disability Plan, coverage continues for 18 months from the date coverage would otherwise end. The cost of this continued coverage is 102% of the combined participant and company contributions.

When Coverage Ends

Coverage for you and/or your dependents ends on the earliest of the following dates:

• The last day of the month in which:
  • You terminate employment (except as a retiree) or elect not to participate;
  • A dependent ceases to be eligible (for example, your dependent child who reaches age 25); or
  • A retiree becomes a suspended retiree (see page 6).

OR

• The date:
  • You are no longer eligible for benefits under this Plan (e.g., employment classification changes from "regular employee" to "non-regular employee" or from non-represented to represented where you are no longer eligible for this Plan);
  • You die;
  • The Plan ends;
  • Your employer discontinues participation in the Plan;
  • You do not make your required contribution; or
  • A Qualified Medical Child Support Order is no longer in effect for a covered dependent.

You are responsible for notifying Benefits Administration when your enrolled spouse or dependent is no longer eligible for coverage. If you do not notify Benefits Administration within 31 days of ineligibility, any contributions you make for ineligible dependents will not be refunded. Any claims paid after the loss of eligibility are considered overpayments and must be repaid.

Loss of Eligibility

Everyone in your family may lose eligibility for plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the Plan, for instance, by filing claims for benefits to which you are not entitled. Coverage may also be terminated if you refuse to repay amounts erroneously paid by the Plan on your behalf or which you recover from a third party. Your participation may be terminated if you fail to comply with the terms of the Plan and its administrative requirements. You may also lose eligibility if you enroll persons who are not eligible.