Index

About the Employee Health Advisory Program

Eligibility and Enrollment

How the Plan Works

Continuation Coverage

Key Terms

Administrative and ERISA Information

Q. What other information do I need to know about the Plan?

A. This section contains technical information about the Plan and identifies its administrator. It also contains a summary of your rights with respect to the Plan and instructions about how you can submit an appeal if you believe you have been denied a benefit to which you are entitled.

The formal name of the Plan is the ExxonMobil Employee Health Advisory Program.

Plan Sponsor and Participating Affiliates

The ExxonMobil Employee Health Advisory Program is sponsored by:

Exxon Mobil Corporation
5959 Las Colinas Boulevard
Irving, Texas 75039-2298

All of Exxon Mobil Corporation's divisions and most of the major U.S. affiliates participate in the ExxonMobil Health Advisory Program. A complete list of participating affiliates is available from the Administrator-Benefits upon written request. 

Certain employees covered by collective bargaining agreements as well as employees of Station Operators Inc., dba ExxonMobil CORS do not participate in the plan.

Basic Plan Information

Plan Administrator
The Plan Administrator for the ExxonMobil Health Advisory Program is the Administrator-Benefits. The Administrator-Benefits is the Manager-Global Benefits Design, Exxon Mobil Corporation. You may contact the Administrator-Benefits as follows:

The address for service of legal process is:
Administrator-Benefits
Exxon Mobil Corporation
4550 Dacoma
Houston, Texas 77092

Claims Fiduciary and Appeals
The Claims Fiduciary is the person to whom all appeals are filed. For the ExxonMobil Employee Health Advisory Program, the Claims Fiduciary is the Care Manager, Magellan Health Services. The Care Manager will decide all appeals for denied benefits. File any appeals with:

Magellan Health Services
P.O. Box 57986
Salt Lake City, Utah 84157-0986

Type Of Plan
The ExxonMobil Employee Health Advisory Program is a welfare plan under ERISA providing professional counseling for personal problems requiring limited intervention and referral services for more complicated problems.

Plan Numbers
The ExxonMobil Employee Health Advisory Program is identified with government agencies under two numbers: the Employer Identification Number 13-5409005 and the Plan Number 609.

Plan Year
The Plan year is the calendar year, January 1 through December 31.

Plan Funding
Benefits are funded through employer contributions.

Benefit Claims

To use EHAP, call Magellan Health Services toll free. You do not pay for or file claim forms for your EHAP counseling sessions. If you require additional services beyond that provided by EHAP, those services may be provided under your medical plan.

If you have a problem with a plan benefit, contact Magellan Health Services. The Care Manager is responsible for determining and informing you of your entitlement to a benefit.

The following categories of claims for benefits apply to the ExxonMobil Employee Health Advisory Program, and according to the type of claim submitted, Magellan Health Services will review your claim and respond within a designated response time. If Magellan Health Services needs additional time (an extension) to decide on your claim because of special circumstances, you will be notified within the claim response period.

Urgent Care claims are claims for medical care or treatment that if normal pre-certification standards were applied would seriously jeopardize the life or health of the patient or the ability of the patient to regain maximum function. Also, if in the opinion of a physician with knowledge of the patient's medical conditions the patient would be subjected to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim, then a decision would be made according to the Urgent Care claim response time.

Pre-Service claims are any claims for benefits where the Plan provisions require approval before medical care is obtained. Because all services under ExxonMobil Employee Health Advisory Program require pre-approval, most claims will fit this category.

Post-service claims are claims for benefits where the Plan provisions do not require approval before medical care is obtained. These claims are made after care is received and apply to claims under the ExxonMobil Employee Health Advisory Program.

Denied Claims

If your claim for benefits is denied completely or partially, you, your beneficiary, or designated representative will receive written notice of the decision. The notice will describe:

• The specific reason(s) for the denial, and
• The process for requesting an appeal.

Filing a Mandatory Appeal

If your claim is denied, you, your beneficiary, or your designated representative may appeal the decision to Magellan Health Services. Your written appeal should include the reasons why you believe the benefit should be paid and information that supports, or is relevant to, your claim (written comments, documents, records, etc). Your written appeal may also include a request for reasonable access to, and copies of, all documents, records and other information relevant to your claim. In the case of an Urgent Care claim, you may request an expedited appeal orally or in writing. You must submit your written appeal within 180 days from the date of the denial notice.

The review will take into account all comments, documents, records and other information submitted relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. Magellan Health Services will respond to the appeal within a designated response time as follows:

If Magellan Health Services needs additional time to decide on your claim because of special circumstances, you will be notified within the claim response period. However, an extension may be requested, but the law stipulates that no additional time will be allowed.

If your appeal is denied, you will receive written notice of the decision. The notice will set forth:

• The specific reason(s) for the denial and the Plan provisions upon which the denial is based.
• A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim.
• A statement of the voluntary appeal procedure and your right to obtain information about such procedure or a description of the voluntary appeal procedure.
• A statement of your right to bring an action under section 502(a) of the Employee Retirement Income Security Act (ERISA).

Legal Actions

No action at law or in equity to recover benefits under the Plan shall be brought unless the mandatory appeal process has been completed. In any event, no such action shall be brought after the expiration of one year from the time an appeal is decided by Magellan Health Services.

No Implied Promises

Nothing in the ExxonMobil Employee Health Advisory Program gives you a right to remain in employment or affects ExxonMobil’s right to terminate your employment at any time and for any reason (which is hereby reserved).

Future of the ExxonMobil Employee Health Advisory Program

ExxonMobil expects to continue the Plan. However, ExxonMobil has the right to change or terminate the Plan at any time and for any reason. A change also may be made to required contributions and future eligibility for coverage, and may apply to those who retired in the past, as well as those who retire in the future.

For health plans, certain rules apply regarding what happens when a plan is changed, terminated or merged.

Claims incurred before the effective date of a plan change or termination won't be affected. Claims incurred after a plan is terminated won't be covered.

Your Rights Under ERISA

As a participant in EHAP, you have certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that as a plan participant, you shall be entitled to:

Receive Information About Your Plan and Benefits

• Examine, without charge, at the office of the Administrator-Benefits and at other specified locations, such as worksites and union halls, all documents governing EHAP, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by EHAP with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
• Obtain, upon written request to the Administrator-Benefits, copies of documents governing the operation of EHAP, including collective bargaining agreements, and a copy of any annual report (Form 5500 Series) and updated summary plan description. The administrator may require a reasonable charge for the copies.
• Receive a summary of EHAP's annual financial report. The Administrator-Benefits is required by law to furnish each participant with a copy of this summary annual report.

Prudent Actions By EHAP Fiduciaries
In addition to creating rights for EHAP participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate EHAP, called "fiduciaries", have a duty to do so prudently and in the interest of you and other EHAP participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA.

Enforce Your Rights

• If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.
• Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of EHAP documents or the latest summary annual report from the EHAP and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Administrator-Benefits to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Administrator-Benefits.
• If you have a claim and an appeal for benefits, which are denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with EHAP's decision or lack thereof concerning the qualified status of a child support order, you may file suit in Federal court. If it should happen that EHAP fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. Any such lawsuit must be brought within 1 year from the time an appeal is decided by the Care Manager. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with Your Questions
If you have any questions about EHAP, you should contact the Care Manager or call Benefits Administration. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Administrator-Benefits, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.