Index

About the Medical Plan

Basic Plan Features

The Prescription Drug Program

Mental Health and Chemical Dependency Care

Covered Expenses

Exclusions

Payments

Claims

Partners in Health

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Eligibility and Enrollment

Q. What are the Medical 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 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 or extended part-time employee or retiree.

You are not eligible if:

• You participate in any other medical 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 16.

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 children 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) who is 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, as long as that spouse or child is not eligible for Medicare.

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 a suspended retiree and not eligible for coverage until the earlier of the date the person:

• Reaches age 55; or
• Begins his or her 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 were participating in either the Comprehensive Medical Plan of Mobil Oil Corporation or the Superior Oil Medical Plan on March 31, 2004, you are eligible to elect coverage in the ExxonMobil Medical Plan. In addition, individuals who are eligible dependents may be eligible for coverage.

A person who otherwise is not a spouse but who, as a dependent of a former Mobil employee who participated in or received benefits under a Mobil-sponsored plan or program prior to March 1, 2000, is considered an eligible dependent as 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, spouses and dependents of retirees covered by the ExxonMobil Medicare Supplement Plan, and employees on certain types of 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 Medical 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 medical 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 the first day of employment and pre-existing condition provisions do not apply for you and any eligible dependents. You must enroll everyone in the same option.

You will be enrolled to pay your monthly contributions – what you might think of as premiums – on a pre-tax basis through the ExxonMobil Pre-Tax Spending Plan, unless you decline this feature when you enroll. Your monthly pre-tax contributions and class of coverage must remain in effect for the entire plan year, unless you experience a change in status. (See the Changing Your Coverage section on page 12.)

As a current employee, if you are not covered by a medical plan to which ExxonMobil contributes and would like to enroll in the POS II option, you may do so. Coverage is effective the first of the month following completion of enrollment. However, you and any eligible dependents you enroll may be subject to pre-existing condition provisions.

You can enroll eligible dependents only if you are enrolled in the POS II option or in the ExxonMobil Medicare Supplement Plan. You can enroll in the POS II option by using Employee Direct Access (EDA) available 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.

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, coverage for the dependents will be cancelled retroactively, and you may be asked to repay any benefits that were paid on their behalf from the Medical Plan. In addition, you may be subject to discipline up to and including termination for falsifying company records.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other group health plan coverage, you may enroll yourself and your dependents in any available EMMP option if you or your dependents lose eligibility for that other group health plan coverage (or if the employer stops contributing toward your and/or your dependent(s)' other coverage). In addition, you may enroll yourself or your dependents in any available EMMP option within 31 days after marriage or 60 days of birth or adoption/placement for adoption retroactive to the marriage, birth or adoption/placement for adoption.

CAUTION: SHOULD YOU DECIDE TO RETROACTIVELY CHANGE TO A DIFFERENT PLAN OPTION, SUCH AS FROM AN HMO TO THE POS II, YOUR BENEFITS FOR ANY MEDICAL SERVICES WHICH WERE RECEIVED ON OR AFTER THE DATE OF MARRIAGE, BIRTH OR ADOPTION/PLACEMENT FOR ADOPTION MAY NOT BE COVERED OR MAY BE REIMBURSED AT A LOWER BENEFIT LEVEL. MAKE SURE YOU FULLY UNDERSTAND THE IMPACT OF CHANGING OPTIONS BEFORE MAKING YOUR ELECTION.

Annual Enrollment
Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, you can switch from your current option to another option available in your area. For example, you may switch from the POS II option to an HMO option if there is one in your area. This is also the time to make changes to your coverage by adding or deleting dependents. Dependents may be added or deleted for any reason. Changes elected during Annual Enrollment take effect the first of the following year. Pre-existing condition provisions may apply to participants who were not enrolled when they were first eligible and were added to coverage during Annual Enrollment.

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 a pre-tax basis, Annual Enrollment is the only time that you can make changes to your coverage unless you experience 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 each year during Annual Enrollment. Otherwise, your contributions will be switched to a pre-tax basis beginning the first day of the following year. As a retiree, you will pay your contributions on an after-tax basis through payroll deduction (if eligible), check, or bank draft.

During Annual Enrollment, changes to your Medical Plan coverage (option or contributions) do not automatically adjust your coverage or contributions to other plans such as the ExxonMobil Dental Plan or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes to those plans must be made separately during Annual Enrollment.

Pre-Existing Conditions

You and your eligible dependents are considered late entrants if you do not enroll when within 31 days of initial or subsequent eligibility or a change in family status. This plan imposes a pre-existing condition limitation. This means that if you and/or your eligible dependent(s) have a medical condition before coming into the ExxonMobil Medical Plan, you and/or your eligible dependent(s) might have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a 6-month period. Generally, this 6-month period ends the day before your coverage becomes effective. The preexisting condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 60 days after birth, adoption, or placement for adoption.

This exclusion may last up to 12 months from your first day of coverage. However, if once you are covered, you don't receive medical advice, diagnosis, care or treatment for the condition for 6 months, the pre-existing exclusion limitation doesn't apply. In addition, you and/or your eligible dependent(s) can reduce the length of this exclusion period by the number of days of your prior "creditable coverage." Most prior group health plan coverage is creditable coverage and can be used to reduce the preexisting condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month exclusion period by your creditable coverage, you need to provide Benefits Administration a copy of any certificates of creditable coverage you and/or your eligible dependent(s) may have received. If you do not have a certificate, but you do have prior health coverage, we will tell you how to obtain one from your prior plan or issuer. There are also other ways that you can show you had creditable coverage. Please contact us if you need help demonstrating creditable coverage. 

All questions about the preexisting condition exclusion and creditable coverage should be directed to Benefits Administration: 

Active Employees
ExxonMobil Benefits Administration
Monday - Friday 8:00 a.m. to 4:00 p.m. (U.S. Central Time), except certain holidays
713-680-5858 (Houston)
713-680-7070 (international, call collect)
800-262-2363 (toll free outside Houston)

Retirees and Survivors
ExxonMobil Benefits Service Center
Monday - Friday 8:00 a.m. to 6:00 p.m. (U.S. Eastern Time), except certain holidays
Toll-Free: 1-800-682-2847
or 800-TDD-TDD4 (833-8334) for hearing impaired

Pre-existing condition provisions do not apply:

• To pregnancy.
• If you change from one option to another during an annual enrollment period.
• If you are promoted from a represented job in which you were covered by another plan to which ExxonMobil contributes to a non-represented job in which you are no longer eligible for that plan.
• If you are transferred by the company and, as a result, are required to change from another option or medical plan to which the company contributes.

Changing Your Coverage

If you pay your contributions on a pre-tax basis and would like to make a coverage change after you are first eligible, you must wait until Annual Enrollment or until 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).

Changes in Status

Changes in status are events that allow you to make changes to your coverage which you pay for on a pre-tax basis 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.

Unless you have a relocation that changes your service area or you experience a change as allowed by HIPAA (see How to Enroll section on page 10), you may not change your plan option (e.g., switching from POS II to an HMO or from one HMO to another HMO) until the next Annual Enrollment.

Birth or Adoption
If you are a Medical Plan participant and you gain a family member through birth, placement for adoption or adoption, you may add the new eligible dependent to your current coverage. You also may change your plan option. If you are not already enrolled for coverage, you can sign up for medical coverage for yourself, your spouse, and your eligible children. If you plan to be covered as a dependent under your spouse's health 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, placement for adoption, or adoption provided you complete the enrollment process within 60 days, even if you already 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 (subject to pre-existing conditions) 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 other requirements of the definition of an eligible dependent, you have 31 days from the date the judgment is signed 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 dependents (your stepchildren) for dependent coverage. You also may change your plan option. If you are not already enrolled for coverage, you can sign up for medical coverage for yourself, your new spouse, and your eligible stepchildren. If you plan to be covered as a dependent under your spouse's health 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 medical 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 COBRA may be available. (See page 54 for more details.)

Divorce or Legal Separation
In the case of divorce, if you are enrolled in the Plan, the covered former spouse and any stepchildren are ineligible for medical 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 medical 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 the Continuation Coverage section of this SPD.

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 is final.

If You Transfer
If you transfer from one location to another, contact Benefits Administration for assistance to ensure that there is no gap in coverage for you or your enrolled dependents. You may add or delete eligible dependents at this time. You may also change your option from the POS II option to an HMO option if one is available in your new location. 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 Medical Plan by check. If you fail to make required contributions, 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 of 1993 (FMLA) or the Uniformed Services Employment and Reemployment Rights Act (USERRA) and your coverage ended, re-enrollment is subject to FMLA or USERRA requirements.

For 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 the cancellation of your election. If you choose to revoke your elected coverage option, you may be able to elect coverage under another plan option. This provision also applies to a significant increase in health care deductible or co-payment.

Addition or Improvement of Option
If a new plan option is added or if benefits under an 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 a plan option is discontinued, you will be able to elect either to receive coverage under another plan option providing similar coverage or to drop medical coverage altogether if no similar option is available. For example, if the POS II option is discontinued, you may elect an HMO option that has service in your area. You may also elect to discontinue medical coverage altogether.

Change In or Loss of Coverage Under Your Spouse's Health Plan
If your spouse's medical 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 any available plan option or add eligible dependents to your coverage. Coverage is generally 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 medical 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 Affect Your Coverage

If a Covered Family Member Lives Away from Home
Refer to page 22 for an explanation of coverage if your covered family member lives away from home (for instance, a child away at school). Notify Aetna Member Services of your family member's address for correct claims processing.

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 becomes 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 54 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 ExxonMobil coverage remains in effect for you and eligible dependents and the POS II option is your primary plan. Medicare benefits, if you sign up for them, will be your secondary benefits. Medicare will coordinate its benefits with the POS II option.

If You or Your Covered Dependents Become Medicare Eligible for Any Reason
Employees or dependents of an employee who become Medicare eligible, either due to age or Social Security disability status, are eligible to participate in the POS II option as long as the employee remains actively employed by ExxonMobil. If the employee retires or dies, Medicare eligible covered dependents must change to the ExxonMobil Medicare Supplement Plan and enroll in Medicare Parts A and B. If you become Medicare eligible and do not enroll in the ExxonMobil Medicare Supplement Plan, you will be responsible for any claim expenses you incur from the date of your Medicare eligibility. 

When a retiree or a retiree's covered eligible dependent becomes eligible for Medicare, either due to age or Social Security disability status, that person cannot participate in the POS II option but will be eligible for the ExxonMobil Medicare Supplement Plan.

If You Die
If you die while enrolled, your covered eligible dependents can continue coverage. Their eligibility continues with the company 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, becomes eligible for the ExxonMobil Medicare Supplement Plan or dies.
• If you have less than 15 years of benefit service, eligibility continues for twice your length of benefit service or until your spouse remarries, becomes eligible for the ExxonMobil Medicare Supplement Plan, 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 Suspended Retiree below.

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 54 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 8 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 due to disability);
  • You elect not to participate;
  • A dependent ceases to be eligible (for example, a dependent child reaches age 25); or
  • A retiree becomes a suspended retiree.
  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 Medical Plan ends;
  • Your employer discontinues participation in the Plan;
  • You do not make any required contribution;
  • A Qualified Medical Child Support Order is no longer in effect for a covered dependent;
  • You, as a retiree, or your eligible dependent becomes eligible for Medicare and for the ExxonMobil Medicare Supplement Plan.

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, 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 Medical Plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the Medical 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 Medical Plan on your behalf or that you recover from a third party. Your participation may be terminated if you fail to comply with the terms of the Medical Plan and its administrative requirements. You may also lose eligibility if you enroll persons who are not eligible, for instance, by covering children who do not meet the eligibility requirements.

Extended Benefits at Termination
You are entitled to extended coverage for as much as a year if you are terminated due to disability with fewer than 15 years of service. This coverage is provided at no cost to you. This is considered a portion of the COBRA continuation period. In order to assure coverage beyond this extension period, you must elect COBRA upon termination of employment.
Several conditions must be met:

• The disability must exist when your employment terminates.
• The extension lasts only as long as the disability continues, but no longer than 12 months.
• This extension applies only to the employee who is terminated because of a disability. Continuation coverage for eligible dependents may be available through COBRA.