IndexAbout the Medical PlanEligibility and EnrollmentBasic Plan FeaturesThe Prescription Drug ProgramMental Health and Chemical Dependency CareCovered ExpensesExclusionsPaymentsClaimsPartners in Health- Health Portal - Health Risk Assessment - 24-Hour Nurse Line - Health Advocate Program - Disease Management Program - Tobacco Cessation Program - Weight Management Program - Cancer Management Program - Centers of Excellence Continuation CoverageAdministrative and ERISA InformationKey TermsBenefit Summary |
The Partners in Health tools and resources include a Health Portal, a Health Risk Assessment, a 24-Hour Nurse Line, Health Advocates, Disease Management Programs, Cancer Management Program, and Centers of Excellence. The Health Portal and Health Risk Assessment are available to all eligible employees, retirees, and dependents (age 18 and older). The remaining resources are available to participants in the POS II option who have primary coverage under the ExxonMobil Medical Plan. The tools and resources offered through Partners in Health are available to you free of charge. However, health care claims (e.g., doctor's fees or facilities charges) are processed according to the Plan provisions discussed earlier. (See the sections How to File Claims, Covered Expenses, and Exclusions.) The Health Portal is an Internet Web gateway to reliable health care information written, reviewed, and approved by the medical staff of the Mayo Clinic. This Internet site is filled with useful health and health care information, including the following:
You may access the Health Portal through the ExxonMobil Family Internet Web site (see Information Sources) or directly at www.exxonmobilpartnersinhealth.com. This online questionnaire, available periodically on the Health Portal, is a quick and easy way to:
The Mayo Clinic Health Risk Assessment can help identify conditions you and your doctor may need to monitor and manage. The assessment is completely confidential, and you may choose to have your results sent to a Health Advocate for review, if you participate in the POS II option. Highly trained, licensed nurses are available by telephone, 24-hours a day, 7 days a week to answer routine questions about your health, or questions about a specific medical situation, condition, or concern. However, these nurses cannot diagnose medical conditions/ailments, prescribe medication or give specific medical instruction. Topics discussed during your call may include services and expenses not covered under the Plan (see page 40). The Health Advocate Program provides direct support to you, your family, and your treating physician(s) in the management of specific health care needs. The Health Advocate staff consists of registered nurses, supported by a medical director. Once you begin working with a Health Advocate, the nurse will work personally with you as long as you need support. Health Advocates will assist you to coordinate a wide array of health care-related support and educational services. As situations require, your Health Advocate will assist you with admission, counseling, inpatient advocacy, discharge planning and home counseling. The nurse will also act as your proactive partner, working directly with you to help you navigate the health care delivery system by assisting with the coordination and management of your health care needs and collaborating with other relevant providers and care managers involved in your treatment. If you or a family member is identified as having an illness or disease or if you have signs or symptoms or a family history that indicate that you are at risk for contracting a serious illness or disease and you have primary coverage under the ExxonMobil Medical Plan, the Health Advocates may contact you to provide support, information, and guidance. If you have certain chronic illnesses and meet eligibility criteria, you may be contacted by a licensed registered nurse through the Disease Management Program. These specially trained nurses focus on helping participants with conditions in which education, daily choices, and lifestyle decisions can have a significant effect on health and the progression of the condition. If you elect to work with your disease management nurse, you will receive educational materials, assistance in managing your condition, and personal support. Disease management services are currently provided for the following primary disease conditions:
Participants over the age of 18 may self-enroll in a phone-based program that will offer support and educational tools to develop tailored quit plans for individuals who use tobacco by calling (800) 330-2746. This is a referral only program for participants over the age of 18 who meet specific body mass index and comorbidity criteria. Referrals are made through the Health Advocate or Disease Management Programs described above. If you are undergoing active cancer treatment, you may be referred to a specifically trained cancer management nurse through your Health Advocate or Disease management nurse. Referrals will be made to provide support to those undergoing treatment. Centers of Excellence (COE) are nationally recognized facilities for the treatment of certain conditions or the delivery of certain procedures where high-level knowledge and expertise provide better care and more likely positive outcomes. COEs are not available for all diseases and all conditions or procedures relevant to a disease state. For instance, at this time there are COEs for pancreatic cancer, but there is insufficient information available to select COEs for lung cancer. Changes to identified COEs may occur in the future. If you have a particular condition or you require a procedure for which treatment at a COE is desirable, a COE may be recommended for treatment. The decision to access a COE is strictly voluntary. Whenever clinically appropriate, you will be referred to a local COE. If access to a clinically appropriate COE requires the patient to travel 100 or more miles, the Medical Plan will reimburse reasonable transportation costs for you and a caregiver. The Plan will also provide a per diem for you and a caregiver to cover lodging and other expenses. If you become hospitalized, only your caregiver will receive the per diem, because food and lodging are already provided as part of the hospital charge. The per diem amounts are established by the Administrator-Benefits. If you decide not to use a COE, you will not incur additional out-of-pocket cost for choosing another hospital in the Plan's network. |
Partners in Health