Index

About Medicare Supplement

Eligibility and Enrollment

The Prescription Drug Program

Other Plan Provisions

Accepting Assignment

Covered Expenses

Exclusions

Coordination of Benefits

Claims

Partners in Health

Administrative and ERISA Information

Key Terms

Benefit Summary

Continuation Coverage

Q. Can coverage be continued after eligibility in the 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.

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 Benefits Administration at the telephone numbers or address listed under Benefits Administration on page 41.

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 shown on page 41.

• 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.

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

• The retiree dies, or
• Divorces.

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

• The parent-retiree or parent-survivor dies;
• The parents become divorced, 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. 

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 retirees may elect COBRA continuation coverage on behalf of their spouse, 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 retiree or divorce, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. 

Cost of COBRA Coverage
A person who elects continuation coverage may be required to contribute up to 102% of contributions to maintain the coverage. A person who elects continuation coverage must pay the required contributions within 45 days from the date coverage is elected.

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:
Contacts for COBRA rights under the ExxonMobil Medicare Supplement Plan
The following sets out the contact numbers based on your status under the ExxonMobil Medicare Supplement. 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.