Index

About Medicare Supplement

The Prescription Drug Program

Other Plan Provisions

Accepting Assignment

Covered Expenses

Exclusions

Coordination of Benefits

Claims

Partners in Health

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Eligibility and Enrollment

Q. Who can participate in the Plan?

A. There are three conditions for eligibility for the Plan. You must:

• Be eligible for Medicare;
• Be an eligible retiree or eligible dependent; and
• Have been covered by any group medical plan to which ExxonMobil contributes immediately before plan eligibility.

Eligible Retiree

For purposes of the Plan, you are an eligible retiree if you attained retiree status from:

• ExxonMobil;
• Exxon;
• Mobil; or
• Superior Oil Company.

You are not eligible to participate in the Plan if you:

• Are a Mobil or Superior Oil retiree and were not enrolled in the Mobil or Superior Oil Medical plan at the time of the merger into the ExxonMobil Medical plan or the ExxonMobil Medicare Supplement plan and were never enrolled prior to the merger; or
• Worked for Mobil Station Operators, Inc. (SOI) or Exxon Company Operated Retail Stores (CORS).

Eligible Dependents

For purposes of the Plan, eligible dependents include:

• The spouse of an eligible retiree.
• The surviving spouse, who has not remarried, of a deceased eligible retiree.
• The surviving spouse, who has not remarried, of a deceased employee.
• The unmarried dependent child of an eligible retiree.

• The unmarried dependent child, whose surviving parent has not remarried, of a deceased employee or eligible retiree.
• A person who becomes an eligible dependent of an ExxonMobil eligible retiree by marriage after becoming eligible for Medicare. To participate in the Plan under this provision, prior group health coverage is not required. However, the person must be added as a covered dependent within 31 days of becoming eligible.

Special Rule for Participants of the Comprehensive Medical Expense Benefit Plan of Mobil Oil Corporation and the Superior Oil Medical Plan
If you or your dependents were participating in the Comprehensive Medical Plan of Mobil Oil Corporation or the Superior Oil Medical Plan on March 31, 2004, and you were Medicare eligible, you are a participant in the Plan effective April 1, 2004. In addition, individuals who became your eligible dependents (e.g., marriage) after March 31, 2004, may be eligible.

Eligibility for Medicare

In general, you are eligible for Medicare if you are at least 65 years of age or have received Social Security disability benefits for 24 consecutive months. Anyone, including children, can be eligible for Medicare by virtue of a disability as described on page 49.

No one becomes eligible for Medicare as the dependent of someone who is eligible for Medicare. For example:

• If you are 65 years of age and your spouse is 63 and not disabled, you are eligible for Medicare but your spouse is not; or
• If you are under age 65 and not disabled and have a spouse either over 65 or eligible due to disability, your spouse is eligible for Medicare but you are not.

Enrolling in Medicare

If you are receiving Social Security benefits, your Social Security office should contact you with information about Medicare before your 65th birthday. If you are not receiving Social Security benefits or if you have not been contacted by Social Security and are nearing your 65th birthday, contact your local Social Security office. To receive maximum benefits from the Plan and Medicare, you must enroll in both:

• Part A covers hospital care and care in a skilled-nursing facility. There is no premium for most Part A participants.
• Part B covers physician bills and some out-of-hospital expenses. A premium for Part B is deducted from your Social Security check. Contact Medicare for current premium information.

If your spouse worked in a job not covered by Social Security or did not work long enough to qualify for free Part A coverage, the Plan pays full benefits with or without Part A coverage. The spouse must, however, sign up for Part B to receive maximum benefits.

Enrolling in Medicare Advantage (Part C) or Medicare Part D
Participants who choose to enroll in a Medicare Advantage (Part C) plan which provides a Medicare prescription drug benefit or Medicare Part D Prescription Drug Plan will no longer be eligible for outpatient prescription drug coverage under the Plan. If you enroll in a Medicare Part C which provides a Medicare prescription drug benefit or Part D program and continue your Plan participation, your required contributions remain the same, but you will not be eligible for outpatient prescription drug benefits under the Plan.

Enrolling in the Plan
The ExxonMobil Benefits Service Center (EMBSC) contacts retirees and their spouses and surviving spouses shortly before their 65th birthdays. If you have not been contacted by the time you become eligible for Medicare, contact the EMBSC. This is particularly important if you become eligible for Medicare by virtue of disability rather than age. You should also contact the EMBSC when your dependent child or spouse becomes eligible for Medicare.

If You Cancel Your Coverage
If you cancel your coverage, you will not be allowed to re-enroll in the future. Also, if you are not covered under this or another medical plan to which ExxonMobil contributes, your otherwise eligible dependents cannot continue coverage under any ExxonMobil medical plans.

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When Plan Eligibility Ends

Eligibility for the Plan ends:

• When a participant fails to make the required contributions.
• When you cancel your coverage in writing.
• For a spouse following a divorce.
• For a surviving spouse and step children upon remarriage.
• For dependent children upon their own marriage or the marriage of the surviving parent.
• For the surviving spouse and dependent children of an employee who died with less than 15 years of ExxonMobil benefit service after a period from the date of death equal to twice the deceased employee's length of ExxonMobil benefit service.
• If, at some future date, the Plan is terminated or replaced.