Index

About Pre-Tax Spending

Eligibility and Enrollment

Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage

Health Care Flexible Spending Account

Dependent Care Flexible Spending Account

Tax Implications

Continuation Coverage

Administrative and ERISA Information

Claiming Reimbursement

Q. How do I get reimbursed from my flexible spending accounts?

A. The answer depends on the type of claim. If you are eligible for reimbursement from:

• The HCFSA, you may be automatically reimbursed for eligible amounts resulting from claims processed as a participant in the ExxonMobil Medical Plan POS II "A" or "B" option, the ExxonMobil Dental Plan and/or claims processed by OptumHealth Vision for the ExxonMobil Vision Plan. For other types of expenses, you must file a claim form and attach adequate documentation.
• The DCFSA, you must file a claim form and attach adequate documentation.

The Health Care Flexible Spending Account

Aetna processes claims for the HCFSA as well as claims for the ExxonMobil Medical Plan POS II "A" or "B" option, the ExxonMobil Dental Plan and the ExxonMobil Vision Plan. If you participate in the ExxonMobil Medical Plan POS II "A" or "B" option, the ExxonMobil Dental Plan and/or the ExxonMobil Vision Plan, Aetna, on receiving a medical, dental or vision claim from you or a provider, processes the claim for the benefit due under these plans and then processes the claim for any pre-tax reimbursement. In most cases, you do not need to file a pre-tax claim form unless you have expenses not processed under these plans. You may not opt out of this automatic rollover process unless you have other health coverage that is secondary. In that case, you must notify Aetna so your claim can be processed properly.

OptumHealth Vision processes claims for the ExxonMobil Vision Plan. If you participate in this plan, and OptumHealth Vision processes a claim for the benefit due, you do not need to file a pre-tax claim form for these claims. If you have other vision expenses not processed by OptumHealth Vision under the ExxonMobil Vision Plan, you will have to file a claim form for pre-tax reimbursement with Aetna.

If you have eligible expenses that are not covered by a medical, dental or vision plan or you participate in plans other than the ExxonMobil Medical Plan POS II "A" or "B" option, the ExxonMobil Dental Plan or the ExxonMobil Vision Plan, to be reimbursed you must file a completed Pre-Tax Spending Plan claim form, and:

• A description of the expense;
• A statement that the expense is not covered by any plan or a statement showing what was not covered by the other plan; and
• Proof of payment.

Over-the-Counter Drug Purchases

Reimbursement of the over-the-counter (OTC) purchases that qualify as "expenses relating to medical care" are eligible for reimbursement through the HCFSA. See Eligible Expenses on page 16 for more information about what is eligible for reimbursement.

The Dependent Care Flexible Spending Account

You must submit a claim form attaching appropriate receipts showing the name, address, Social Security (or taxpayer identification) number of the provider, as well as the period covered. A copy of a canceled check with a fully completed claim form is sufficient if you do not have a bill, voucher or receipt.

Filing Claims for Both Accounts

• You must file claims for expenses incurred during the plan year (January 1 through December 31) so that they are received by Aetna no later than April 15 (or if April 15 falls on a non-business day, on the next succeeding business day) following the end of the plan year. The Plan will not reimburse you for claims received after that date unless you have proof that the claims were to be delivered by the 15th. For example, if a facsimile, the facsimile confirmation to the correct telephone number must be before midnight April 15th. If mailed using a mail or delivery service, the delivery receipt must indicate a guaranteed date by April 15th.
• If you need to submit a claim, but do not yet have all the required supporting documents, submit the claim so Aetna receives it before the claim filing deadline. You can then submit the supporting documentation later, but in no event can documentation be accepted after the end of the year in which the claim has been submitted. Documentation submitted to support a claim must show a description of the service or provider co-payment received for reimbursement.
• You forfeit any funds remaining in your accounts for which valid claims have not been received by April 15 following the end of the plan year. Forfeited funds revert to the Plan.
• The Plan pays you directly. It does not pay providers. You will receive an explanation of payment and a statement showing the status of your account.
• If you file a claim near the April 15 deadline, you may wish to use a mail or delivery service providing a receipt that will help track the claim.
• It is advisable to make photocopies of claims and all supporting materials.

You will receive a quarterly statement of the status of your account. You may also find current account information on Aetna Navigator^TM.