Index

About Pre-Tax Spending

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

Health Care Flexible Spending Account

Dependent Care Flexible Spending Account

Claiming Reimbursement

Tax Implications

Continuation Coverage

Administrative and ERISA Information

Eligibility and Enrollment

Q. Who is eligible to enroll in the ExxonMobil Pre-Tax Spending Plan?
A. Most U.S. dollar-paid employees of Exxon Mobil Corporation and participating affiliates are eligible to participate in the Plan.

Eligibility

Full-time employees not hired on a temporary basis (also called "regular employees") are eligible their first day of employment. This includes an employee who is classified as a non-regular employee, but who has been designated as an Extended Part-Time Employee under his or her employer's employment policies relating to flexible work arrangements.

Leased employees as defined in the Internal Revenue Code, temporary or part-time employees (classified as "non-regular employees"), barred employees or special agreement persons are not eligible to participate in the Plan. A barred employee is an employee who is covered by a collective bargaining agreement, except to the extent participation is provided under such agreement.

A special-agreement person is, generally, a person paid on a commission or commission salary basis other than a person paid while employed by the Marketing department of ExxonMobil; an employee providing service to a non-affiliated organization that pays the person's salary or wages; or an employee working pursuant to an agreement that specifically excludes the person from coverage for benefits.

Retirees are not eligible to participate in the Plan because they do not receive taxable wages.

Initial and Annual Enrollment

• Employee Contributions. Participants in the Medical, Dental and Vision Plans are automatically enrolled to pay their monthly contributions on a pre-tax basis through the Plan. You may decline this tax-savings feature, but you must decline it every year during annual enrollment period and each time you make a change to your elected benefits - e.g. if you change the level of coverage in the Dental Plan in order to continue paying on an after-tax basis, you must elect to opt out again.
• To participate in the Health Care Flexible Spending Account (HCFSA), you must enroll each year during the annual enrollment period.
• To participate in the Dependent Care Flexible Spending Account (DCFSA), you must enroll each year during the annual enrollment period.

• Within 30 days of your date of hire, you may enroll in the HCFSA or DCFSA parts of the Plan to cover expenses for the rest of that calendar year. You must enroll again each year to participate in one or both of the flexible spending accounts. You also may decline paying your monthly medical, dental and vision contributions on a pre-tax basis at this time.

Changes During the Year - Medical, Dental and Vision Plans (Health Plans) Pre-Tax Contributions

The following is a quick reference table as discussed more fully below.

If this event occurs...	You may...
Marriage	Enroll yourself and spouse and any eligible dependents or change your Medical Plan Option
Divorce - Employee enrolled in Health Plans	Change your level of coverage. You may not drop coverage for yourself or other covered eligible dependents.
Divorce - Employee loses coverage under Spouse's health plans	Enroll yourself and other dependents that might have lost eligibility for Spouse's health plans.
Gain a dependent through birth, adoption or placement for adoption, marriage or guardianship.	Enroll new dependents and change Medical Plan Option.
Death of a spouse or other eligible dependent.	Change your level of coverage. You may not drop coverage for yourself or other covered eligible dependents.
You or a dependent loses eligibility under another employer's group health plan or other employer contributions cease which creates a "HIPAA special enrollment" right.	Enroll yourself and other dependents that might have lost eligibility. This only pertains to the Medical Plan. Change your level of coverage and change Medical Plan Option.
Loss of dependent's eligibility (i.e., no longer a tax dependent).	Change your level of coverage. You may not drop coverage for yourself or other eligible dependents.
You lose eligibility because of a change in your employment status, e.g., regular to non-regular.	Your Health Plan participation will automatically be termed at the end of the month.
You gain eligibility because of a change in your employment status, e.g. non-regular to regular.	Enroll yourself or any eligible dependents in Health Plans.
Termination of Employment by spouse or other dependent or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse's or dependent's plan in which you or they were enrolled.	Enroll yourself and other dependents that may have lost eligibility under the spouse's or dependent's plan in Health Plans and change your Medical Plan Option.

6

Your former spouse is ordered to provide coverage to your children through a QMSCO.	End the dependent's coverage, change level of coverage and terminate your participation in Health plans.
Commencement of Employment by spouse or other dependent or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under another employer's plan.	End other dependent coverage and terminate participation in Health Plans if the employee represents that they have or will obtain coverage under the other employer plan.
Change in worksite or residence affecting eligibility to participate in the elected Medical Plan Option.	Change your Medical Plan Option and change level of coverage. You may not drop coverage for yourself or other eligible dependents.
Judgment, decree or other court order requiring you to cover a dependent (Begin a QMSCO).	Change your Medical Plan Option and change level of coverage.
Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court.	Enroll in the same Health Plans you had prior to termination.
Termination of employment and rehire after 30 days.	Enroll in Health Plans as a new hire.
You are covered under your spouse's medical plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year.	Enroll yourself and eligible dependents in the Health Plans.
You begin a leave of absence.	Call Benefits Administration 1-800-262-2363
You return from a leave of absence of more than 30 days (paid or unpaid).	Call Benefits Administration 1-800-262-2363

All changes will be allowed if the medical/dental/vision change is made in EDA within 30 days of the event or the form is received by the Benefits Administration Office within 60 days of the event. For most events, the effective date will be the first of the month after the forms are received or the transaction is completed in EDA. Subject to any enrollment rules applicable to a Medical Plan Option, an employee may add a dependent effective the first day of a month if required contributions are made on a pre-tax basis and adding the dependent does not change the amount of required contributions.

Loss of Other Health Coverage. You may enroll or add eligible dependents when you or your dependent loses other health coverage. Enrollment can be requested when the individual loses eligibility for the other coverage. You must enroll within 60 days of the loss of coverage. The resulting coverage is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change Medical plan options at this time.

Entitlement to Medicare or Medicaid. If you, your spouse, or dependent who is enrolled becomes entitled to coverage (i.e., becomes enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) (Public Law 89-97 (79 Stat. 291)) or Title XIX of the Social Security Act (Medicaid) (Public Law 89-97 (79 Stat. 343)), other than coverage consisting solely of benefits under section 1928 of the Social Security Act (the program for distribution of pediatric vaccines), you may cancel coverage for that individual. 

Birth, Adoption or Placement for Adoption. You may enroll or add eligible dependents after the birth, adoption or placement for adoption of a child. You must enroll within 60 days of the birth, adoption or placement for adoption that triggered the enrollment opportunity. Enrollment is effective not later than the date of such birth, adoption or placement for adoption; however, if you enroll more than 30 days after the birth, adoption or placement for adoption, you will be required to pay the contributions for the period that is prior to the enrollment action on an after-tax basis, with pre-tax beginning the first of the month following the receipt of the election. You may also at this time change Medical plan options.

Marriage. You may enroll or add eligible dependents after marriage. You must enroll within 60 days of the marriage and enrollment is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change Medical plan options at this time. 

Loss of Dependent. You are responsible for ending coverage with Benefits Administration when your enrolled spouse or dependent is no longer eligible for coverage. If you do not complete your change within 60 days, any contributions you make for ineligible dependents will not be refunded and your pre-tax contributions will not be reduced until the beginning of the next calendar year. Any claims paid after the loss of eligibility must be repaid by you.

Transfer or Change in Residence. If you move from one location to another, and the move makes you no longer eligible for the selected Medical Plan option, you may change from your current Medical Plan option to one that is available in your new location. You may not make any other changes. For more information, call Benefits Administration.

Coverage Change. If you are covered under your spouse's medical plan and the plans coverage changes to a lesser coverage with a higher deductible mid-year, then you may enroll and add eligible dependents. If the cost for coverage under your spouse's health plan significantly increases or there is a significant curtailment of coverage that permits revocation of coverage during a plan year and you drop that coverage, you will be able to sign up for medical coverage for yourself and your eligible dependents. You must enroll within 60 days following the date you lose coverage under your spouse's plan.

Significant Curtailment of Benefits with Loss of Coverage. If during the year it is determined by the Administrator-Benefits that there has been a substantial decrease in the medical care providers available under an option or a reduction in the benefits for a specific type of medical condition or treatment with respect to which you or your spouse or dependent is currently in a course of treatment; or any other similar fundamental loss of coverage, then you may be allowed to elect to participate under another benefit package option providing similar coverage or to drop coverage if no similar benefit package option is available.

Changes During the Year - Health Care FSA

The pre-tax Plan permits you to increase, decrease, revoke or elect to participate in the Health Care FSA during the Plan only as provided in the following chart .

Changes in your elections must be consistent with the changes in status and the change must be made within 30 days of the event.

If this occurs...	You may...
Marriage	Enroll or increase your election because of the newly eligible spouse.
Divorce	Revoke or decrease your election because your spouse is no longer eligible.
Divorce - Employee loses coverage under Spouse's Health Plans.	Enroll or increase.
Gain a dependent through birth, adoption or placement for adoption, marriage or guardianship.	Enroll or increase your election because of the newly eligible dependent.
Move or change residence.	You are not eligible to make any changes.

8

Change in medical or your financial condition.	You are not eligible to make any changes.
Loss of dependent's eligibility (e.g., no longer a tax dependent).	Revoke or decrease your election.
You lose eligibility because of a change in your employment status, (e.g., regular to non-regular or you begin a leave of absence).	Revoke your election. You may continue the coverage during the leave on an after-tax basis until the end of the year in which the leave commenced.
You gain eligibility because of a change in your employment status, (e.g. non-regular to regular).	Enroll.
Termination of Employment by spouse or other dependent or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse or dependent's plan.	Enroll or increase your election.
Your dependent becomes eligible for Medicare or Medicaid.	Revoke or decrease your election.
Commencement of Employment by spouse or other dependent or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under spouse or dependent's plan.	May decrease or cease election if you gain eligibility under spouse's or dependent's plan. Your election to cease or decrease coverage for that individual (including yourself) corresponds only if coverage for that individual becomes effective or is increased under the other employer's plan.
Job transfer requiring relocation including one affecting eligibility to participate in an HMO.	You are not eligible to make any changes.
Provider leaves plan option (POS or HMO).	You are not eligible to make any changes.
Termination of employee and rehire within 30 days or retroactive reinstatement ordered by court.	Elections effective at termination are automatically restored unless another event has occurred which allows a change.
Termination of employment and rehire after 30 days.	Enroll as a new hire.
You are covered under your spouse's medical plan and plan change's coverage to a lesser coverage with a higher deductible mid-year.	You are not eligible to make any changes.
You begin a leave of absence.	Call Benefits Administration 1-800-262-2363.
You return from a leave of absence of more than 30 days (paid or unpaid).	Call Benefits Administration 1-800-262-2363. Upon return, you have the right to reinstate coverage at prior coverage level (and make-up unpaid contributions) or at a level reduced pro rata for the missed contributions. The make-up contributions may be made on a pre-tax basis even if straddle more than one year. In either case, you may not submit expenses for the period during which you did not continue your coverage.

9

Death of a spouse or other eligible dependent.	Revoke or decrease.
Death of a spouse where employee is covered by spouse's employer's group health plan.	Enroll or increase or decrease.
Judgment, decree or other court order requiring you to cover a dependent. (Begin a QMSCO).	Enroll or Increase.
Another parent is ordered to provide coverage to your child through a QMSCO.	Revoke or decrease your election if coverage actually provided.

Changes During the Year - Dependent Care FSA

The pre-tax Plan permits an employee to increase, decrease, revoke or elect to participate in the Dependent Care FSA during the Plan only as provided in the following chart. 

Changes in your elections must be consistent with the change in status and the change must be made within 30 days of the event.

If this occurs...	You may...
Marriage	Revoke or decrease (e.g., spouse does not work and cares for the children at home). Enroll of increase (e.g., children are brought into family who now need daycare).
Divorce or Death of Spouse.	Enroll or increase (e.g., now need daycare). Revoke or decrease (e.g., stepchildren no longer qualifying children).
Gain a dependent through birth, adoption or placement for adoption, marriage or guardianship.	Enroll or increase your election if newly eligible dependent needs dependent care.
Move or change residence.	You are not eligible to make any changes.
A dependent is no longer your dependent.	You can revoke or decrease your election (e.g., stepchildren no longer qualifying children).
You or your spouse change to or from part-time or full-time employment (excludes change to extended part-time status).	Enroll, increase, revoke or decrease your election.
You or your spouse change work schedules which change either hours of dependent care required or the amount of dependent care costs.	Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs.
Job transfer with or without relocation.	Enroll, increase, revoke or decrease your election amount only if the relocation results in a change to dependent care costs.

10

Change in the amount paid for dependent care.	Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs (e.g., awarded a scholarship or other subsidy for childcare).
Change from one dependent care center to another one that charges a different rate.	Enroll, increase, revoke or decrease your election amount consistent with the change in qualified dependent care expense.
Your child reaches age 13 and is no longer a qualifying dependent.	Revoke or decrease your election amount consistent with the change in dependent care costs.
Change in home dependent care provider, (e.g., change to a nanny-sharing arrangement).	Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs.
Loss of dependent's eligibility (e.g., no longer a tax dependent).	Revoke or decrease your election.
You lose eligibility because of a change in your employment status, (e.g., regular to non-regular).	Revoke your election.
You begin a leave of absence.	Call Benefits Administration 1-800-262-2363.
You return from a leave of absence of more than 30 days (paid or unpaid).	Call Benefits Administration 1-800-262-2363.
Death of qualifying dependent	Revoke or decrease, (e.g., care no longer needed).

Annual Enrollment
Each year, as part of the annual enrollment process you will receive enrollment instructions. You must enroll by the published deadline in order to participate in one or both of the flexible spending accounts for the next year. Be sure to budget carefully because the Internal Revenue Service has strict rules that apply to spending accounts. Any amounts in the HCFSA and/or DCFSA at the end of the plan year that are not used to reimburse eligible expenses must be forfeited.

Changing Your Election

The Plan is governed by federal and state income tax laws and regulations, and the provisions of the Plan document. Once you make an election — contributions on a pre-tax or after-tax basis and/or amounts to the flexible spending accounts — your election must remain in effect for the entire plan year unless you have a change in status.

When you have a change in status, you can make changes as follows:

• Election for medical, dental and vision plan contributions paid on a pre-tax or after-tax basis.
  • Your contributions are paid on a pre-tax basis when you enroll for medical, dental and vision plan coverage. You may change this election (pay after-tax) when you enroll or within 60 days of a change in status. On the other hand, if you are paying your contributions on an after-tax basis, you may elect to pay on a pre-tax basis with a change in status. Also, if you are paying on an after-tax basis and you change your level of coverage (i.e. employee to family), in order to continue paying on an after-tax basis, you must elect to opt out again.
  • Make your election on EDA or by submitting a Medical, Dental and Vision Authorization Form. Your EDA election must be done within 30 days of the event or the form must be received by Benefits Administration within 60 days of the change in status. Depending on the event, the change to your election is effective as of the first of the month following the change in status or the actual date of the event.
  • You are not allowed to make changes after the 60-day period until the next annual enrollment period or until another change in status.

• HCFSA and/or the DCFSA election.
  • As stated in the charts on page 5, with a change in status, you may increase, decrease or cancel an election of pre-tax dollars for unreimbursed, out-of-pocket, eligible expenses in either one or both accounts - the HCFSA (medical/dental/vision expense) and/or the DCFSA (dependent care). Your elections to the HCFSA and/or DCFSA must be made separately within 30 days of the event. Be sure to budget carefully because any unused amounts in the HCFSA and/or DCFSA must be forfeited.
  • Make your election using Employee Direct Access (EDA) or submit your Flexible Spending Account - Enrollment/Change Form. Your EDA election or form must be received by Benefits Administration within 30 days following the change in status. Your adjusted spending account election is generally effective the first of the month following your election. If you decrease your election, you may only file claims for eligible expenses totaling the new lower amount incurred after the effective date of the change. For any year, you may only reduce your election for the remainder of the year to the amount that is greater than or equal to the amount already contributed. If you cancel your election (reduce to zero), you may only file claims for eligible expenses incurred before you changed your election.
  • If your election is not received by Benefits Administration within 30 days of the change in status, you may not make a new pre-tax spending account election or change your current pre-tax spending account election until you have another change in status or until the next annual enrollment period.

The plan year is the calendar year, January 1 through December 31.

You may only make changes to your elections through EDA (located on the ExxonMobil Me HR Intranet site) if they are made within 30 days after the event. Otherwise, you must contact Benefits Administration to obtain an enrollment form to make a change. Forms are also available from Benefits Administration for those individuals who do not have access to EDA.

Effective Date of Change
Your election is effective on pre - tax basis the actual date of the event only for births, adoptions, and placements for adoption if the election is received by Benefits Administration within 30 days of the event. With regard to all other events, your election is effective the first of the month following receipt of your election, but if the transaction is completed in EDA or the form is received by the Benefits Administration Office on the first day of a month, it is effective that day. Annual elections cannot be decreased to less than the amount already contributed at the time the election is received.

Enrollment Mistakes

If you have elected to participate in the DCFSA when you don't have any children under the age of 13, and your written request to revoke your election is received within the first 90 days after the effective date of the election, Benefits Administration may revoke your election prospectively if the supporting evidence clearly shows that the election was a mistake. If you fail to request a change within the first 90 days, no change will be made and you will forfeit the contributions made for the entire year. 

If you discover after the effective date of an election any other enrollment mistake, it may be possible to allow a change, but only if Administrator-Benefits concludes that (1) there is "clear and convincing evidence" that you made a mistake; (2) the mistake is of a type that can be corrected; and (3) the correction is appropriate. You must submit your appeal to change to the Administrator-Benefits the election within 90 days of the effective date of the election's effective date.

Leaves of Absence and FSA

During a paid leave you may continue to participate in the HCFSA. You would continue your monthly contributions, file claims and receive reimbursement for eligible expenses, subject to claim filing deadlines.

However, during an unpaid Leave of Absence you may not continue to participate in the DCFSA. 

If you choose to continue participating in the HCFSA during an unpaid leave, you may continue to file claims and receive reimbursements for eligible expenses. Your contributions must be paid monthly on an after-tax basis during your leave or in a lump sum on a pre-tax basis (if taxable compensation is available) prior to beginning your leave.

You may also choose to revoke your election and discontinue your participation in the Plan. If you revoke your election while on leave of absence, expenses you incur during the period of revocation will not be reimbursable from the Plan. 

Leaves that last less than 30 days do not affect your eligibility to participate in either the HCFSA or the DCFSA and such a leave is not a change in status which permits changes. Once you return to work, contributions will be adjusted for the time you were absent. 

Upon return from a leave that lasts more than 30 days; if you return in the same calendar year, you will be reinstated to your prior coverage at a level reduced pro rata for the missed contributions. For example, assume that Maria elected $1,200 in health FSA coverage for the plan year and paid $100 per month for the coverage. On April 1, after submitting no claims for reimbursement, Maria begins a three-month leave. She does not elect to continue coverage. When Maria returns on July 1, she will have $900 reinstated ($1,200 minus $300 in missed contributions) at a cost of $100 per month for the remainder of the year. Expenses incurred during the period that the HCFSA was not in force are not eligible for reimbursement.

Participation When Employment Ends

When you leave ExxonMobil, your coverage under the Plan will end on the last day of the month following your termination or retirement date. Reimbursement from the HCFSA for expenses you incur after your termination or retirement is not permitted unless you are offered and elect COBRA coverage for the HCFSA. Health care expenses you incur prior to termination or retirement will be reimbursed up to the amount of your projected election for the year. Dependent care expenses you incur prior to termination or retirement will be reimbursed up to the amount you contributed. 

If you die as a participating employee, your surviving spouse, the executor or administrator of your estate or a court-appointed party may file claims for eligible expenses incurred before your death.

Continuation Coverage (COBRA)

Under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985), you may be entitled to continue coverage in the HCFSA for the remainder of the year and to receive reimbursement for eligible expenses incurred following termination or retirement. You will be allowed to elect COBRA coverage only if the maximum amount available to you from the HCFSA for the remainder of the year is greater than or equal to your required contribution for the remainder of the year. During the period of COBRA coverage, you continue your contributions to the plan for the amount of your current election for the HCFSA plus a two percent administrative fee. Because you would no longer be receiving taxable pay from which your elected amount can be deducted, your contributions would be made on an after-tax basis. Please see the Continuation Coverage section on page 31 for more information.