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Eligibility and Enrollment
Q. What are the Medical Plan's eligibility requirements?
A. Most U.S. dollar payroll regular employees of Exxon Mobil Corporation and participating affiliates are eligible for this Plan.
Generally, you are eligible if:
You are not eligible if:
- You participate in any other employer medical plan to which ExxonMobil contributes.
- You fail to make any required contribution toward the cost of the Plan.
- You fail to comply with general administrative requirements including but not limited to enrollment requirements.
- You lost eligibility as described under the Loss of Eligibility section
on page 18.
Eligible Family Members
You may also elect coverage for your eligible family members including:
- Your spouse. When you enroll your spouse for coverage, you may be required to provide proof that you are legally married.
- Your child(ren) under age 26. Coverage ends at the end of the month in which they reach age 26. If your situation involves a family member other than your biological or legally adopted child, call Benefits Administration.
- Your totally and continuously disabled child(ren) who is incapable of self-sustaining employment by reason of mental or physical disability, that occurred prior to otherwise losing eligibility and meets the Internal Revenue Service's definition of a dependent.
- A child or spouse of a Medicare-eligible retiree enrolled in the ExxonMobil Medicare Supplement Plan, as long as that spouse or child is not eligible for Medicare.
Refer to Key Terms for definitions of eligible family members,
child,
suspended retiree,
spouse, and
Qualified Medical Child Support Order.
Suspended Retiree
A person who becomes a retiree
due to incapacity within the meaning of the ExxonMobil Disability Plan and
who begins long-term disability benefits under that plan, but whose
benefits stop because the person is no longer incapacitated is a suspended
retiree and not eligible for coverage until the earlier of the date the
person:
- Reaches age 55; or
- Begins his or her benefit under the ExxonMobil Pension Plan at which time the person
is again considered a retiree and may enroll.
The family members of a deceased suspended retiree will
be eligible for coverage under this Plan only after the occurrence of the
earlier of the following:
- The date the suspended retiree would have attained age
55; or
- The date a survivor
begins receiving a benefit due to the suspended retiree's accrued
benefit from the ExxonMobil Pension Plan.
Special Eligibility Rules
A person who otherwise is not a spouse but who, as a dependent of a former Mobil employee
who participated in or received benefits under a Mobil-sponsored plan or program prior
to March 1, 2000,
is considered an eligible dependent as long as that person's eligibility for coverage as a dependent
under a Mobil-sponsored plan would have continued.
Classes of Coverage
You can choose coverage as an:
- Employee or retiree only;
- Employee or retiree and spouse;
- Employee or retiree and child(ren); or
- Employee or retiree and family.
There are also classes of coverage for extended part-time
employees, surviving spouses and family members of deceased employees and retirees, spouses and family members of retirees covered by the ExxonMobil Medicare Supplement Plan, and employees on certain types of leaves of absence.
For employees on an approved leave of absence, their
contribution rate will change from the employee contribution rate to the
Leave of Absence contribution rate as shown in the table on the next page.
| |
Leave of Absence Contribution Rate begins |
| Type of Leave |
Immediately |
No later than
after 6 months |
No later than
after 12 months |
| Military (voluntary) |
X |
|
|
| Civic Affairs |
X |
|
|
| Health / Dependent Care |
|
X |
|
| Education |
|
X |
|
| Personal |
|
|
X |
Each class of coverage described in this section has its own contribution rate. Employees
contribute to the Medical Plan through monthly deductions from their pay on
a pre-tax or after-tax basis. Retirees and survivors receiving monthly
benefit checks from ExxonMobil pay by deductions from these checks on an
after-tax basis. Other retirees or survivors and participants with
continuation coverage pay by check or by monthly draft on their bank
account.
Double Coverage
No one can be covered more than once in the Medical
Plan. You and your spouse cannot both enroll as employees (or retirees)
and elect coverage for each other as eligible family members. If you and
your spouse work for the company or are both retirees you may both be
eligible for coverage. Each of you can be covered as an individual
employee (or retiree), or one of you can be covered as the employee (or
retiree) and the other can be an eligible family member.
Also, if you have children, each child can only be covered by one of
you.
In addition, a marriage between two ExxonMobil employees
does not allow enrollment or cancellation in any of the ExxonMobil
health plans if either employee is then making contributions on a
pre-tax basis. In order to change your coverage, you need to wait until
you experience a change in status that allows coverage changes or Annual
Enrollment.
How to Enroll
As a newly hired employee, if you enroll in the Medical
Plan within 30 days of your start date, coverage begins the first day of
employment. If you enroll between 31 and 60 days from your date of hire,
coverage will be effective the first day of the month following receipt of
the forms by Benefits Administration. You must enroll everyone in the same
option.
If you are eligible for the ExxonMobil Pre-Tax Spending
Plan, you will be enrolled to pay your monthly contributions on a pre-tax
basis unless you annually decline this feature. Your monthly pre-tax contributions
and class of coverage must remain in effect for the entire plan year,
unless you experience a change in status. (See Changing
Your Coverage on page 12).
As a current employee, if you are not covered by a medical plan to which ExxonMobil contributes and would like to enroll in the Medical Plan, you may do so but all of your contributions through the end of the current calendar year will be on an after-tax basis unless you have a subsequent change in status which will allow you to enroll in the ExxonMobil Pre-Tax Spending Plan. Coverage is effective the first of the month following completion of enrollment.
You can enroll eligible family members only if you are enrolled in an EMMP option or in the ExxonMobil Medicare Supplement Plan. You can enroll in a Medical Plan option by using Employee Direct Access (EDA) available on the ExxonMobil Me HR Intranet site. Enrollment forms are also available from Benefits Administration for those individuals who do not have access to EDA.
You may be requested to provide documents at some future date to prove that the family members you enrolled were eligible (e.g., marriage certificate, birth certificate). If you fail to provide such requested documents within 90 days of the request, coverage for the family members will be cancelled the first of the following month and you may be subject to discipline up to and including termination of employment for falsifying company records.
If you are declining enrollment for yourself or your family members (including your spouse) because of other group health plan coverage, you may enroll yourself and your family members in any available EMMP option if you or your family members lose eligibility for that other group health plan coverage (or if the employer stops contributing toward your and/or your family member(s)' other coverage). In addition, you may enroll yourself or your family members in any available EMMP option within 60 days after marriage (with coverage effective the first of the following month) or after birth, adoption or placement for adoption (with coverage retroactive to the birth, adoption or placement for adoption).
Under the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009 you may change your EMMP election for yourself and any eligible family members within 60 days of either (1) termination of Medicaid or CHIP coverage due to loss of eligibility, or (2) becoming eligible for a state premium assistance program under Medicaid or CHIP coverage. In either case, coverage is effective the first of the month following receipt of the forms by Benefits Administration.
CAUTION: SHOULD YOU DECIDE TO RETROACTIVELY CHANGE TO A DIFFERENT EMMP OPTION, SUCH AS FROM AN AETNA SELECT OR CIGNA OPTION TO A POS II OPTION, YOUR BENEFITS FOR ANY MEDICAL SERVICES WHICH WERE RECEIVED ON OR AFTER THE EFFECTIVE DATE OF COVERAGE FOLLOWING THE BIRTH, ADOPTION OR PLACEMENT FOR ADOPTION MAY NOT BE COVERED OR MAY BE REIMBURSED AT A LOWER BENEFIT LEVEL. MAKE SURE YOU FULLY UNDERSTAND THE IMPACT OF CHANGING OPTIONS BEFORE MAKING YOUR ELECTION.
Annual
Enrollment
Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, you can switch from your current option to another available option.. This is also the time to make changes to your coverage by adding or deleting family members. Family members may be added or deleted for any reason but they must be deleted if they are no longer eligible. Changes elected during annual enrollment take effect the first of the following year.
Employees are automatically enrolled in the Pre-Tax
Spending Plan to pay monthly contributions on a pre-tax basis unless
this feature is declined each time. This choice is only available during
the annual enrollment period or with a change in status.
If you pay your monthly contributions on an after-tax basis and would like to continue making contributions on an after-tax basis for the following year, you must elect to do so each year during Annual Enrollment and after each change in status. Otherwise, your contributions will be switched to a pre-tax basis beginning the first day of the following year. As a retiree, you will pay your contributions on an after-tax basis through payroll deduction (if eligible), check, or bank draft.
During Annual Enrollment, changes to your EMMP coverage
(option or contributions) do not automatically adjust your coverage or
contributions to other plans such as the ExxonMobil Dental Plan, ExxonMobil Vision Plan or the
flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes
to those plans must be made separately during Annual Enrollment.
Changing Your Coverage
An employee may add a family member effective the first day of a month if required contributions are made on a pre-tax basis and adding the family member does not change the coverage level or if you are enrolled on an after-tax basis, you may make changes to your EMMP coverage level (but not your EMMP option) and add eligible family members at any time.
To make a change to your coverage you may also wait until Annual Enrollment or until you experience one of the following Changes in Status.
Changes in Status
This section explains which events are considered changes in status and what changes you may make as a result. If you have a change in status, you must complete your change within 60 days. If you do not complete your change within 60 days, changes to your coverage may be limited.
Important Note: Your election made due to a change in status cannot be changed after the form is received by Benefits Administration or the transaction is completed in EDA if it changes your pre-tax contributions.
The following is a quick reference guide to the Changes
in Status that are discussed in more detail after the table.
Changes During the Year - Medical/Dental/Vision (Health Plans)
| If this
event occurs... |
You may... |
| Marriage |
Enroll yourself and spouse and any eligible family members 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 family members. |
| Divorce - Employee loses coverage
under spouse's health plans |
Enroll yourself and other family members who might have lost eligibility for spouse's health plans. |
| Gain a family member through birth,
adoption or placement for adoption, marriage or guardianship |
Enroll new family member and change Medical Plan Option. |
| Death of a spouse or other eligible
family member. |
Change your level of coverage. You may not drop coverage for yourself or other covered eligible family members. |
| You or a family member 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 family members who might have lost eligibility. This only pertains to the Medical Plan. Change your level of coverage and change Medical Plan Option. |
| Loss of family member's eligibility (i.e.,
no longer a tax dependent) |
Change your level of coverage. You may not drop coverage for yourself or other eligible family members. |
| 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 family members in Health Plans. |
| Termination of Employment by spouse or other family member or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse's or family member's plan in which you or they were enrolled |
Enroll yourself and other family members who may have lost eligibility under the spouse's or family member's plan in Health Plans and change your Medical Plan Option. |
| Your former spouse is ordered to
provide coverage to your children through a QMCSO |
End the family member's coverage, change level of coverage and terminate their participation in Health plans. |
Commencement of Employment by spouse or other family member 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 family member's coverage and terminate their participation in Health Plans if the employee represents that they have or will obtain coverage under the other employer plan. You may also cancel coverage for yourself, if health care coverage is obtained through your spouse’s 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, or drop coverage for yourself or other eligible family members. |
| If you, your spouse, or family member becomes entitled to Medicare or Medicaid |
You may cancel coverage for you or the Medicare/Medicaid eligible family member. |
| Judgment, decree or other court order requiring you to cover a family member. (Begin a QMCSO) |
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 family members 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 form is received within 60 days of the event by the Benefits Administration Office or the change is made in EDA within 30 days. 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.
Birth, Adoption or Placement for Adoption
If you gain a family member through birth, adoption or placement for adoption, you may add the new eligible family member to your current coverage. You may also enroll yourself, your spouse, and all eligible children. You also may change your plan option. Coverage is effective on the date of birth, adoption or placement for adoption provided you complete the enrollment process within 60 days. You must add the new family member within 60 days even if you already have family coverage. See the Changing your Coverage section for additional circumstances in which changes can be made.
If you enroll your new family member between 31 and 60 days from the birth or adoption and your coverage level changes, you will pay the cost difference on a post-tax basis until the end of the month in which the forms are received by Benefits Administration. Beginning the first day of the following month your deduction will be on a pre-tax basis.
Sole Legal Guardianship or Sole Managing
Conservatorship
If you (or your spouse, separately or together) become the sole court appointed legal guardian or sole managing conservator of a child and the child meets all other requirements of the definition of an eligible family member, you have 60 days from the date the judgment is signed to enroll the child for coverage. You must provide a copy of the court document signed by a judge appointing you (or your spouse separately or together) guardian or sole managing conservator. Coverage will be effective as of the first of the month following your completion of the enrollment.
Marriage
If you are enrolled in the Plan, you can enroll your new spouse and his or her eligible family members (your stepchildren) for coverage. You also may change your plan option. If you are not already enrolled for coverage, you can sign up for medical coverage for yourself, your new spouse, and your stepchildren. If you gain coverage under your spouse's health plan, you can cancel your coverage. You must make these changes within 60 days following the date of your marriage or wait until Annual Enrollment
or another change in status. Coverage will be effective as of the first
of the month following your completion of the enrollment.
Death of a Spouse
If you lose coverage under your spouse's health plan, you can sign up for medical coverage for yourself and your eligible family members. You must make these changes within 60 days following the date you lose coverage or wait until Annual Enrollment or another change in status. If you and your family members are enrolled in the ExxonMobil Medical Plan, any stepchildren will cease to be eligible upon your spouse's death unless you are their court appointed guardian or sole managing conservator.
When a Child is No Longer Eligible
If an enrolled family member is no longer an eligible family member, coverage continues through the end of the month in which they cease to be eligible. In some cases, continuation coverage under COBRA may be available. (See page 59 for more details about COBRA.) You must notify and provide the appropriate forms to Benefits Administration as soon as a family member is no longer eligible. If you fail to notify and provide the appropriate forms to Benefits Administration within 60 days, the family member will not be entitled to elect COBRA. There may also be consequences for falsifying company records.
Divorce
In the case of divorce, your former spouse and any stepchildren are covered through the end of the month in which the divorce is final. You must notify and provide the appropriate forms to Benefits Administration as soon as your divorce is final. If you fail to notify and provide the appropriate forms to Benefits Administration within 60 days, the former spouse and family member will not be entitled to elect COBRA. There may also be consequences for falsifying company records. Please see the Continuation Coverage section of this SPD.
You may not make a change to your coverage if you and your spouse become legally separated because there is no impact on eligibility.
If you lose coverage under your spouse's health plan on account of divorce, you can sign up for medical coverage for yourself and your eligible family members. You must enroll within 60 days following the date you lose coverage under your spouse's plan or wait until Annual Enrollment or another change in status. Coverage will be effective as of the first of the month following your completion of the enrollment.
Transfer or Change 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. For more information, call
Benefits Administration.
See Information Sources at the front of this
SPD.
Leave of Absence
If you are on an approved leave of absence, you can continue coverage by
making required contributions directly to the Medical Plan by check. If
you chose not to continue your coverage while on leave, your coverage
ends on the last day of the month in which your leave began and you will
be required to pay for the entire month's contributions. If you fail to
make required contributions while on leave, coverage will end.
If the company should make any payment on your behalf to continue your coverage
while you are on leave and you decide not to return to work, you will be required
to reimburse the company for required contributions.
If you are on an approved leave of absence and the Leave
of Absence contribution rate begins, you may continue your coverage
by making your required contribution.
If you were on a leave that meets the requirements of the
Family and Medical Leave Act of 1993 (FMLA) or the Uniformed Services
Employment and Reemployment Rights Act (USERRA) and your coverage ended,
re-enrollment is subject to FMLA or USERRA requirements.
For more information, call Benefits Administration. See
Information Sources at the front of this
SPD.
Change in Coverage Costs or Significant
Curtailment
If the cost for coverage charged to you significantly increases or
decreases during a plan year, you may be able to make a corresponding
prospective change in your election, including the cancellation of your
election. If you choose to revoke your elected coverage option, you may
be able to elect coverage under another plan option. This provision also
applies to a significant increase in health care
deductible
or co-payment.
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 family members. You must enroll within 60 days
following the date you lose coverage under your spouse's plan or wait
until Annual Enrollment or another change in status. Coverage due to a change in status will be
effective as of the first of the month following your completion of the
enrollment, or in the case of Annual Enrollment, the first of the following year.
Addition or Improvement of Option
If a new plan option is added or if benefits under an existing option are significantly improved during a plan
year, you may be able to cancel your current election in order to make an election for coverage
under the new or improved option.
Loss of Option
If a plan option is discontinued, you will be able to elect either to
receive coverage under another plan option providing similar coverage or
to drop medical coverage altogether if no similar option is available.
For example, if a POS II option is discontinued, you may elect another
option that has service in your area. You may also elect to discontinue
medical coverage altogether.
Remember, if you make your contributions on a pre-tax
basis and you experience any of the events mentioned previously, or if
you are newly eligible as a result of a change or loss of coverage under
your spouse's medical plan, it is your responsibility to complete your
change within 60 days of experiencing the event. If you miss the 60-day
notification period, you will not be able to make changes
until Annual Enrollment or until
you experience another change in status.
Other Changes that May Affect Your Coverage
If a Covered Family Member Lives Away from Home
Refer to page 24 for an explanation of coverage if your covered family member lives
away from home (for instance, a child away at school). Notify Aetna Member Services of
your family member's address for correct claims processing.
If You are a Retiree under Age 65
If you are a retiree under age 65, you and your family members who are not eligible for Medicare can continue to participate in the Plan. When you (as a retiree) or a covered family member of a retiree becomes eligible for Medicare, Medicare will become the primary plan for the retiree or the family member and benefits will be coordinated. The retiree or family member is no longer eligible for the Medical Plan, but is eligible to enroll in the EMMSP.
If You are an Extended Part-Time Employee
If you terminate employment as an extended part-time employee, you are not eligible to continue to participate in the Plan. You may be eligible
to elect continuation coverage for yourself and your eligible family members under COBRA provisions.
See page 58 for details.
If You Work Past Age 65
If you continue to work for ExxonMobil past age 65, although you are
eligible for Medicare, your ExxonMobil coverage remains in effect for you
and eligible family members and the Medical Plan is your primary plan.
Medicare benefits, if you sign up for them, will be your secondary
benefits. Medicare will coordinate its benefits with the POS II option.
If You or Your Covered Family Members Become Medicare Eligible for Any Reason
Employees or family members of an employee who become Medicare eligible, either due to age or Social Security disability status, are eligible to participate in any Medical Plan option as long as the employee remains as a regular employee. If the employee retires or dies, Medicare eligible covered family members must change to the ExxonMobil Medicare Supplement Plan and enroll in Medicare Parts A and B. When a retiree or a retiree's covered eligible family member becomes eligible for Medicare, either due to age or Social Security disability status, that person cannot participate in any Medical Plan option but will be eligible for the ExxonMobil Medicare Supplement Plan.
If You Die
If you die while enrolled, your covered eligible family members can continue coverage. Their eligibility continues with the
company contributions for a specified amount of time:
- If you have 15 or more years of benefit service at the time of
your death, eligibility continues until your spouse remarries, becomes eligible
for the ExxonMobil Medicare Supplement Plan or dies.
- If you have less than 15 years of benefit service,
eligibility continues for twice your length of benefit service or until your
spouse remarries, becomes eligible for the ExxonMobil Medicare Supplement
Plan, or dies, whichever occurs first.
Children of deceased employees or retirees may continue participation as long as
they are an eligible family member. If your surviving spouse
remarries, eligibility for your children also ends.
Special rules may apply to family members of individuals who become retirees due to
disability. See Suspended Retiree
below.
Eligible family members of deceased extended part-time employees are not eligible to continue to
participate in the Plan. These family members may be eligible to elect continuation coverage under
COBRA provisions. See page 58 for details.
If You Become a Suspended Retiree
If you are a retiree and you would otherwise lose coverage because you have become a suspended retiree
under the ExxonMobil Disability Plan (see page 8 for details), you may continue coverage for
yourself and all your family members who were eligible for plan participation before you became a
suspended retiree for either 12 or 18 months.
Coverage continues for 12 months from the date coverage would otherwise end if you received
transition benefits under the ExxonMobil Disability Plan. However, if you did not receive
transition benefits under the ExxonMobil Disability Plan, coverage continues for 18 months from
the date coverage would otherwise end. The cost of this continued coverage is 102% of the
combined participant and company contributions.
When Coverage Ends
Coverage for you and/or your family members ends on the earliest of the following dates:
- The last day of the month in which:
- You terminate employment (except as a retiree or due to disability);
- You elect not to participate;
- A family member ceases to be eligible (for example, a
child reaches age 26);
- A retiree
becomes a suspended retiree;
- You are no longer eligible for benefits
under this Plan (e.g., employment classification changes
from "regular employee" to "non-regular
employee" or from non-represented to represented
where you are no longer eligible for this Plan);
- You do not make any required contribution;
- A Qualified Medical Child Support Order
is no longer in effect for a covered family member;
- You, as a retiree, or your eligible family member
becomes eligible for Medicare and for the ExxonMobil
Medicare Supplement Plan;
- An expatriate employee's assignment to the
United States ends;
OR
- The date:
- You die;
- The Medical Plan ends;
- Your employer discontinues participation in the
Plan.
You are responsible for ending coverage with Benefits Administration when your enrolled spouse or family member is no longer eligible for coverage. If you do not complete your change within 60 days, any contributions you make for ineligible family members will not be refunded.
Loss of Eligibility
Everyone in your family may lose eligibility for Medical Plan coverage,
and you may be subject to disciplinary action up to and including termination
of employment if you commit fraud against the Medical Plan, for instance, by
filing claims for benefits to which you are not entitled. Coverage may also
be terminated if you refuse to repay amounts erroneously paid by the Medical
Plan on your behalf or that you recover from a third party. Your participation
may be terminated if you fail to comply with the terms of the Medical Plan and
its administrative requirements. You may also lose eligibility if you enroll persons who are not
eligible, for instance, by covering children who do not meet the
eligibility requirements.
Extended Benefits at Termination
You are entitled to extended coverage for as much as a year if you are terminated due to disability with
fewer than 15 years of service. This coverage is provided at no cost to you. This is considered a
portion of the COBRA continuation period. In order to assure coverage beyond this extension
period, you must elect COBRA upon termination of employment.
Several conditions must be met:
- The disability must exist when your employment terminates.
- The extension lasts only as long as the disability continues, but no longer than 12 months.
- This extension applies only to the employee who is terminated
because of a disability. Continuation coverage for eligible family members may be available through COBRA.
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