About the Medical Plan

Basic Plan Features

The Prescription Drug Program

Mental Health and Chemical Dependency Care

Covered Expenses

Exclusions

Payments

Claims

Partners in Health

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Eligibility and Enrollment

Q. What are the Medical Plan's eligibility requirements?

A. Most U.S. dollar payroll employees of Exxon Mobil Corporation and participating affiliates are eligible for this Plan.

Generally, you are eligible if:

• You are a regular employee.
• You are an Extended Part-time Employee.
• You are a retiree.
• You are a survivor, which means an eligible family member of a deceased regular or extended part-time employee or retiree.
• You are an expatriate employee required to participate in the Medical Plan.

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 or receives a lump-sum settlement 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

If you were participating in either the Comprehensive Medical Plan of Mobil Oil Corporation or the Superior Oil Medical Plan on March 31, 2004, you are eligible to elect coverage in the ExxonMobil Medical Plan. In addition, individuals who are eligible family members may be eligible for coverage.

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.

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.

For expatriate employees who are not currently enrolled in the Medical Plan, coverage for the expatriate employee will be effective on the first date the employee is scheduled to begin the expatriate assignment. Coverage for eligible family members of an expatriate employee will be effective on the earlier of the date the expatriate employee enrolls the family member, or the date the eligible family member accompanies the employee on assignment.

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 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 Medical Plan 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 Medical Plan 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 Plan 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 MEDICAL PLAN OPTION, SUCH AS FROM AN HMO 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. For example, you may switch from a POS II option to an HMO option if there is one in your area. 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 Medical Plan 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 Plan coverage level (but not your Plan 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.

13

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.
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.

14

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 58 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. You may not make any other changes. 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 an HMO 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 57 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 57 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.