Index

About Dental

Dental PPO

Covered Expenses

Exclusions

Payments

Claims

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Eligibility and Enrollment

Q. What are the 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 dependent of a deceased regular or extended part-time employee or retiree.

You are not eligible if:

		You participate in any other employer dental 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 14.

Eligible Dependents

You may also elect coverage for your eligible dependents including:

• Your spouse. When you enroll your spouse for coverage, you may be required to provide proof that you are legally married.
• Your unmarried dependent child(ren) under age 25 who are not employed on a regular, full-time basis. Coverage ends at the end of the month in which they reach age 25. If your situation involves a dependent other than your biological or legally adopted child who lives with you, call Benefits Administration.
• Your totally and continuously disabled, unmarried dependent child(ren) 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 dependent 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 dependents, dependent 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 considered a suspended retiree and is not eligible for coverage until the earlier of the date the person:

• Reaches age 55, or
• Begins his or her retirement 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 Dental Plan. In addition, individuals who are eligible dependents 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 dependents of deceased employees and retirees 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 Dental 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 Dental Plan . You and your spouse cannot both enroll as employees (or retirees) and elect coverage for each other as eligible dependents. 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 dependent. 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 Dental Plan within 30 days of your start date, coverage begins the first day of employment. If you enroll between 31 and 60 days of your date of hire, coverage will be effective the first day of the month following receipt of the forms by Benefits Administration. 

You can enroll eligible dependents only if you are enrolled in this Plan. You can enroll in the Plan 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. 

Your monthly pre-tax contributions - what you might think of as premiums - will be paid on a pre-tax basis through the ExxonMobil Pre-Tax Spending Plan, unless you decline this feature when you enroll. Your monthly contributions and coverage option must remain in effect for the entire plan year, unless you experience a change in status. (See the Annual Enrollment and Changing Your Coverage sections.)

You may be requested to provide documents at some future date to prove that the dependents 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 dependents will be canceled retroactively without the refund of any contribution that you made, and you may be asked to repay any benefits that were paid on their behalf from the Plan. In addition, you may be subject to discipline up to and including termination for falsifying company records.

Under the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009, effective April 1, 2009, you may change your Plan election for yourself and any eligible dependents 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 enrollment.

Annual Enrollment
Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, you may elect to enroll yourself and your eligible dependents. Your coverage will always become effective January 1st of the following year. Dependents may be added or deleted for any reason but they must be deleted if they are no longer eligible. You can enroll/change benefits using Employee Direct Access (EDA) located on the ExxonMobil Me HR Intranet site. If you do not have EDA access, contact Benefits Administration. 

Employees will be enrolled in the Pre-Tax Spending Plan to pay monthly contributions on a pre-tax basis unless this feature is declined. This choice is only available during the annual enrollment period or with a change in status. 

If you pay your monthly contributions on a pre-tax basis, Annual Enrollment is the only time that you can make changes to your coverage unless you experience 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 during each 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 via payroll deduction (if eligible), check, or bank draft.

Pre-existing Conditions

Any dental diagnosis or treatment started before coverage begins is pre-existing and will not be covered. This provision also applies to your dependents. Here are some examples:

• Your dependent child is undergoing orthodontic work. None of this work is covered if the first appliance is inserted before coverage begins.
• You need full or partial dentures. If the necessary impression is taken before you begin coverage, expenses associated with the dentures are not covered.
• Your dentist diagnoses you with gum disease. If the diagnosis was made prior to your being a covered participant, expenses associated with the treatment of gum disease are not covered.

Pre-existing condition provisions do not apply if you are promoted from a represented job, where you were covered by another plan to which ExxonMobil contributed, to a non-represented job where you are no longer eligible for that plan.

Changing Your Coverage

If you pay your contributions on a pre-tax basis and would like to make a coverage change after you are first eligible, you must wait until Annual Enrollment or until you experience one of the following Changes in Status. If you experience a change in status, you must make the coverage change election within 60 days of the event.

You can enroll/change benefits using Employee Direct Access (EDA) available on the ExxonMobil Me HR Intranet site or by contacting Benefits Administration if you do not have EDA access.

If you are enrolled in the Dental Plan on an after-tax basis, you must wait until Annual Enrollment to make changes to your coverage unless it is due to losing or gaining an eligible dependent.

Changes in Status

Changes in status are events that allow you to make changes to your coverage if you pay for contributions on a pre-tax basis during the plan year. 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 of the event. If you do not complete your change within 60 days of the event, changes to your coverage may be limited.

Changes made to your dental coverage due to a change in status do not automatically adjust your coverage or contributions to other company plans such as medical plans or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes to those plans must be made separately.

Changes During the Year - Medical/Dental/Vision (Health Plans)

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 dependent through birth, adoption or placement for adoption, you may add the new eligible dependent to your current coverage. You may also enroll yourself, your spouse, and all eligible children. 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 dependent within 60 days even if you already have family coverage. If you do not enroll your new dependents within the first 60 days in the case of birth, adoption or placement for adoption, you can enroll them later during Annual Enrollment or with another change in status. 

If you enroll your new dependent 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 you and your spouse, separately or together) become the sole court appointed legal guardian or sole managing conservator of a Dependent Child and the child meets all other requirements of the definition of an eligible dependent, 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 may enroll your new spouse and any eligible dependents (your stepchildren who live with you) for dependent coverage. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself, your new spouse, and your eligible stepchildren. If you gain coverage under your spouse's dental 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 dental plan, you can sign up for dental coverage for yourself and your eligible dependents or you may change your level of coverage in the Dental Plan. 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 dependents are enrolled in the ExxonMobil Dental Plan, any stepchildren who live with you 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 dependent is no longer an eligible dependent (e.g., dependent gets married or gets a full time regular job), 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 32 for more details about COBRA.) You must notify Benefits Administration as soon as a dependent is no longer eligible. If you fail to notify Benefits Administration within 60 days, any contributions you are making to cover that dependent will continue until the end of the current plan year and the dependent will not be entitled to elect COBRA. You may also be liable for claims paid on behalf of the ineligible dependent as well as liable 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 Benefits Administration as soon as your divorce is final. If you fail to notify Benefits Administration within 60 days, any contributions you are making to cover that spouse and dependents will continue until the end of the current plan year and the spouse and dependent will not be entitled to elect COBRA. You may also be liable for claims paid on behalf of the ineligible spouse and dependent as well as liable 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; however, if your stepchildren no longer reside with you after a legal separation, they must be removed as they are no longer eligible to participate in the Dental Plan.

If you lose coverage under your spouse's dental plan on account of divorce, you can sign up for dental coverage for yourself and your eligible dependents. 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 Dental Plan option, you may not drop coverage for yourself or other eligible dependents. 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 Dental 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 other types of leaves, you may be subject to pre-existing conditions limitations when you return to work and enroll in the Dental Plan if you don't continue your coverage while on leave.

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. This provision also applies to a significant increase in the dental deductible or co-payment.

Change In or Loss of Coverage Under Your Spouse's Dental Plan
If the cost of coverage under your spouse's dental plan significantly increases or there is a significant curtailment or loss of coverage that permits the revocation of coverage during a plan year, you will be eligible to elect dental coverage for yourself and any eligible dependents. 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.

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 the plan is discontinued, you will be able to elect either to receive coverage under another plan option providing similar coverage or to drop dental coverage altogether if no similar option is available.

Other Changes That May Affect Your Coverage

If You are a Retiree under Age 65
If you are a retiree under age 65, you and your dependents who are not eligible for Medicare can continue to participate in the Plan. When you (as a retiree) or a covered dependent become eligible for Medicare, Medicare will become the primary plan and benefits will be coordinated.

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 dependents under COBRA provisions. See page 32 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 coverage remains in effect and the Plan is your primary plan.

If You or Your Covered Dependents Become Medicare Eligible
When a retiree or a covered eligible dependent become eligible for Medicare, benefits will be coordinated with Medicare.

If You Die
If you die while enrolled, your covered eligible dependents can continue coverage. Their eligibility continues under the Plan with the payment of required 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 or dies.
• If you have less than 15 years of benefit service, eligibility continues for twice your length of Benefit Service or until the spouse remarries or dies, whichever occurs first.

Children of deceased employees or retirees may continue participation as long as they are an eligible dependent. If your surviving spouse remarries, eligibility for your children also ends. Special rules may apply to dependents of individuals who become retirees due to disability. See Continued Coverage for suspended retirees on page 35.

Eligible dependents of deceased extended part-time employees are not eligible to continue to participate in the Plan. These dependents may be eligible to elect continuation coverage under COBRA provisions. See page 32 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 6 for details), you may continue coverage for yourself and all your dependents 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 dependents 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 dependent ceases to be eligible (for example, a dependent child reaches age 25); or 
  • A retiree becomes a suspended retiree (see page 6). 
  • 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 your required contribution;
  • A Qualified Medical Child Support Order is no longer in effect for a covered dependent;

OR

• The date:
  • You die;
  • The Plan ends;
  • Your employer discontinues participation in the Plan.

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 of ineligibility, any contributions you make for ineligible dependents will not be refunded and your pre-tax contributions cannot be reduced until the next plan year or a subsequent change in status. Any claims paid after the loss of eligibility are considered overpayments and must be repaid by you.

Loss of Eligibility

Everyone in your family may lose eligibility for plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the 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 Plan on your behalf or which you recover from a third party. Your participation may be terminated if you fail to comply with the terms of the Plan and its administrative requirements. You may also lose eligibility if you enroll persons who are not eligible.