ExxonMobil Medical Plan
Network vs. Non-Network Providers
Aetna and Cigna both negotiate with doctors, hospitals and other providers to charge less for their networks. When you choose a provider who is “in network,” it means you will pay less out of pocket.
Aetna POS II A & B: If you see a non-network provider, you will pay a higher coinsurance percentage and will have a higher out-of-pocket maximum. You may also be responsible for additional costs if your provider charges more than similar providers in your area (called the Reasonable & Customary limit).
Aetna Select and Cigna OAPIN: You will pay the full cost for non-network services.
Compare coverage for services under the four medical plan options available.
Aetna POS II A |
Aetna POS II B |
Aetna Select |
Cigna OAPIN |
|||
---|---|---|---|---|---|---|
In-network you pay* |
Non-network you pay |
In-network you pay* |
Non-network you pay |
Network only you pay |
Network only you pay |
|
Annual deductible |
||||||
|
$600 |
$800 |
$400 |
$500 |
$0 |
$0 |
|
$1,200 |
$1,600 |
$800 |
$1,000 |
$0 |
$0 |
Preventive Care |
||||||
|
$0 |
$0 |
$0 |
$0 |
$0 |
$0 |
|
||||||
Office visit |
||||||
|
$40 copay |
45% |
$25 copay |
40% |
$25 copay |
$25 copay |
|
$60 copay |
45% |
$45 copay |
40% |
$45 copay |
$45 copay |
Telemedicine |
$40 copay |
not applicable |
$25 copay |
not applicable |
$25 copay |
$25 copay |
Urgent care |
$60 copay |
45% |
$45 copay |
40% |
$60 copay |
$60 copay |
Emergency care |
$150 copay |
$150 copay |
$150 copay |
$150 copay |
$150 copay + 10% |
$150 copay + 10% |
Ambulance |
25% |
25% |
20% |
20% |
10% |
10% |
Inpatient care |
$300 deductible |
$600 deductible |
$200 deductible |
$400 deductible |
10% |
10% |
Outpatient care |
25% after |
45% after |
20% after |
40% after |
10% |
10% |
Annual medical out-of-pocket maximum |
(includes Rx) |
(includes Rx) |
||||
|
$4,500 |
$18,000 |
$3,000 |
$15,000 |
$3,000 |
$3,000 |
|
$9,000 |
$36,000 |
$6,000 |
$30,000 |
$6,000 |
$6,000 |
Prescription drugs Up to 34-day fills (from participating retail locations) |
||||||
|
30% |
30% |
$15 copay |
$15 copay |
||
|
30% |
30% |
30% |
30% |
||
|
50% |
50% |
50% |
50% |
||
Prescription drugs Up to 90-day fills (mail order or participating retail locations) |
||||||
|
25% |
25% |
$30 copay |
$30 copay |
||
|
25% |
25% |
25% |
25% |
||
|
50% |
50% |
50% |
50% |
||
Annual prescription drug out-of-pocket maximum |
||||||
|
$2,500 |
$2,500 |
Included in the medical out-of-pocket maximum |
|||
|
$5,000 |
$5,000 |
If you are not able to find an In-network provider, contact Aetna Member Services for information on the Plan's alternate network deficiency benefit. If Aetna confirms a network provider is not available for the services you need, they will authorize use of a designated non-network provider for your care.
For more detailed plan information, review the Medical plan SPDs in the Spotlight below and the 2024 Benefits Coverage (SBC) here.
Which medical plan option should you choose? It depends on your health care needs and your personal preferences. There are a few things to think about as you decide. You can also compare up to 3 medical plan options at a time in the Your Total Rewards portal when making your Annual Enrollment elections.
Would you rather pay more in contributions OR more when you need care?
If you prefer to pay less when you need care, consider options with no deductible and lower copays. Keep in mind, you’ll pay higher contributions out of your paycheck for these options. If you don’t have many health care needs, these plans may end up costing you more.
If you prefer to pay lower contributions from your paycheck, you should consider the Aetna POS II options. These options offer lower monthly contributions, but the deductibles and copays are higher, which means you will pay more when you get care.
Two plan options — Aetna Select and Cigna OAPIN — require you to use only network providers for care. Both options have extensive networks of providers and facilities, so if you see a non-network doctor or use a non-network facility, you will pay 100% of the cost. We strongly recommend you work with a primary care physician to coordinate your care.
The annual out-of-pocket is an important consideration if you’ve had extensive health care claims the last two years or expect high claims in the future. The ExxonMobil Medical Plan pays for 100% of eligible health care expenses after you reach the out-of-pocket maximum in a plan year.
The Network Only options have lower out-of-pocket maximums than the POS II options.
Important Savings Reminder
If you earn the Culture of Health (CoH) rate by fulfilling the requirements every year, you can reduce your monthly contributions for the next calendar year by:
- $30/month for participant only coverage
- $60/month for participant + spouse
- $60/month for participant + child(ren) coverage
- $90/month for family coverage
Annual deductible: The amount you must pay each calendar year before the Plan begins to pay for covered health care expenses you incur.
Annual out-of-pocket maximum: The most you have to pay for medical services in a calendar year; includes the deductible, coinsurance and copays but does not include monthly contributions.
Coinsurance: Your financial responsibility (percentage of the cost) after the deductible has been met
Copay: A fixed amount you pay at the time of service, in which you do not have to meet the deductible first
Network providers: A provider, facility or hospital that has negotiated with Aetna or Cigna to belong to their network. Network providers charge less for their services because of those negotiated rates.
Non-network providers: Doctors or facilities who do not have a contract with Aetna or Cigna to belong to their network. Using non-network providers will result in higher costs for you.
Preventive care: Care typically covered at no cost to you, and includes services like annual health exams, immunizations, early warning screenings and certain medications.
Surprise billing: When you get emergency care or get treated by a non-network provider at a network hospital or facility, you are now protected from “surprise billing.” Surprise billing is when you receive an unexpected bill or charge from a provider who you have no control over, such as an anesthesiologist or radiologist at an in-network facility. Your plan will treat this as a network charge, which reduces your financial exposure.