Administrative and ERISA information

Administrative and ERISA information for the ExxonMobil Employee Medical Plan - Aetna Select option

Basic Plan information

Plan name

ExxonMobil Medical Plan.

This SPD describes the Aetna Select – in network option.

Plan sponsor and participating affiliates

The ExxonMobil Medical Plan is sponsored by:

ExxonMobil Corporation

5959 Las Colinas Blvd.
Irving, Texas 75039-2298

All of Exxon Mobil Corporation's divisions and most of the major U.S. affiliates participate in the ExxonMobil Medical Plan. A complete list of participating affiliates is available from the Administrator-Benefits upon written request.

Certain employees covered by collective bargaining agreements do not participate in the Plan.

Plan numbers

The ExxonMobil Medical Plan is identified with government agencies under two numbers:

The Employer Identification Number (EIN), 13-5409005, and the Plan Number (PN), 538.

Plan administrators

Various aspects of the Plan are administered by various parties. The Administrator of the Plan shall have the full power to control and manage all aspects of the Plan in accordance with its terms and all applicable laws. The Administrator may allocate or delegate its responsibilities for the administration of the Plan to others and employ others to carry out or give advice with respect to its responsibilities under the Plan, including administrative services of the following nature: Claim Administration; Cost Containment; Financial; Banking and Billing Administration. Benefits provided under this plan are funded by ExxonMobil.

The Plan Administrator for the ExxonMobil Medical Plan is the Administrator-Benefits. The Administrator-Benefits is the Manager-Global Benefits Design, Exxon Mobil Corporation. You may contact the Administrator-Benefits at the following address. Legal process may be served upon the Administrator-Benefits c/o Exxon Mobil Corporation by serving the Corporation’s Registered Agent for Service of Process, Corporation Service Company (CSC).

For appeals of eligibility or enrollment issues:

Administrator-Benefits

P.O. Box 18025
Norfolk, VA 23501-1867

For service of legal process:

Corporation Service Co.
211 East 7th Street, Suite 620
Austin, TX 78701-3218

Authority of Administrator-Benefits

The Administrator-Benefits (and those to whom the Administrator-Benefits has delegated authority) has the full and final discretionary authority to determine eligibility for benefits, to construe and interpret the terms of the Medical Plan in its application to any participant or beneficiary, and to decide any and all claim appeals.

NOTE: Effective January 1, 2019, no appeals of eligibility will be available regarding decisions that a  dependent child no longer meets the clinical definition of totally and continuously disabled. All decisions by Magellan or Aetna confirming a dependent no longer meets the clinical definition of totally and continuously disabled are final.

Type of plan

The ExxonMobil Medical Plan is a welfare plan under ERISA providing medical benefits.

Plan year

The plan year is the calendar year.

Collective bargaining agreements.

Eligibility for participation in the ExxonMobil Medical Plan by represented employees is governed by local bargaining requirements. A copy of the plan documents are available for examination upon written request

Funding

The Plan is funded through contributions by the Employer and/or plan participants. Benefits under the EMMP are funded through participant and company contributions. Each year, ExxonMobil determines the rates of required participant contributions to the Medical Plan. These rates are based on past and projected plan experience. This plan is self-funded by ExxonMobil. (See Self-funded in the Key terms.)

Claims administrator

The claims administrator provides information about claims payment. The claims administrator is Aetna for medical claims, Magellan for mental health and substance abuse claims, and Express Scripts for prescription drug claims.

No implied promises

Nothing in this SPD says or implies that participation in the Plan is a guarantee of continued employment with the company.

Future of the Plan

The company reserves the right at any time and for any reason to terminate, suspend, withdraw, amend or modify the ExxonMobil Medical Plan or any of its provisions. If any changes are made in the future, you will be notified in accordance with legal requirements. In the event the ExxonMobil Medical Plan is terminated, you will have the right to elect continuation coverage, as described in the COBRA section of this guide, in any other health plan maintained by ExxonMobil or its controlled group.

Your rights under ERISA

As a participant in the ExxonMobil Medical Plan, you have certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all participants shall be entitled to:

Receive information about your plan and benefits

Examine, without charge, at the office of the Administrator-Benefits and at other specified locations, such as worksites, and union halls, all documents governing the Medical Plan, including contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Medical Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.

Obtain, upon written request to the Administrator-Benefits, copies of documents governing the operation of the Medical Plan including collective bargaining agreements and copies of the latest annual report (Form 5500 Series) and updated Summary Plan Descriptions. The Administrator may require a reasonable charge for the copies.

Receive a summary of the Medical Plan’s annual financial report. (The Administrator-Benefits is required by law to furnish each participant with a copy of this Summary Annual Report.)

Prudent actions by plan fiduciaries

In addition to creating rights for Medical Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Medical Plan, called fiduciaries, of the Medical Plan have a duty to do so prudently and in the interest of you and other Medical Plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA.

Enforce your rights

If your claim for a benefit is denied or ignored in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Medical Plan documents or the latest Summary Annual Report from the Medical Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Administrator-Benefits to provide  the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator.

If you have a claim and an appeal for benefits, which are both denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the Medical Plan's decision or lack thereof concerning the qualified status of a domestic relations order, you may file suit in Federal court. Any such lawsuits must be brought within one year of the date on which an appeal was denied. If it should happen that Medical Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with your questions

If you have any questions about the Medical Plan, you should contact the Plan Administrator. If you have any questions about your rights under ERISA, or if you need assistance in obtaining documents from the Administrator-Benefits, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.