Basic Medical Plan information
ExxonMobil Medical Plan
Plan sponsor and participating affiliates
The ExxonMobil Medical Plan is sponsored by:
Exxon Mobil 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.
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 administrator and discretionary authority
The Plan Administrator of the ExxonMobil Medical Plan is the Administrator-Benefits who is the Manager-Global Benefits Design, Exxon Mobil Corporation. 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. Various aspects of the Cigna Option are administered by Cigna.
The Administrator-Benefits has delegated to Cigna the full and final discretionary authority to interpret and apply plan terms and to make factual determinations in connection with its review of claims under the Cigna Open Access Plus-In Network Option. Such discretionary authority is intended to include, but not limited to, the determination of the eligibility of persons desiring to enroll in or claim benefits under the Cigna Option, the determination of whether a person is entitled to benefits under the Cigna Option, and the computation of any and all benefit payments. The Administrator-Benefits also delegates to Cigna the full and final discretionary authority to perform a full and fair review, as required by ERISA, of each claim denial which has been appealed by the claimant or his duly authorized representative.
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:
Address: P.O. Box 18025
Norfolk, VA 23501-1867
For service of legal process:
Corporation Service Company
211 East 7th Street, Suite 620
Austin, TX 78701-3218
Cigna - for appeals on benefits issues:
Cigna may be contacted for appeals of benefits issues at an address provided by calling Cigna Customer Service or as reflected on your Explanation of Benefits.
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 Cigna 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.
The Plan's fiscal year ends on December 31.
Collective bargaining agreements
The Medical Plan is maintained pursuant to one or more collective bargaining agreements and if a particular Employer is a sponsor. Copies of applicable collective bargaining agreements are available for examination from the Administrator-Benefits upon written request.
Eligibility for participation in the ExxonMobil Medical Plan by represented Employees is governed by local bargaining requirements.
The Cigna Option, is funded solely through contributions by the Employer and/or Plan Participants. Benefits under the Medical Plan are funded through participant and company contributions. Each year, Exxon Mobil Corporation determines the rates of required participant contributions to the ExxonMobil Medical Plan. These rates are based on past and projected Cigna Option experience. (See self-funded plan in the Key terms section.)
Cigna is the claims processor and claims fiduciary.
No implied promises
Nothing in this booklet says or implies that participation in the ExxonMobil Medical 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 SPD. 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 ExxonMobil 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 the ExxonMobil Medical Plan documents or the latest Summary Annual Report from the ExxonMobil 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 denied or ignored, in whole or in part, you may file suit in a Federal court. Such lawsuit must be filed in the United States District Court for the Southern District of Texas, Houston, Texas, or in the United States District Court for the federal judicial district where the employee currently works. If a retiree or terminee, the suit must be filed in the last location worked prior to termination of employment. Beneficiaries must also file in the same federal judicial district that the employee or retiree would be required to file. Any such lawsuits must be brought within one year of the date on which an appeal was denied.
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.
The Plan and all rights hereunder are governed by and construed, administered, and regulated in accordance with the provisions of ERISA, HIPAA, and the Internal Revenue Code (“Code”) to the extent applicable, and to the extent not preempted by ERISA, the laws of the state of Texas, without giving effect to its conflicts of laws provision. The Plan may not be interpreted to require any person to take action, or fail to take any action, if to do so would violate any applicable law.
Nonalienation of Benefits.
No benefit, right or interest of any Covered Person under the Plan shall be subject to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, charge, garnishment, execution or levy of any kind, either voluntary or involuntary, including any liability for, or subject to, the debts, liabilities or other obligations of such person; and any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge, garnish, execute or levy upon, or otherwise dispose of any right to benefits payable hereunder or legal causes of action, shall be void. Notwithstanding the foregoing, the Plan may choose to remit payments directly to health care providers with respect to covered services, if authorized by the Covered Person, but only as a convenience to Covered Persons. Health care providers are not, and shall not be construed as, either “participants” or “beneficiaries” under this Plan and have no rights to receive benefits from the Plan or to pursue legal causes of action on behalf of (or in place of) Covered Persons under any circumstances.
If a check to a Participant for benefits under the Plan remains uncashed after issue, amounts attributable to such check shall remain in the Plan until the time the participant has requested these funds even if the Participant leaves the plan. Contact Cigna Customer Service for additional information.
Assistance with your questions
If you have any questions about the ExxonMobil 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.