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Eligibility and enrollment

Eligibility and enrollment details for the ExxonMobil Dental Plan

Generally, you are eligible if:

You are a regular employee.
You are a trainee as described in the Key Terms section.
You are a retiree.
You are a survivor/surviving spouse, which means an eligible family member of a deceased regular or retiree.
You are a long-term Expatriate with U.S. Company-sponsored green card (also called permanent resident visas or PRVs) who retires/retired at the end of your current U.S. assignment on or after July 1, 2020 and remain in the U.S. with a valid PRV. If you choose not to enroll, there will be no opportunity to enroll at a later point in time during retirement.

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.
You are an Expatriate employee.

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, contact the ExxonMobil Benefits Service Center.
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 at age 26 and, meets the Internal Revenue Service's definition of a dependent, and, if a child of a retiree, is not eligible to be enrolled in Medicare as their primary medical plan.

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 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 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

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)
Employee or retiree, spouse and child(ren)

There are also classes of coverage for surviving spouses and family members 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 COBRA contribution rate as shown in the table below, upon election of COBRA coverage.

COBRA Contribution Rate Begins	Immediately	No later than after 6 months	No later than after 12 months
Type of Leave
Military (voluntary)	O
Health / Dependent Care		O
Personal			O

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 a family member cannot both enroll as employees (or retirees) and elect coverage for each other as eligible family members. If you and your spouse or adult child work for the company (or are 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 and your spouse have children, each child can only be covered by one of you.

When the orthodontia maximum has been met under an ExxonMobil Dental Plan, dependents cannot be added to another ExxonMobil employee's dental plan to obtain additional orthodontic benefits. The $2,000 limit is per lifetime, per member.

In addition a marriage between two ExxonMobil employees does not allow enrollment or cancellation in any of the ExxonMobil health plans. 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

Employees:

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 completion of enrollment in ExxonMobil Benefits or through the ExxonMobil Benefits Service Center.

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 annually 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 Annual enrollment and Changing your coverage sections.)

You can enroll eligible family members only if you are enrolled in this Plan. You can enroll in the Plan using the ExxonMobil Benefits or through the ExxonMobil Benefits Service Center.

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 canceled the first of the following month and you may be subject to discipline up to and including termination of employment for falsifying company records.

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 enrollment through the ExxonMobil Benefits portal or through the ExxonMobil Benefits Service Center phone line.

Retirees:

Effective January 1, 2019, retirees have three opportunities to enroll in the Dental Plan:

At retirement, or
Upon loss of other employer coverage, or
When first eligible to be enrolled in Medicare as your primary plan.

There is no opportunity to enroll yourself in the Dental Plan at any other time, including during annual enrollment.

If you were enrolled in the Dental Plan as an employee, you and your eligible covered family members will continue to be enrolled in the Plan at retirement. However, as a retiree, you will pay your contributions on an after-tax basis via payroll deduction (if eligible), check, or bank draft.

Eligible family members may be added to your coverage at one of the three enrollment opportunities listed above or if you experience a change in status. Eligible family members cannot be added to your coverage at any other time, including during annual enrollment.

All enrollments must be completed within 60 days of the enrollment event. Coverage is effective the first of the month following receipt of your election by the ExxonMobil Benefits Service Center (EMBSC), except in the case of a birth or adoption of a child when changes will be effective on the date of the birth or adoption.

You can enroll either online or by phone. To enroll online go to www.exxonmobil.com/benefits. To enroll by phone call the Benefits Service Center at 800-682-2847.

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 the required time period, coverage for the family members will be cancelled the first of the following month. If you enroll family members who are not eligible for the Plan, for instance, by covering children who do not meet the eligibility requirements, you may lose eligibility for yourself and your family under all ExxonMobil health plans.

You may cancel your coverage at any time; however, you may not re-enroll unless you experience a corresponding change in status or you wait until one of the enrollment opportunities listed above. Coverage will be terminated at the end of the month in which your elected change has been received.

Eligible family members may also be removed from your coverage at any time; however, they may not be reinstated unless you experience a corresponding change in status or you wait until one of the enrollment opportunities listed above.

Note: You are required to remove family members who are no longer eligible for coverage at the time of loss of eligibility. To remove an ineligible family member (a divorced spouse for example) you are required to notify the Benefits Service Center within 60 days of the loss of eligibility or your ineligible family members will not be entitled to COBRA benefits continuation. If you fail to notify the Benefits Service Center, you may also lose eligibility for yourself and your family under all ExxonMobil health plans. In addition, you will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person(s).

Annual enrollment

Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, employees can make changes to coverage by adding or removing family members. Family members may be added or removed for any reason during annual enrollment. However, family members must be removed as soon as they are no longer eligible. Changes elected during annual enrollment take effect the first of the following year.

Note: You should not wait until annual enrollment to remove a family member who loses eligibility; they should be removed at the time eligibility is lost. For consequences for covering an ineligible family member, see Loss of Eligibility.

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 do not want to make any changes, you don’t have to do anything during Annual Enrollment to continue with your current plan selection for the following year. However, if as an employee you want to participate in a Flexible Spending Account (FSA), you must enroll each year, even if you are currently enrolled in an FSA.

If as an employee 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.

Note: Effective January 1, 2019, retirees cannot enroll in or make changes to their Dental Plan coverage during annual enrollment. They may still elect to drop coverage for themselves or a family member.

Changing your coverage

Employees:

To make a change to your coverage after your initial enrollment you must wait until Annual Enrollment or until you experience one of the following Changes in status.

Note: Changes in coverage associated with a change in status are effective the first day of a month after enrollment is completed, except in the case of a birth or adoption of a child when changes will be effective on the date of the birth or adoption. If the change is made during Annual Enrollment, changes are effective the first day of the following year.

Retirees:

To make a change to your coverage after your retirement you must wait until you experience a Post-Retirement Change in Status that allows enrollment into the Plan.

Changes in Status during employment

Retirees and survivors please see Post-Retirement Changes in Status.

This section explains which events are considered changes in status during your employment and what changes you may make as a result. If you have a change in status, you are required to complete your change within 60 days. If you do not complete your change within 60 days, changes to your coverage may be limited. If you fail to remove an ineligible family member within 60 days of the event that causes the person to be no longer eligible, (e.g., divorce) you are required to continue to pay the same pre-tax contribution for coverage even though you have removed the ineligible person(s). Your pre-tax contribution for coverage will remain the same until you have another change in status or the first of the plan year following the next annual enrollment period. In addition, you will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person(s). The only exception is death of an eligible family member.

Important Note: Your election made due to a change in status cannot be changed after the transaction is completed in ExxonMobil Benefits or the form is received by ExxonMobil Benefits Service Center. If you make a mistake in ExxonMobil Benefits Web , contact ExxonMobil Benefits Service Center immediately or no later than the first work day following the day on which the mistake was made.

The following is a quick reference guide to the Changes in status during employment discussed in more detail after the table.

If this event occurs...	As an employee you may...
Marriage	Enroll yourself and spouse and any new eligible family members.
Divorce - Employee enrolled in Dental Plan	You are required to remove coverage for your former spouse and step child(ren) but you may not remove coverage for yourself or other covered eligible family members.
Divorce - Employee loses coverage under spouse's dental plan	Enroll yourself and other eligible family members that might have lost eligibility for spouse's dental plans.
Gain a family member through birth, adoption or placement for adoption or guardianship	Enroll yourself and any eligible family members.
Death of a spouse or other eligible dependent.	Change your level of coverage. You may not cancel coverage for yourself or other covered eligible family members.
Other loss of family member's eligibility (e.g. sole managing conservatorship of grandchild ends)	Change your level of coverage. You may not cancel 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, lockout / strike	Your Dental 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 the Dental Plan.
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 eligible family members that may have lost eligibility under the spouse's or family member's plan in the Dental Plan.
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 the Dental Plan.
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 the Dental Plan if the employee represents that they have or will obtain coverage under the other employer plan. You may also cancel coverage for yourself, if health care coverage is obtained through your spouse’s employer plan.
Judgment, decree or other court order requiring you to cover a family member. (Begin a QMCSO)	Change your Dental Plan level of coverage.
Termination or end of QMCSO	You may remove the affected family member from coverage and change level of coverage.
Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court	Dental Plan coverage is reinstated.
Termination of employment and rehire after 30 days	Enroll in the Dental Plan as a new hire.
You are covered under your spouse's dental plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year	Enroll yourself and eligible family members in the Dental Plan.
You begin a leave of absence	Contact ExxonMobil Benefits Service Center
You return from a leave of absence of more than 30 days (paid or unpaid).	Contact ExxonMobil Benefits Service Center
You return from expatriate assignment outside of the U.S.	You have 60 days since your repatriation date to enroll in the Dental Plan by contacting the ExxonMobil Benefits Service Center. Any changes done within this period will be effective upon your repatriation date and there would be no gap in coverage. If no action is taken, the next opportunity to enroll will be during Annual Enrollment.

Changes will only be allowed if the change is made in ExxonMobil Benefits portal within 60 days of the event. Unless otherwise noted, the effective date will be the first of the month after the transaction is completed in in ExxonMobil Benefits portal.

Marriage

If you are enrolled in the Dental Plan, you can enroll your new spouse and his or her eligible family members (your stepchildren) for coverage. If you are not already enrolled for coverage, you can sign up for dental coverage for yourself, your new spouse, and your 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.

Divorce

In the case of divorce:

Your former spouse and any stepchildren are only eligible for coverage through the end of the month in which the divorce is final.
You are required to remove coverage for your former spouse and stepchild(ren) within 60 days of your divorce.
You must notify and provide any requested documents to the ExxonMobil Benefits Service Center as soon as your divorce is final.
If you do not to notify the ExxonMobil Benefits Service Center within 60 days will result in your former spouse and stepchild(ren) not being entitled to elect COBRA.
If you fail to remove your spouse and any stepchild(ren) within 60 days of the event you will continue to have pay the same pre-tax contribution for coverage even though you have removed your former spouse and stepchild(ren).
Your pre-tax contribution for coverage will remain the same until you have experienced another change in status or the first of the plan year following the next Annual Enrollment period.
You will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person.

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 dental plan because of divorce, you can sign up for dental 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.

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. Coverage is effective on the date of birth, adoption or placement for adoption. 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 enrollment is processed through ExxonMobil Benefits portal or though ExxonMobil Benefits Service Center. Beginning the first day of the following month your deduction will be on a pre-tax basis.

Death of a spouse

If you lose coverage under your spouse's dental plan, you can sign up for Dental Plan 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 Dental Plan, any stepchildren will cease to be eligible upon your spouse's death unless you are their court appointed guardian or sole managing conservator.

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.

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 Continuation coverage for more details about COBRA.)You must notify to the ExxonMobil Benefits Service Center through the ExxonMobil Benefits portal or by phone as soon as a family member is no longer eligible. If you fail to notify the ExxonMobil Benefits Service Center within 60 days, the family member will not be entitled to elect COBRA. While we have an administrative process to remove dependent children reaching the maximum eligibility age, you remain responsible for ensuring that the child is removed from coverage. If you fail to ensure that a family member is removed in a timely manner, there may be consequences for falsifying company records

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 or, if applicable, pre-pay your benefits. If you chose not to continue your coverage while on leave, your coverage ends on the last day of the month in which your cancelation is processed through the ExxonMobil Benefits portal 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. See Classes of coverage in the Eligibility and Enrollment section for rate information.

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, contact ExxonMobil Benefits Service Center.

Post-Retirement Changes in Status

Employees please see Changes in Status during employment.

If this event occurs...	As a retiree you may...
Marriage	Add your spouse and any new eligible family members.
Divorce – Retiree and spouse enrolled in ExxonMobil health plans	You are required to remove coverage for your former spouse and any stepchild(ren).
Divorce – Retiree loses coverage under spouse’s health plans	Enroll yourself and add other eligible family members who might have lost eligibility for spouse’s plan.
Gain a family member through birth, adoption or placement for adoption or guardianship	Add new eligible family members.
Death of a spouse.	You must remove coverage for any stepchild(ren) unless you are their court appointed guardian or sole managing conservator.
You or a family member loses eligibility under another employer's group health plan.	Enroll yourself and add eligible family members.
You become entitled to enroll in Medicare as your primary medical plan even if you do not actually enroll in Medicare.	Enroll and add eligible family members.
Your disabled child becomes entitled to enroll in Medicare as their primary medical plan, even if your child is not actually enrolled in Medicare.	You must remove coverage for your child.
Judgment, decree or other court order requiring you to cover a family member. (Begin a QMCSO)	Add new eligible family members.

Other changes that may affect your coverage

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 coinsurance.

If the cost of coverage under your spouse's dental plan significantly increases or there is a significant curtailment of coverage that permits revocation of coverage during a plan year and you cancel that coverage, you will be able to sign up for dental coverage for yourself and any eligible family members.

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 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 family member and are not eligible to be enrolled in Medicare as their primary medical plan. If your surviving spouse remarries, eligibility for your stepchildren also ends. Special rules may apply to family members of individuals who become retirees due to disability. (See Continuation coverage for suspended retirees).

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, you may continue coverage for yourself and 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), or
A retiree becomes a suspended retiree (see suspended retiree under Eligible Family Members).
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; from regular to expatriate employee),
You do not make your required contribution,
A Qualified Medical Child Support Order is no longer in effect for a covered family member,

The date:
You die,
The Plan ends,
Your employer discontinues participation in the Plan,
You enrolled an ineligible family member and in the opinion of the Administrator-Benefits, the enrollment was a result of fraud or a misrepresentation of a material fact.

You are responsible for ending coverage with the ExxonMobil Benefits Service Center 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.

For employees and eligible family members, if your participation in any group health plan (e.g., Medical, Dental, Vision), to which ExxonMobil contributed, was suspended for non-payment of required contributions, in order to enroll in this Plan you must repay all required contributions retroactively to the date of suspension. If you are a retiree and have missed payments during 2021, contact immediately the ExxonMobil Benefits Service Center (EMBSC) for guidance in order to regularize your situation before year end.

If you are a retiree, eligible family member of retiree or a survivor and have missed payments, contact the ExxonMobil Benefits Service Center (EMBSC) immediately for guidance in order to regularize your situation.

Cancellation and reinstatement process for retirees, eligible family member of a retiree or a survivor participating in Dental, Vision, and/or any of the ExxonMobil Retiree Medical Plan (EMRMP) options (together or separately, the Retiree Health Plans)- will be as follows.

Cancellation of Retiree Health Plans due to non-payment of premiums:

Cancellations due to non-payment of plan premiums will be prospective, with a 3 month grace period starting 1^st month of unpaid contributions, so participants may pay owed contributions within that grace period to avoid cancellation. For example, if retiree has not made payments for their January, February, and March premiums during that 3 month timeframe, coverage will be cancelled effective April 1.

Reinstatement of Retiree Health Plans:

Once your coverage has been terminated, you can request to be reinstated upon showing good cause. The applicable Retiree Health Plan- (or its designee) will review requests for reinstatements on a case-by-case basis. If an individual has been involuntarily disenrolled for failure to pay plan premiums, they may request reinstatement no later than 60 calendar days following the effective date of disenrollment.

Reinstatement for good cause will occur only when:

1) Reinstatement is requested no later than 60 calendar days following the effective date of disenrollment (in the example, 60 days from April 1)

2) The individual has been determined to meet the criteria specified below (i.e., receives a favorable determination); and

3) Within three (3) months of disenrollment for nonpayment of plan premiums, the individual pays in full the plan premiums owed at the time they were disenrolled (in the example, within 3 months from April 1).

If you fail to pay premiums within the grace period, your coverage is terminated, and you fail to show good cause, you and your eligible dependents will not have an opportunity to re-enroll at a future date in the applicable ExxonMobil Health Plan. You are still responsible for paying all owed premiums incurred during the grace period in which you were still part of the applicable ExxonMobil Health Plan.

Requests for reinstatement must be accompanied by a credible statement (verbal or written) explaining the unforeseen and uncontrollable circumstances causing the failure to make timely payment. An individual may make only one reinstatement request for good cause in the 60-day period. Generally, these circumstances constitute good cause:

A serious illness, institutionalization, and/or hospitalization of the member or their authorized representative (i.e. the individual responsible for the member’s financial affairs), that lasted for a significant portion of the grace period for plan premium payment;
Prolonged illness that is not chronic in nature, a serious (unexpected) complication to a chronic condition or rapid deterioration of the health of the member, a spouse, another person living in the same household, person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs) that occurs during the grace period for the plan premium payment;
Recent death of a spouse, immediate family member, person living in the same household or person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs); or
Home was severely damaged by a fire, natural disaster, or other unexpected event, such that the member or the member’s authorized representative was prevented from making arrangement for payment during the grace period for plan premium;
An extreme weather-related, public safety, or other unforeseen event declared as a Federal or state level of emergency prevented premium payment at any point during the plan premium grace period. For example, the member’s bank or U.S. Post Office closes for a significant portion of the grace period; or

There may be situations in addition to those listed above that result in favorable good cause determinations. If an individual presents a circumstance which is not captured in the listed examples, it must meet the regulatory standards of being outside of the member’s control or unexpected such that the member could not have reasonably foreseen its occurrence, and this circumstance must be the cause for the non-payment of plan premiums. The Plan expects non-listed circumstances will be rare.

Examples of circumstances that do not constitute good cause include:
- Allegation that bills or warning notices were not received due to unreported change of address, out of town for vacation, visiting out of town family, etc.;
- Authorized representative did not pay timely on member’s behalf;
- Lack of understanding of the ramifications of not paying plan premiums;
- Could not afford to pay premiums during the grace period; or
- Need for prescription medicines or other plan services.

The ExxonMobil Business Service Center is the appointed designee reviewing reinstatement requests and making good cause determinations.

Loss of eligibility

Fraud against the Plan

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, for instance, by covering children who do not meet the eligibility requirements. This includes failing to provide timely notification of when a covered family member loses eligibility, e.g., spouse loses eligibility due to divorce.

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.