List of key terms in the ExxonMobil Dental Plan
In this section, you will find both General Terms pertaining to the Dental Plan and Common dental terms.
An employee who is covered by a collective bargaining agreement except to the extent participation in the Dental Plan is provided under such agreement.
The person or entity that receives benefits when you die. The Plan provides a standard list of beneficiaries but you may name another beneficiary if you wish.
Generally, all the time from the first day of employment until you leave the company's employment. Excluded are:
- unauthorized absences,
- leaves of absence of over 30 days (except military leaves or leave under the Federal Family and Medical Leave Act),
- certain absences from which you do not return,
- periods when you work as a non-regular employee, as a special agreement person, in a service station, car wash, or car-care center operations, or
- when you are covered by a contract that requires the company to contribute to a different benefit program, unless a special authorization credits the service.
Change in status
Life or work event that allows you to make changes to your elections during the plan year and outside of the annual enrollment period.
A person under age 26 who is:
- A natural or legally adopted child of a regular employee or retiree,
- A grandchild, niece, nephew, cousin, or other child related by blood or marriage over whom a regular employee, retiree, or the spouse of a regular employee or retiree (separately or together) is the sole court appointed legal guardian or sole managing conservator,
- A child for whom the regular employee or retiree has assumed a legal obligation for support immediately prior to the child's adoption by the regular employee or retiree, or
- A stepchild of a regular employee or retiree.
Child does not include a foster child.
Aetna, or affiliates, for claims.
Charges by a dentist or physician for services and supplies required for dental care and treatment. Charges in excess of the reasonable and customary charge made for similar services and supplies by dentists or physicians in the same area are not covered. Where alternative services or supplies are customarily available for such treatment, reimbursement will be based on the least expensive service or supply resulting in professionally adequate treatment.
Most U.S. dollar-paid employees of ExxonMobil and participating affiliates are eligible. Full-time employees not hired on a temporary basis (also called regular employees) are eligible. Extended part-time employees, as classified on the employer's books and records, are also eligible.
The following are not eligible to participate in the Plan: leased employees as defined in the Internal Revenue Code, barred employees, or special agreement persons as defined in the Plan document. Generally, special-agreement persons are persons paid by the company on a commission basis, persons working for an unaffiliated company that provides services to the company, and persons working for the company pursuant to a contract that excludes coverage of benefits.
Eligible family members
Eligible family members are generally your:
- A child who is described in any one of the following paragraphs (1) through (3):
- (1) has not reached the end of the month during which age 26 is attained, or
- (2) is totally and continuously disabled and incapable of self-sustaining employment by reason of mental or physical disability, provided the child:
- (a) meets the Internal Revenue Service's definition of a dependent, and
- (b) was covered as an eligible family member under this Plan immediately prior to age 26 when the child's eligibility would have otherwise ceased, and
- (c) the child met the clinical definition of totally and continuously disabled before age 26 and continues to meet the clinical definition through subsequent periodic reassessment reviews, and
- (d) if a child of a retiree, is not eligible to be enrolled in Medicare as their primary medical plan, or
- (3) the child is recognized under a qualified medical child support order as having a right to coverage under this Plan.
A child aged 26 or over who was disabled by reason of a mental disability but who no longer meets the requirements of paragraph two (2) above, ceases to be an eligible family member 60 days following the date on which the applicable requirement is not met.
Please note: An eligible employee or retiree's parents are not eligible to be covered.
Expatriate employees include service-oriented employees employed by non-U.S., non-participating employers who are temporarily working in the United States either under a visa that requires coverage by an ExxonMobil plan of such employee while in the United States or in an assignment in the United States and the terms of the assignment require proof of adequate medical coverage. Expatriate employees include regular employees working on an assignment outside the United States where the terms of the assignment require proof of adequate medical coverage.
Extended part-time employee
An employee who is classified as a non-regular employee, but who has been designated as an Extended Part-Time Employee under his or her employer's employment policies relating to flexible work arrangements.
A service or supply that is:
- Ordered by a dentist or physician,
- Reasonably required for the treatment or management of the condition for which it is ordered, and
- Commonly and customarily recognized by the United States dental community as appropriate in the treatment or management of the condition for which it is ordered. The Administrator-Benefits has the exclusive and final authority to determine if a service or supply is medically necessary as used in the Plan. In making this determination, the findings and assessments of the United States dental community and the experience and expertise of the claims administrator shall be considered along with evaluation from independent professionals. As used herein, the United States dental community shall include national dental associations, societies and organizations including, but not limited to, the American Dental Association. The Administrator-Benefits may apply different standards to different services or supplies in determining medical necessity. Additionally, the Administrator-Benefits may consider the Dental Clinical Policy Bulletins (CPBs) published by Aetna, the claims administrator. Dental CPBs are based on established, nationally accepted governmental and/or professional society recommendations, as well as other recognized sources. These Dental CPBs may be found on the Aetna website at www.aetna.com.
A written pre-determination request will result in a detailed response as to whether a treatment or service is covered under the Dental Plan and whether the proposed cost is within reasonable and customary limits, thus ensuring all parties are aware of the financial consequences, providing all circumstances described in the request remain unchanged. Please note that a pre-determination, either verbal or written, is not a guarantee of payment, as claims are paid based on the actual services rendered and in accordance with Plan provisions.
Qualified Medical Child Support Order
A Qualified Medical Child Support Order (QMCSO) is a court decree under which a court order mandates health coverage for a child. A QMCSO must include, at a minimum:
- Name and address of the employee covered by the health plan.
- The name and address of each child for whom coverage is mandated.
- A reasonable description for the coverage to be provided.
- The time period of coverage.
- The name of each health plan to which the order applies.
You may obtain, without charge, a copy of the Plan's procedures governing QMCSO determinations by written request to the Administrator-Benefits.
An employee of a participating employer, whether or not the person is a director, who, as determined by the participating employer, regularly works a full-time schedule, and is not employed on a temporary basis. The definition includes a person who regularly works a full-time schedule but who, for a limited period of time, is approved for a part-time regular work arrangement under the participating employer’s work rules relating to part-time work for regular employees.
Generally, a person at least 55 years old who retires as a regular employee with 15 or more years of benefit service and who has not thereafter recommenced employment as a covered employee or a non-regular employee. Retiree status may also be attained by someone who is retired by the company and entitled to long-term disability benefits under the ExxonMobil Disability Plan after 15 or more years of benefit service, regardless of age.
Employees who terminate while non-regular (including extended part-time employees) are not eligible for retiree status regardless of age or service.
Generally, a person paid on a commission or commission salary basis other than a person paid while employed by the Marketing Department of ExxonMobil; an employee providing service to a non-affiliated organization that pays the person's salary or wages, or an employee working pursuant to an agreement that specifically excludes the person from coverage for benefits.
All references to marriage shall mean a marriage that is legally recognized under the laws of the state or other jurisdiction in which the marriage takes place, consistent with U.S. federal tax law. All references to a spouse or a married person shall refer to individuals who have such a marriage.
A surviving unmarried spouse or child of a deceased ExxonMobil regular employee or 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. A person remains a suspended retiree 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.
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.
An employee who is classified as a non-regular employee, but who has been characterized as a Trainee and has graduated from high school.
Common dental terms
Terminal tooth or root that retains or supports a bridge or a fixed or removable prosthesis.
A device used to provide function or therapeutic (healing) effect. An appliance may be fixed or removable.
The wearing away of a tooth's enamel.
Dental x-ray showing approximately the coronal (crown) halves of the upper and lower jaw.
A tooth shaped cover placed over a tooth that is badly damaged or decayed, may also be referred to as a cap.
The destruction or decomposition of a tooth as a result of bacterial action.
A person acting within the scope of his or her license and holding the degree of Doctor of Dental Surgery (DDS).
A device replacing missing teeth.
A prosthesis replacing one or more teeth that is cemented in place in the mouth. It consists of one or more pontics held in place by one or more retainers on abutment teeth.
A solution of fluoride applied topically to teeth to prevent dental decay.
An X-ray of every tooth, from crown to root to supporting structures, mostly using bitewing X-rays (with film inside the mouth).
A prosthetic device placed in the jaw to which a tooth or denture may be anchored.
A negative reproduction of a given area.
Occlusal night guard
A dental instrument that protects the teeth from damage done during sleep. The night guard may cover one or both rows of teeth and is fitted to each patient so that the teeth fit perfectly to limit the grinding and clenching during the night.
The branch of dentistry primarily concerned with the detection, prevention, and correction of abnormalities in the positioning of the teeth in their relationship to the jaws.
An X-ray of the entire mouth all teeth on both upper and lower jaws on a single X-ray (with film outside the mouth).
A prosthesis that replaces one or more, but less than all, of the natural teeth and associated structures and is supported by the teeth and/or the gums. It may be removable or fixed, on one side or two sides.
An X-ray highlighting only one or two teeth at a time. A periapical X-ray looks similar to a bite-wing X-ray. However, it shows the entire length of each tooth, from crown to root.
The removal of the bacterial plaque and calculus from supra gingival (above the gum line) and sub gingival (below the gum line) regions including scaling and root planing (removal of any remaining calculus and smoothing of irregular areas of the root surface).
A person acting within the scope of his or her license and holding the degree of Doctor of Medicine (M.D.).
The part of a fixed bridge that is suspended between the abutments and which replaces a missing tooth or teeth.
The removal of tartar and stains from teeth through the cleaning of the teeth by a dentist or dental hygienist.
Any inlay, crown, bridge, partial denture, or complete denture that restores or replaces loss of tooth structure, teeth, or oral tissue, which results in repair, restoration, or reformation of the shape, form, and function of part or all of a tooth or teeth.
Root canal therapy
Treatment of a tooth with damaged pulp, generally through complete removal of the pulp, sterilization of the pulp chamber and root canals, and filling the resulting space with sealing material.
The removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces.
Designed to preserve the space created by the premature loss of a deciduous (baby) tooth in a child with deciduous or mixed dentition. They are used until normal eruption of the permanent tooth occurs or until it becomes practical to place a permanent prosthesis in place.
Temporomandibular Joint Disorder (TMJ/TMD)
Any myofascial pain dysfunction involving the temporomandibular joint connecting the skull and jawbone.