You are required to be given the information in this section because you are covered under a group health plan (the ExxonMobil Employee Assistance Program). This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan under certain circumstances when coverage would otherwise end. This section generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.
The right to COBRA coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to your spouse and children, if they are covered under the Plan when they would otherwise lose their group health coverage or other rights under the Plan. This section does not fully describe COBRA coverage or other rights under the Plan. For additional information about your rights and obligations under the Plan and under federal law, you should review this SPD or contact the ExxonMobil Benefits Service Center at the telephone numbers or address listed the Contacts for COBRA rights under the ExxonMobil Employee Assistance Program.
If you, your spouse and your family members lose coverage under a qualifying event, you have the right to continue by electing COBRA. You have to make an active COBRA enrollment in EAP. EAP services are available at no charge throughout the COBRA period.
Determination of Benefits Administration Entity to Contact:
- Current ExxonMobil Employees and their covered family members should use ExxonMobil Benefits (http://www.exxonmobil.com/benefits) or contact the ExxonMobil Benefits Service Center;
- Former ExxonMobil Employees and their covered family members, who have elected and are participating through COBRA, contact the ExxonMobil COBRA Administration.
The contact information for each of these entities is as shown in the Contacts for COBRA Rights Under the ExxonMobil Medical Plan section.
What is COBRA coverage?
COBRA coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this section. If a specific qualifying event occurs and any required notice of that event is properly provided to the ExxonMobil Benefits Service Center, COBRA coverage must be offered to each person losing coverage who is a qualified beneficiary. You, your spouse, and your children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Certain newborns, newly adopted children, and alternate recipients under QMCSOs may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below.
Who is entitled to elect COBRA?
If you are an employee, you will be entitled to elect COBRA, if you lose your coverage under the Plan because either one of the following qualifying events happens:
- Your hours of employment are reduced, or
- Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will be entitled to elect COBRA if you lose coverage under the Plan because any of the following qualifying events happens:
- Your spouse dies,
- Your spouse's hours of employment are reduced,
- Your spouse’s employment ends for any reason other than his or her gross misconduct,
- You become divorced from your spouse. Also, if your spouse (the employee) reduces or eliminates your group health coverage in anticipation of a divorce, and a divorce later occurs, then the divorce may be considered a qualifying event for you even though your coverage was reduced or eliminated before the divorce.
A person enrolled as the employee’s child will be entitled to elect COBRA if he or she loses coverage under the Plan because any of the following qualifying events happens:
- The parent-employee dies,
- The parent-employee's hours of employment are reduced,
- The parent-employee's employment ends for any reason other than his or her gross misconduct, or
- The child stops being eligible for coverage under the Plan as a child.
When is COBRA coverage available?
When the qualifying event is the end of employment or reduction of hours of employment or death of the employee, the Plan will offer COBRA coverage to qualified beneficiaries. You need to notify the ExxonMobil Benefits Service Center of any other qualifying events.
For the other qualifying events (divorce of the employee resulting in the spouse or a child losing eligibility for coverage), a COBRA election will be available to you only if you notify and provide the appropriate forms to the ExxonMobil Benefits Service Center or ExxonMobil COBRA Administration within 60 days after the later of (1) the date of the qualifying event or (2) the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the qualifying event. Current employees may give notice of qualifying events by logging onto ExxonMobil Benefits portal.
Please note: Notice is not effective until either a change is made on ExxonMobil Benefits or the proper information is received by the ExxonMobil Benefits Service Center. If notice is not submitted during the 60-day notice period, then all qualified beneficiaries will lose their right to elect COBRA.
Election of COBRA
Each qualified beneficiary will have an independent right to elect COBRA. Covered employees and spouses (if the spouse is a qualified beneficiary) may elect COBRA on behalf of all qualified beneficiaries, and parents may elect COBRA on behalf of their children. Any qualified beneficiary for whom COBRA is not elected within the 60-day election period specified in the Plan’s COBRA election notice WILL LOSE HIS OR HER RIGHT TO ELECT COBRA.
How long does COBRA coverage last?
COBRA coverage is a temporary continuation of Plan coverage that lasts between 18-36 months depending on the qualifying event.
You, your spouse and covered dependents may qualify for up to 18 months of continuation coverage, if you qualify due to one of the following qualifying events:
- Your employment ends for any reason other than termination for gross misconduct;
- Your work hours are reduced and you are no longer eligible to participate in the Plan ; or
- Unpaid Leave of Absence
Your covered spouse and covered dependent may qualify for up to 36 months of continuation coverage, if they qualify due to one of the following qualifying events:
- You die;
- You and your spouse get a divorce; or
An enrolled child no longer meets the definition of “child” under the terms of the Plan.
Second qualifying event extension COBRA coverage
If your family experiences another qualifying event while receiving COBRA coverage as a result of the covered employee’s termination of employment or reduction of hours (including COBRA coverage during a disability extension as described above), the covered spouse and children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given the COBRA Administrator. This extension may be available to the spouse and any children receiving COBRA coverage if the employee or former employee dies, gets divorced, or if the covered child stops being eligible under the Plan as a child. This extension is not available under the Plan when a covered employee becomes entitled to Medicare after his or her termination of employment or reduction of hours. This extension due to a second qualifying event is available only if you notify the correct benefits administration entity within 60 days of the date of the second qualifying event.
Disability extension of 18-month COBRA continuation coverage
The 18-month continuation period may be extended for you and your covered family members if the Social Security Administration determines that you or another family members, who is a qualified beneficiary, is disabled at any time during the first 60 days of continuation coverage. If all of the following requirements are met, coverage for all family members who are qualified beneficiaries as a result of the same qualifying event can be extended for up to an additional 11 months (for a total of 29 months):
- This extension is available only for qualified beneficiaries who are receiving COBRA coverage because of a qualifying event that was the covered employee’s termination of employment or reduction of hours.
- The disability must have started at some time before the 61st day after the covered employee’s termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above).
- A copy of the Notice of Award from the Social Security Administration is provided to the COBRA Administrator [ExxonMobil Benefits Service Center] within 60 days of receipt of the notice and before the end of the initial 18 months of continuation coverage.
- If the disabled qualified beneficiary elects continuation coverage, you must pay an increased premium of 150 percent of the monthly cost of Plan coverage that’s continued, beginning with the 19th month of continuation coverage.
Extension Due to Medicare Eligibility
Coverage may also last up 36 months for a covered spouse or covered dependent when loss of coverage is the result of a qualifying event that is the end of the employee’s employment or the reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. In this case, COBRA coverage under the Plan for qualified beneficiaries (other than the employee) may last until up to 36 months after the date of the employee’s Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA coverage for his spouse and children who lost coverage as a result of his termination can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). This COBRA coverage period is available only if the covered employee becomes entitled to Medicare within 18 months BEFORE termination or reduction of hours.
When COBRA Coverage Ends
- COBRA coverage may be terminate before the maximum period if the member requests early termination, or if Exxon Mobil Corporation no longer provides group health coverage to any of its eligible employees or eligible retirees. Otherwise coverage will last for the applicable period.
Are there other coverage options besides COBRA continuation coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a special enrollment period. You can learn more about many of these options at www.healthcare.gov.
More information about individuals who may be qualified beneficiaries during COBRA
A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is considered to be a qualified beneficiary provided that, if the covered employee is a qualified beneficiary, the covered employee has elected COBRA coverage for himself or herself.
The child's COBRA coverage begins when the child is enrolled in the Plan, whether through special enrollment or open enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the Plan, the child must satisfy the otherwise-applicable Plan eligibility requirements (for example, regarding age).
Alternate recipients under QMCSOs
A child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order (QMCSO) received by ExxonMobil during the covered employee's period of employment with ExxonMobil is entitled to the same rights to elect COBRA as an eligible child of the covered employee.
Cost of COBRA coverage
EAP services are available at no charge throughout the COBRA period.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov.
Keep your plan informed of address changes
In order to protect your family's rights, you should keep ExxonMobil Benefits Service Center informed of any changes in your address as well as the addresses of family members. You should also keep a copy, for your records, of any notices you send.
Contacts for COBRA rights under the ExxonMobil Medical Plan
The following sets out the contact numbers based on your status under the ExxonMobil Medical Plan. FAILURE TO NOTIFY THE CORRECT ENTITY COULD RESULT IN YOUR LOSS OF COBRA RIGHTS.
If your status is not listed, call the ExxonMobil Benefits Service Center for help.
|Employees and their covered family members:|
ExxonMobil Benefits Service Center
Monday – Friday 8:00 a.m. to 6:00 p.m. (U.S. Eastern Time)
Web: ExxonMobil Benefits (http://www.exxonmobil.com/benefits)
|ExxonMobil Benefits Service Center
P.O. Box 18025
Norfolk, VA 23501-1867
|Former employees and family members who have elected and are participating through COBRA:|
ExxonMobil COBRA Administration
|Wageworks National Accounts Services
ExxoMobil COBRA Administration
P.O. Box 2968
Alpharetta, GA 30023-2968
Benefit claims procedures
If ComPsych determines that you need urgent care, ComPsych will provide telephonic crisis counseling and make an appropriate referral to your benefit plan and/or emergency resources in the community. The EAP does not provide urgent care.
Because ComPsych pays all EAP providers directly, you should not make any payment to a provider for EAP services. In the event that you mistakenly pay a provider for EAP services, ComPsych will make a determination on your request for reimbursement within 15 days after receipt of the Claim (if EAP services have not yet been received) or with 30 days after receipt of the Claim (if the EAP services have already been received). ComPsych will notify you of its determination in writing, within the 15 day or 30 day period, as applicable.
To use EAP, call ComPsych at 888-226-1420. You do not pay for or file claim forms for your EAP counseling sessions. If you require additional services beyond that provided by EAP, those services may be provided under your medical plan.
If you have a problem with a plan benefit, contact ComPsych. The Care Manager is responsible for determining and informing you of your entitlement to a benefit.
The following categories of claims for benefits apply to the ExxonMobil Employee Assistance Program, and according to the type of claim submitted, ComPsych will review your claim and respond within a designated response time. If ComPsych needs additional time (an extension) to decide on your claim because of special circumstances, you will be notified within the claim response period.
Urgent care means care needed to avoid serious jeopardy to your life or health or to regain maximum function (or required to avoid severe pain), as determined by ComPsych or your treating physician. ComPsych does not make Claim determinations relating to urgent care.
Pre-service claims are any claims for benefits where the Plan provisions require approval before care is obtained.
Post-service claims are claims made after care is received and apply to claims under the ExxonMobil Employee Assistance Program.
Type of Claim
Urgent care claims
An additional 15 days. However, if an extension is necessary due to incomplete information, you must provide the additional information within 45 days from the date of receipt of the extension notice.
An additional 15 days. However, if an extension is necessary due to incomplete information, you must provide the additional information within 45 days from the date of receipt of the extension notice.
If your claim for benefits is denied completely or partially, and you authorize written communication to you, ComPsych will provide written notice to you, your beneficiary, or designated representative. The notice will describe:
- The specific reason(s) for the denial for the denial decision,
- Identify Plan provisions on which the decision is based,
- Describe any additional material or information necessary for an appeal review and an explanation of why it is necessary,
- Explain the review procedure, including time limits for appealing the decision and to sue in federal court,
- Identify your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol, or similar criterion relied on in making the decision, and
- Identify your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EAP services are not clinically appropriate).
If you do not authorize written notice, ComPsych will furnish this information to you or your Authorized Representative by telephone.
Filing a mandatory appeal
If you believe your Claim for EAP benefits was denied in error, you may appeal the decision. Your appeal must be submitted in writing to ComPsych within 180 days following your receipt of a denial notice.
Your appeal should state the reasons why you feel your Claim for EAP benefits is valid and include any additional documentation that you feel supports your Claim for EAP benefits. You can also include any additional questions or comments. You may submit written comments, documents, records and other information relating to your appeal, whether or not the comments, documents, records or information were submitted in connection with the initial Claim for EAP benefits. On your request, ComPsych will make relevant documents available to you.
The review of the initial decision will consider all new information, whether or not it was presented or available for the initial decision. The person who conducts the appeal review will be different from the person(s) who originally denied your Claim for EAP benefits and will not report directly to the original decision maker or prior reviewer.
You or your Authorized Representative will be notified of the appeal decision within the following time frames:
- If the case involves an adverse determination on a request for EAP services or a pre-service adverse determination relating to reimbursement, within thirty (30) days of ComPsych's receipt of the request for appeal;
- If the case involves a post-service adverse determination relating to reimbursement, within sixty (60) days of ComPsych's receipt of the request for appeal.
If ComPsych needs additional time to decide on your claim because of special circumstances, you will be notified within the claim response period. However, an extension may be requested, but the law stipulates that no additional time will be allowed.
If you authorize written communication, ComPsych will give you or your Authorized Representative the decision on the appeal in writing. If the denial is upheld on appeal, the notice will set forth:
- The specific reason(s) for the denial and the Plan provisions upon which the denial is based.
- A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim.
- Notice of your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol, or similar criterion relied on in making the decision.
- Notice of your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EAP services are not clinically appropriate).
- A statement of your right to bring an action under section 502(a) of the Employee Retirement Income Security Act (ERISA).
If you do not authorize written notification, ComPsych will furnish this information to you or your Authorized Representative by telephone. If you do not agree with the final decision of ComPsych, you may bring a lawsuit in federal district court within one year of the final decision. You cannot bring legal action unless your Claim has been reviewed and denied by ComPsych.
No action at law or in equity to recover benefits under the Plan shall be brought unless the mandatory appeal process has been completed. In any event, no such action shall be brought after the expiration of one year from the time an appeal is decided by ComPsych.