List of key terms in the ExxonMobil medical fully-insured HMO Plan
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 leaves 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.
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.
Most U.S. dollar-paid employees of Exxon Mobil Corporation 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):
- has not reached the end of the month during which age 26 is attained; or
- is totally and continuously disabled and incapable of self-sustaining employment by reason of mental or, physical disability, provided the child:
- meets the Internal Revenue Service's definition of a dependent and
- was or would have been covered as an eligible family member under this Plan immediately prior to the birthday on which the child's eligibility would have otherwise ceased, or
- was covered as an eligible family member under a predecessor plan which provided for coverage of disability, if the disability occurred prior to the birthday on which the child's eligibility under that plan would have otherwise ceased, the child continued to be considered eligible for coverage because of such disability and the child had not lost eligibility under the predecessor plan; and
- the child is disabled before such birthday and has remained continuously disabled, and
- the child is recognized under a qualified medical child support order as having a right to coverage under this Plan.
A child who was disabled by reason of mental disability but who no longer meets the requirements of paragraphs 2(a) above, ceases to be an eligible family member 300 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.
ExxonMobil Medical Plan
The plan sponsored by Exxon Mobil Corporation which provides medical benefits for eligible employees, retirees, survivors and their family members and includes the fully-insured and selffunded HMO options and the POS II options.
A fully-insured HMO option, under the EMMP, is a health insurance agreement purchased by ExxonMobil from an insurance company. The HMO is ultimately responsible for providing funding to pay for employee's health claims in accordance with the health insurance agreement. Fully-insured health plans are regulated by the state in which they operate. You may contact your state's insurance regulator for more information.
Providers and facilities that participate in a health maintenance organization available under this plan.
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.
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 longterm 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.
(As used in the ExxonMobil Medical Plan, a self-insured HMO.) - A self-funded HMO, under the EMMP, is an option set up by ExxonMobil to set aside funds to pay employees’ health claims. Because ExxonMobil has hired insurance companies to administer the claims for these plans, they may look just like fully-insured plans but they are funded by ExxonMobil. For example, all Aetna and Cigna HMO options under the EMMP are self-insured HMOs. Aetna and Cigna are responsible for processing claims and are the respective claims fiduciary. ExxonMobil is responsible for providing the funds to the Plan to pay health claims. This does not impact the way that your HMO operates. The U.S. Department of Labor regulates self-insured plans, not the state. You may contact the Department of Labor at the address listed in the ERISA section: Assistance with Your Questions.
means the geographic area, designated by the Plan, in which a Plan participant must live or otherwise meet the eligibility requirements in order to be eligible as a participant in the Plan, determined by the participant's home address zip code.
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.
An employee who is classified as a non-regular employee, but who has been characterized as a Trainee and has graduated from high school.