You are required to be given the information in this section because you are covered under a group health plan (the Plan). 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 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 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 under the Benefits Service Center.
You, your spouse, and your family members may have other options available when you lose group health coverage. For example, they may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
Determination of the Benefits Service Center entity to contact:
- Exxon, ExxonMobil, Mobil, XTO, or Superior Oil Retirees, or their Survivors, or their covered family members contact ExxonMobil Benefits Service Center.
The contact information is as shown under Contacts for COBRA Rights under the ExxonMobil Retiree Medical Plan.
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 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. Under the Plan, qualified beneficiaries who elect COBRA coverage must pay the entire cost of COBRA coverage.
Who is entitled to elect COBRA?
If you are the spouse of a retiree, you will be entitled to elect COBRA if you lose coverage under the Plan because any of the following qualifying events happen:
- The retiree dies,
- You become divorced from the retiree. Also, if the retiree 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 retiree’s child will be entitled to elect COBRA if he or she loses coverage under the Plan because any of the following qualifying events happen:
- The retiree dies, 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 death of the retiree, the Plan will offer COBRA coverage to qualified beneficiaries. You need to notify the Benefits Service Center of any other qualifying events. See Contacts for COBRA rights under the ExxonMobil Retiree Medical Plan for the listing of the Benefits Service Center entities.
You must give notice of some qualifying events
For the other qualifying events (divorce of the retiree and 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 correct Benefits Service Center entity 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. See Contacts for COBRA rights under the ExxonMobil Retiree Medical Plan for the listing of Benefits Administration entities. In providing this notice, you must notify the correct Benefits Service Center entity based on your status. If these procedures are not followed or if the wrong entity is notified during the 60-day notice period, THEN ALL QUALIFIED BENEFICIARIES WILL LOSE THEIR RIGHT TO ELECT COBRA. Notice of these qualifying events from retirees and survivors must be made via the ExxonMobil Benefits Web or by calling the ExxonMobil Benefits Service Center. Notice is not effective until either the properly completed form is received by the Benefits Service Center.
Election of COBRA
Each qualified beneficiary will have an independent right to elect COBRA. Covered retirees 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 coverage. When the qualifying event is the death of the employee (or retiree), the covered retiree’s divorce or a child's losing eligibility as a child, COBRA coverage under the Plan can last for up to a total of 36 months.
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. Some of these options may cost less than COBRA continuation coverage. 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 retiree during a period of COBRA coverage is considered to be a qualified beneficiary provided that, if the covered retiree is a qualified beneficiary, the covered retiree 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).
Cost of COBRA coverage
A person who elects continuation coverage may be required to pay 102% of the cost to the Plan to maintain the coverage. A person who elects continuation coverage must pay the required contributions within 45 days from the date coverage is elected retroactively to the date benefits terminated under the Plan.
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 the correct Benefits Service Center entity 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 to the Benefits Service Center.
Contacts for COBRA rights under the ExxonMobil Retiree Medical Plan
The following sets out the contact numbers based on your status under the ExxonMobil Retiree 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 assistance at 1-800-682-2847.
Retirees, their survivors and covered family members:
ExxonMobil Benefits Service Center
Monday – Friday except certain holidays
8:00 a.m. to 6:00 p.m. (U.S. Eastern Time)
800-682-2847 (toll free)
800-TDD-TDD4 (833-8334) for the hearing impaired
ExxonMobil Benefits Service Center
P.O. Box 18025
Norfolk, VA 23501-1867