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Eligibility and enrollment

Eligibility and enrollment for the Retiree Medical Plan - POS II A and B Options

Q. What are the Medical Plan's eligibility requirements? 


A. Most U.S. retirees and eligible family members of Exxon Mobil Corporation and participating affiliates are eligible for the POS II Options.

Generally, you are eligible if:

  • You are a retiree
  • You are a survivor/surviving spouse, which means an eligible family member of a deceased retiree, or employee
  • You are a Long Term Disability Retiree and are not eligible for Medicare Part A or B.
  • 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 for the Retiree Medical Plan if:

  • You participate in any other employer medical plan to which ExxonMobil contributes.
  • You are eligible for coverage under the ExxonMobil Medical Plan.
  • 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 eligible for Medicare as your primary plan.

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, even if medicare eligible. 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, call the Benefits Service Center.
  • Your totally and continuously disabled child(ren)who is over age 26 and  who is incapable of self-sustaining employment by reason of mental or physical disability, that occurred prior to otherwise losing eligibility and meets the Internal Revenue Service's definition of a dependent, and is not eligible to be enrolled in Medicare as their primary medical plan.
  • A child or spouse of a Medicare-eligible retiree or survivor enrolled in the Medicare Primary Option (MPO), as long as that spouse or child over age 26 are not eligible to be enrolled in Medicare.

Effective January 1, 2019, a totally and continuously disabled child over age 26 of a retiree, deceased retiree, or deceased employee who is entitled to be enrolled in Medicare as their primary medical plan is not eligible for coverage under the ExxonMobil Retiree Medical Plan, or any other ExxonMobil health plan available to retirees (such as Dental and Vision coverage). 

Refer to Key Terms for definitions of eligible family members, child, suspended retiree, and spouse.

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 a suspended retiree and not eligible for coverage until the earlier of the date the person:

  • Reaches age 55, or
  • Begins his or her 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:

  • Individual only (Retiree, Spouse, Surviving Spouse, Surviving Child),
  • Retiree and spouse,
  • Individual and child(ren), or
  • Retiree and family.

There are also classes of coverage for surviving spouses and family members of deceased employees and retirees, and spouses and family members of retirees covered by the Medicare Primary option and Medicare Supplement Plan option.

Each class of coverage described in this section has its own contribution rate. 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.  You must complete the forms required for payment of contributions within 60 days of enrollment in the Plan.  If you fail to do so, coverage will be retroactively suspended and you will be prevented from enrolling at a future date until you pay past contributions.

Double coverage

No one can be covered more than once in the Retiree Medical Plan. You and a family member cannot both enroll as retirees and elect coverage for each other as eligible family members. If you and your spouse or adult child are both retirees you may both be eligible for coverage. Each of you can be covered as an individual retiree, or one of you can be covered as the 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.

How to enroll

Retirees have three opportunities to enroll in the ExxonMobil Retiree Medical Plan: 

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

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

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).

Post-Retirement changes in status

If this event occurs... 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, sole court appointed legal guardian, or sole managing conservator Add new eligible family members.
Death of a spouse You must remove coverage for any stepchild(ren) unless you are their court appointed legal 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 lose eligibility because of a change in your employment status, e.g., retiree to rehired employee. Your Retiree Medical Plan participation will automatically be suspended at the date of rehire and you will be covered under the ExxonMobil Medical Plan.
You gain eligibility because of a change in your employment status, e.g., employee to retiree. Enroll yourself and add eligible family members.
You change your residence affecting your eligibility to participate in your elected Retiree Medical Plan option Change your Retiree Medical Plan option.
You or your spouse become entitled to enroll in Medicare as your primary plan You or your spouse lose eligibility under the Retiree Medical Plan options but may enroll in the Medicare Primary Option.
Your disabled child over age 26 becomes entitled to enroll in Medicare as their primary plan (even if your child is not enrolled yet in Medicare) You must remove coverage for your child.
Judgment, decree, or other court order requiring you to cover a family member.
(e.g. begin a QMCSO)
Add new eligible family members.

 

Changes at retirement

If you were enrolled in the ExxonMobil Medical Plan, your enrollment and your covered family members will transfer to the ExxonMobil Retiree Medical Plan. If you were enrolled in a POS II option as an employee, you will maintain claims, deductibles, and out-of-pocket history as a retiree, regardless of whether you choose POS II A and B. However, as a retiree, you will pay your contributions on an after-tax basis via payroll deduction (if eligible), check, or bank draft.

If you are not covered by a medical plan to which ExxonMobil contributes and would like to enroll in the ExxonMobil Retiree Medical Plan, or if you would like to change your Retiree Medical Plan option, you must do so within 60 days of your retirement date. Coverage is effective the first of the month following receipt of your election by the Benefits Service Center.

Annual enrollment

Each year, during the fall, ExxonMobil offers an annual enrollment period. During this time, you can switch from your current Retiree Medical Plan option to another available option. Changes elected during annual enrollment take effect the first of the following year.

Retirees cannot enroll in health benefitor add eligible family members during annual enrollment. Eligible family members can only be added to your coverage at one of the enrollment opportunities listed above or if you experience a corresponding change in status. 

Do not wait to remove a family member who loses eligibility; they should be removed as soon as eligibility is lost at the time of loss of eligibility and not at annual enrollment. For consequences for covering an ineligible family member, see Loss of Eligibility.

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. 

Other situations 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. If you choose to cancel your elected coverage option, you may be able to elect coverage under another Retiree Medical Plan option.

This provision also applies to a significant increase in plan option deductible or copayment.

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

Addition or improvement of plan options

If a new Retiree Medical Plan option is added or if benefits under an existing option are significantly improved during a plan year, you may be able to cancel your current election in order to make an election for coverage under the new or improved option.

Loss of option

If a service area under the Plan is discontinued, you will be able to elect either to receive coverage under another Retiree Medical Plan option providing similar coverage or to cancel medical coverage altogether if no similar option is available. For example, if an option is discontinued, you may elect another option that has service in your area or you may elect to participate in the RMP POS II option. You may also cancel medical coverage altogether.

If a covered family member lives away from home

Coverage depends on whether the Plan option you are enrolled in as a retiree offers service in the area where you live. If your covered family member does not live with you (for instance, you have a child away at school), please contact Aetna Member Services to confirm whether service is available where your family member lives. (See service area in Key Terms).

If you or your covered spouse become eligible for Medicare

If you are a retiree, you and your family members who are not eligible for Medicare participate in the Retiree Medical Plan.  When you (as a retiree) or a covered spouse of a retiree becomes eligible for Medicare as your primary plan, you or your spouse will no longer be eligible for the POS II, Aetna Select, and Cigna OAPIN options in the Retiree Medical Plan, but you or your spouse may be eligible to enroll in the Medicare Primary Option (MPO). If you fail to enroll in the MPO when first eligible, then you or your covered spouse will not be able to enroll at a later time without proof of having other employer provided medical coverage immediately prior to enrollment.

If you die

If you die while enrolled, your covered eligible family members can continue coverage through the Retiree Medical Plan. Eligibility continues for your spouse until your spouse remarries, or becomes eligible for Medicare.  Upon eligibility for Medicare as their primary plan, your spouse can continue coverage through the Medicare Primary Option.

Children of deceased employees or retirees may continue participation in the Retiree Medical Plan as long as they are an eligible family member and are not eligible to be enrolled in Medicare as their primary 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 Suspended retiree below.

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 all your family members who were eligible for Medical 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 die,
  • You elect not to participate,
  • A family member ceases to be eligible (for example, a child reaches age 26),
  • You become a suspended retiree,
  • You are no longer eligible for benefits under this Plan (e.g. as a surviving spouse, you re-marry),
  • You, as a retiree, or your eligible family member becomes eligible for Medicare and for the Medicare Primary Option; 
  • Your former employer  discontinues participation in the Plan,

OR

The date:

  • You do not make any required contribution,
  • You are rehired by ExxonMobil after retirement as an employee or non-regular employee,
  • The Retiree Medical Plan ends,
  • 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 Benefits Service Center when your enrolled spouse or family member is no longer eligible for coverage. To end coverage for your spouse or family member when no longer eligible, contact the ExxonMobil Benefits Service Center. If you do not complete your change within 60 days, any contributions you make for ineligible family members will not be refunded.

Loss of eligibility

Fraud against the Plan

Everyone in your family may lose eligibility for Retiree Medical Plan coverage if you file claims for benefits to which you are not entitled. Coverage may also be terminated if you refuse to repay amounts erroneously paid by the Retiree Medical Plan on your behalf or that you recover from a third party. Additionally, coverage may be terminated if you fail to reimburse the Plan for any amount owed to the Plan, or if you receive and fail to report to the Claims Processor any discounts, write-offs or other arrangements with providers that result in misrepresentation of your out-of-pocket costs. Your participation may be terminated if you fail to comply with the terms of the Retiree Medical 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 coverage. Termination may be retro-active to the date of coverage.

In the event a retiree is rehired and is eligible for the ExxonMobil Medical Plan (EMMP), the retiree and eligible family members are no longer eligible for the EMRMP and coverage is rescinded for all periods during which the retiree is employed. The rehired retiree and eligible family members will be enrolled retroactively in the EMMP until the earlier of failure to comply with the administrative requirements of the EMMP or re-employment ends.  Any claims paid during such periods of employment under the EMRMP will be reprocessed under the EMMP.

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