Eligibility and enrollment

There are several conditions for eligibility for the MPO. You must:

• Be an eligible retiree or eligible family member,
• Be enrolled in Medicare Parts A and B and continue to pay any required premiums,
• Provide a Medicare Beneficiary Identifier (MBI), located on your Medicare card to ExxonMobil Benefits Service Center (EMBSC),
• Have a residential U.S. street address on file with CMS,
• Not be enrolled in another group or individual Medicare Advantage plan (Part C)
• Not be enrolled in an individual Medicare Part D prescription drug plan in the open market (Part D). You may only be enrolled in a group Medicare Part D, also referred to as Employer Group Waiver Plan (EGWP) if a former employer enrolls you.

How to enroll

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

1. At retirement, or
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 MPO at any other time, including during annual enrollment. If you are 65 or older at the time of your retirement or you are about to turn 65 while participating in the Retiree Medical Plan option, and have other employer coverage, you must waive coverage to maintain eligibility (please refer to the Other Employer Sponsored coverage - Waiving MPO section).

Eligible spouses may be added to your coverage at one of the three enrollment opportunities listed above or if you experience a change in status. Eligible spouses cannot be added to your coverage at any other time, including during annual enrollment.

Post-Retirement changes in status

The following describes all the change in status events that allow changes in status post-retirement that apply to the ExxonMobil Retiree Medical Plan.

Marriage	Add your spouse and any new eligible family members to the applicable ExxonMobil Retiree Medical Plan option.
Divorce – Retiree and spouse enrolled in ExxonMobil health plans	You must 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 to the applicable ExxonMobil Retiree Medical Plan option.
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 to the applicable ExxonMobil Retiree Medical Plan option.
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 subject to the applicable waiver.
You lose eligibility because of a change in your employment status, e.g., retiree to rehired employee.	Your MPO participation will automatically be suspended at the date of rehire and you will be covered under the ExxonMobil Medical Plan.
You change your US residential address to a Non-US address affecting your eligibility to participate in the MPO	You must remove yourself and all eligible family members from the ExxonMobil Retiree Medical Plan.
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 and must enroll in the MPO
Your disabled child becomes entitled to enroll in Medicare as their primary plan, even if your child is not actually enrolled 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.

Other Employer Sponsored coverage – Waiving MPO

You can waive your enrollment in MPO and preserve your eligibility to enroll at a later date (if the MPO is still an available option at that time) at either one of the 2 scenarios described below:

Retirees / spouses turning 65 while participating in the Retiree Medical Plan option: If you/your spouse are turning 65 and are covered under another Employer Sponsored Health Plan through either your own active employment or as a dependent of your spouse’s active employment, you/your spouse can waive coverage for the Medicare Primary Option (MPO). You/your spouse have 90 days to waive: you must request a waiver form to EMBSC (1-800-682-2847) and return it signed anytime within 60 days prior to becoming Medicare eligible and up to the end of the month you turn 65 years old. You/your spouse can then enroll in MPO at a later date when the other Employer Sponsored Health plan ends, with proof of loss of coverage. You have 90 days from loss of coverage to enroll, after which you/your spouse will not be eligible to enroll in MPO.

New retirees over the age of 65: If you are retiring from ExxonMobil and over the age of 65 and are eligible for other coverage through another employer sponsored health plan and want to waive enrollment in MPO, you must sign a waiver within 60 days of retirement date from ExxonMobil. You and your spouse (if applicable) must return a signed waiver to EMBSC (1-800-682-2847) by end of the 60th day of retirement. You and your spouse (if applicable) can then enroll in MPO at a later date when the other plan ends, with proof of loss of coverage. You have 90 days from loss of coverage to enroll, after which you and your spouse (if applicable) will not be eligible to enroll in MPO.

Important Note: If you have not reached 65 at the time of your retirement, and have been covered by another employer-sponsored group medical plan immediately before Plan eligibility, you will have to show loss of coverage under that employer sponsored group medical plan to enroll any time after your Medicare eligibility. You have 90 days from the date of loss of coverage under an employer sponsored group medical plan to provide documentation of loss of this coverage and enroll in the Medicare Primary Option (MPO). If you do not enroll within 90 days from your loss of coverage you will not have another opportunity to enroll.

Eligible retiree

For purposes of the MPO, you are an eligible retiree if you attained retiree status from:

• ExxonMobil,
• Exxon,
• Mobil, or
• Superior Oil Company.
• Expatriates 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 and waive home country health coverage. If you choose not to enroll, there will be no opportunity to enroll at a later point in time during retirement.

Retirees of Station Operators, Inc. doing business as ExxonMobil Company Operated Retail Stores (CORS) are not eligible for coverage under the MPO.

Eligible family members

For purposes of the MPO, eligible family members who are also eligible to be enrolled in Medicare as their primary medical plan include:

• The spouse of an eligible retiree.
• The surviving spouse, who has not remarried, of a deceased eligible retiree or deceased employee.

NOTE: A dependent child of a retiree, deceased retiree, or deceased employee is not eligible for coverage under the MPO, with the exception of a grandfathered population of dependent children who were participating in the ExxonMobil Retiree Medical Plan, Medicare Supplement Plan option on December 31, 2018.

A person who becomes the spouse of an eligible retiree after becoming entitled to be enrolled in Medicare may be added to the MPO within 60 days of becoming eligible without demonstrating loss of coverage under another employer-sponsored medical plan. See change in status chart. Family members who are not entitled to be enrolled in Medicare as their primary medical plan may be eligible for coverage under the Retiree Medical Plan option of the ExxonMobil Retiree Medical Plan. See the SPD for the Retiree Medical Plan option for more information.

Enrolling in the MPO

The ExxonMobil Benefits Service Center (EMBSC) and Aetna contact retirees and their spouses and surviving spouses shortly before their 65th birthdays. If you have not been contacted by the time you become eligible for Medicare, contact the EMBSC at 1-800-682-2847. This is particularly important if you or your spouse become eligible for Medicare by virtue of disability rather than age. Your enrollment in the MPO is subject to your Medicare Parts A & B effective date that occurs the first of the month in which you turn age 65 (if your birthday is on the first of the month, coverage begins the first of the prior month prior), providing an MBI (Medicare Beneficiary Identifier), providing a physical US address, not be enrolled in other individual or group Medicare Part C, or individual Medicare Part D Prescription drug plan. However, if you do not comply with the requirements listed above by the effective date, you will remain covered under your current medical plan option for a period not exceeding 3 months after your retirement month or the month in which you turn 65.

When you receive your Medicare Beneficiary Identifier (MBI) red, white, and blue ID card, contact the EMBSC at 1-800-682-2847. For the hearing impaired, call 1-800-TDD-TDD4 (1-800-833-8334) and provide EMBSC with your Medicare information to complete your enrollment under the MPO. You’ll first receive a letter directly from Aetna confirming your MPO effective date of coverage, followed by your Aetna Medicare ID card.

If you do not enroll in Medicare Parts A and B and provide your Medicare Beneficiary Identifier (MBI) (located on your Medicare card) to the EMBSC by the end of the third month following either the month you turn age 65 or the month you retire, you and any eligible family members will lose coverage under the ExxonMobil Retiree Medical Plan and you will not have an opportunity to re-enroll at a later date, unless you waive coverage (see Eligibility and Enrollment Section)

When the MPO eligibility ends

Eligibility for the MPO ends:

• When a participant fails to make the required contributions to the MPO (see section Cancellation and Reinstatement Process for more information) or Medicare Parts A or B.
• When you cancel your coverage in writing.
• For a spouse following a divorce.
• For a surviving spouse and stepchildren upon remarriage (all coverage ends under the ExxonMobil Retiree Medical Plan).
• For children (children that were part of the Medicare Supplement Plan by December 31, 2018) upon the marriage of the surviving parent.
• For the surviving spouse and children (children that were part of the Medicare Supplement Plan by December 31, 2018) of an employee who died with less than 15 years of ExxonMobil service after a period from the date of death equal to twice the deceased employee's length of ExxonMobil benefit service.
• If, at some future date, the MPO is terminated or replaced.

If you cancel your coverage or did not properly waive coverage, you will not be allowed to re-enroll in the future. Also, if you are not covered under this or another medical plan to which ExxonMobil contributes, your otherwise eligible family members cannot continue coverage under any ExxonMobil medical plans.

Cancellation and Reinstatement Process effective January 1, 2022

Cancellation of EMRMP due to non-payment of premiums:

Cancellations due to non-payment of plan premiums will be prospective, with a 3 month grace period starting 1st month of unpaid contributions, so participants may pay owed contributions within that grace period to avoid cancellation. For example, if retiree has not made payments for their January, February, and March premiums during that 3 month timeframe, coverage will be cancelled effective April 1.

Reinstatement of EMRMP:

Once your coverage has been terminated, you can request to be reinstated upon showing good cause. The EMRMP (or its designee) will review requests for reinstatements on a case-by-case basis. If an individual has been involuntarily disenrolled for failure to pay plan premiums, they may request reinstatement no later than 60 calendar days following the effective date of disenrollment.

Reinstatement for good cause will occur only when:

1. Reinstatement is requested no later than 60 calendar days following the effective date of disenrollment (in the example, 60 days from April 1)
2. The individual has been determined to meet the criteria specified below (i.e., receives a favorable determination); and
3. Within three (3) months of disenrollment for nonpayment of plan premiums, the individual pays in full the plan premiums owed at the time they were disenrolled (in the example, within 3 months from April 1).

If you fail to pay premiums within the grace period, your coverage is terminated, and you fail to show good cause, you and your eligible dependents will not have an opportunity to re-enroll at a future date in the EMRMP. You are still responsible for paying all owed premiums incurred during the grace period in which you were still part of the EMRMP.

Requests for reinstatement must be accompanied by a credible statement (verbal or written) explaining the unforeseen and uncontrollable circumstances causing the failure to make timely payment. An individual may make only one reinstatement request for good cause in the 60-day period. Generally, these circumstances constitute good cause:

• A serious illness, institutionalization, and/or hospitalization of the member or their authorized representative (i.e. the individual responsible for the member’s financial affairs), that lasted for a significant portion of the grace period for plan premium payment;
• Prolonged illness that is not chronic in nature, a serious (unexpected) complication to a chronic condition or rapid deterioration of the health of the member, a spouse, another person living in the same household, person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs) that occurs during the grace period for the plan premium payment;
• Recent death of a spouse, immediate family member, person living in the same household or person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs); or
• Home was severely damaged by a fire, natural disaster, or other unexpected event, such that the member or the member’s authorized representative was prevented from making arrangement for payment during the grace period for plan premium;
• An extreme weather-related, public safety, or other unforeseen event declared as a Federal or state level of emergency prevented premium payment at any point during the plan premium grace period. For example, the member’s bank or U.S. Post Office closes for a significant portion of the grace period.

There may be situations in addition to those listed above that result in favorable good cause determinations. If an individual presents a circumstance which is not captured in the listed examples, it must meet the regulatory standards of being outside of the member’s control or unexpected such that the member could not have reasonably foreseen its occurrence, and this circumstance must be the cause for the non-payment of plan premiums. The Plan expects non-listed circumstances will be rare.

Examples of circumstances that do not constitute good cause include:

• Allegation that bills or warning notices were not received due to unreported change of address, out of town for vacation, visiting out of town family, etc.;
• Authorized representative did not pay timely on member’s behalf;
• Lack of understanding of the ramifications of not paying plan premiums;
• Could not afford to pay premiums during the grace period; or
• Need for prescription medicines or other plan services.

The EMBSC (ExxonMobil Business Service Center) is the appointed designee reviewing reinstatement requests and making good cause determinations.