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Administrative and ERISA information

Administrative and ERISA information for the ExxonMobil Vision Plan

This section contains technical information about the Plan and identifies its administrator. It also contains a summary of your rights with respect to the Plan and instructions about how you can submit an appeal if your claim for benefits is denied.

The formal name of the Plan is the ExxonMobil Vision Plan.

Plan sponsor and participating affiliates

The ExxonMobil Vision Plan is sponsored by:
Exxon Mobil Corporation
22777 Springwoods Village Parkway
Spring, TX 77389

All of Exxon Mobil Corporation's divisions and major U.S. affiliates participate in the Plan. A complete list of participating affiliates is available from the Administrator-Benefits upon written request.

Basic Plan information

Plan administrator

The Administrator-Benefits is the Manager-Global Benefits Design, Exxon Mobil Corporation. You may contact the Administrator-Benefits at the following address. Legal process may be served upon the Administrator-Benefits c/o ExxonMobil by serving the Corporation’s Registered Agent for Service of Process, Corporation Service Company (CSC).

For appeals of eligibility or enrollment issues:

DEPT 02694
PO Box 64116
The Woodlands, TX,  77387-4116

For service of legal process:

Corporation Service Co.
211 East 7th Street, Suite 620
Austin, TX 78701-3218

Authority of administrator-benefits

The Administrator-Benefits (and those to whom the Administrator-Benefits has delegated authority) has the full and final discretionary authority to determine eligibility for benefits under the Plan.

Claims administrator

The claims administrator, UnitedHealthcare Vision, provides information about claims payment, providers participating in the Plan, benefit pre-determinations, and appeals of denied claims. See Information sources.

Claims fiduciary and appeals

The claims fiduciary is the person to whom all appeals are filed. The claims fiduciary is UnitedHealthcare Vision for all vision benefit appeals.

Members who are dissatisfied with the resolution of an adverse decision or complaint have the right to appeal to UnitedHealthcare Vision or to file a complaint with the appropriate Department of Insurance. UnitedHealthcare Vision has full and final discretionary authority to construe and interpret the terms of the Plan in its application to any participant or beneficiary and to decide any and all claim appeals.

Members must request in writing an appeal and the reason for the appeal. Appeals must be filed within 180 calendar days of the previous resolution.

Appeals are submitted to:
UnitedHealthcare Vision Claims Department
P.O. Box 30978
Salt Lake City, UT 84130

Standard service appeal 

Determination will be made within 14 calendar days.

Standard claim appeal 

Determination usually within 30 calendar days, but no more than 60 calendar days.

Type of plan

The ExxonMobil Vision Plan is a welfare plan under ERISA providing vision benefits.

Plan numbers

The ExxonMobil Vision Plan is identified with government agencies under two numbers: 
Employer Identification Number (EIN), 13-5409005, and the Plan Number (PN), 635.

Plan year

The plan year is the calendar year.

Plan funding

Benefits are funded through participant contributions.

No implied promises

Nothing in this booklet says or implies that participation in the ExxonMobil Vision Plan is a guarantee of continued employment with the company.

Future of the Plan 

ExxonMobil has the right to change, suspend, withdraw, amend, modify, or terminate the Plan or any of its provisions at any time and for any reason. A change may also be made to required contributions and future eligibility for coverage, and may apply to those who retired in the past, as well as those who retire in the future. If any material changes are made in the future, you will be notified. For group health plans, certain rules apply regarding what happens when a plan is changed, terminated or merged. Expenses incurred before the effective date of a plan change or termination will not be affected. Expenses incurred after a plan is terminated will not be covered.

Your rights under ERISA

Receive information about your plan and benefits

  • Examine, without charge, at the office of the Administrator-Benefits and at other specified locations, such as worksites and union halls, all documents governing the Plan, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration.
  • Obtain, upon written request to the Administrator-Benefits, copies of documents governing the operation of the Plan, including collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated Summary Plan Description. The administrator may require a reasonable charge for the copies.
  • Receive a summary of the Plan's annual financial report. The Administrator-Benefits is required by law to furnish each participant with a copy of this Summary Annual Report.

Prudent actions by Plan fiduciaries

In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan.  The people who operate your Plan, called fiduciaries of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries.  No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a plan benefit or exercising your rights under ERISA.

Enforce your rights

  • If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision, without charge, and to appeal any denial, all within certain time schedules.
  • Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest Summary Annual Report from the Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Administrator-Benefits to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator.
  • If you have a claim and an appeal for benefits, which are denied or ignored, in whole or in part, you may file suit in a Federal court. If it should happen that Plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. Any such lawsuit must be brought within 1 year of when you first had the right to sue. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
  • You may contact the Texas Department of Insurance if you have any complaints at 800-252-3439 or you may write the Texas Department of Insurance PO Box 149104, Austin, TX 78714-9104, fax 512-475-1771 (not toll free).

Assistance with your questions

If you have any questions about your Plan, you should contact UnitedHealthcare Vision at 877-303-2415 or contact ExxonMobil Benefits Service Center (See Information Sources on page 1). If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Administrator-Benefits, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

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