The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) entitles you and your covered family members to extend vision benefits beyond the date your coverage would normally end.
Continuation coverage rights under COBRA
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 you when you would otherwise lose your group health coverage. It can also become available to your spouse and children, if they are covered under the Plan, when they would otherwise lose their group health coverage 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 Information Booklet or contact ExxonMobil Benefits Administration at the telephone numbers or address listed under Benefits Administration on page 3.
You, your spouse and your family members may have other options available when you lose group health coverage. For example, you 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 Benefits Administration entity to contact:
IMPORTANT: Benefits Administration references throughout this notice change depending on your status. Unless specifically stated otherwise, you should refer to the correct Benefits Administration entity using the list below. If your status is not listed, contact ExxonMobil Benefits Administration/Health and Welfare Services for assistance.
- Current Employees or their covered family members should use EDA or contact ExxonMobil Benefits Administration/ Health and Welfare Services,
- Exxon, ExxonMobil, Mobil, XTO or Superior Oil Retirees, or their Survivors, or their covered family members contact ExxonMobil Benefits Service Center, and
- Former Exxon, ExxonMobil or XTO Employees and Exxon and ExxonMobil Retirees (who retired before October 1, 2005) and their Survivors, or covered family members, who have elected and are participating through COBRA, contact ExxonMobil COBRA Administration.
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 Benefits Administration, 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 an employee, you will be entitled to elect COBRA, if you lose your coverage under the Plan because either one of the following qualifying events happens:
- Your hours of employment are reduced, or
- Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will be entitled to elect COBRA if you lose coverage under the Plan because any of the following qualifying events happens:
- Your spouse dies,
- Your spouse's hours of employment are reduced,
- Your spouse’s employment ends for any reason other than his or her gross misconduct,
- You become divorced from your spouse. Also, if your spouse (the employee) 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 employee’s child will be entitled to elect COBRA if he or she loses coverage under the Plan because any of the following qualifying events happens:
- The parent-employee or parent-retiree dies,
- The parent-employee's hours of employment are reduced,
- The parent-employee's employment ends for any reason other than his or her gross misconduct, 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 end of employment or reduction of hours of employment or death of the employee, the Plan will offer COBRA coverage to qualified beneficiaries. You need to notify Benefits Administration of any other qualifying events.
You must give notice of some qualifying events
For the other qualifying events (divorce 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 Benefits Administration 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. In providing this notice, you must notify the correct Benefits Administration entity based on your status and follow the procedures outlined in this section. 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 procedures for qualifying events
Notices of qualifying events from current employees must be made by logging onto Employee Direct Access (EDA) located on the Employee Connect HR intranet site. Forms are also available from ExxonMobil Benefits Administration/ Health and Welfare Services for those individuals who do not have access to EDA. Notices 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 EDA or the ExxonMobil Benefits Web change is made or the properly completed form is received.
Election of COBRA
Each qualified beneficiary will have an independent right to elect COBRA. Covered employees 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, the covered employee’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.
When the qualifying event is the end of employment or the reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA coverage under the Plan for qualified beneficiaries (other than the employee) who lose coverage as a result of the qualifying event can last until up to 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA coverage for his spouse and children who lost coverage as a result of his termination can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). This COBRA coverage period is available only if the covered employee becomes entitled to Medicare within 18 months BEFORE termination or reduction of hours.
Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA coverage under the Plan generally can last for only up to a total of 18 months.
The COBRA coverage periods described above are maximum coverage periods. COBRA coverage can end before the end of the maximum coverage periods described in this notice for several reasons, which are described in the Plan’s summary plan descriptions.
There are two ways (described in the following paragraphs) in which the period of COBRA coverage resulting from a termination of employment or reduction of hours can be extended.
Disability extension of COBRA coverage
If a qualified beneficiary is determined by the Social Security Administration to be disabled and you notify the correct Benefits Administration entity, in a timely fashion, all of your qualified beneficiaries in your family may be entitled to receive up to an additional 11 months of COBRA coverage, for a total maximum of 29 months. This extension is available only for qualified beneficiaries who are receiving COBRA coverage because of a qualifying event that was the covered employee’s termination of employment or reduction of hours. The disability must have started at some time before the 61st day after the covered employee’s termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above).
The disability extension is only available if you notify Benefits Administration in writing of the Social Security Administration’s determination of disability within 60 days after the latest of:
- The date of the Social Security Administration’s disability determination,
- The date of the covered employee’s termination or reduction of hours, and
- The date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee’s termination of employment or reduction of hours.
You must also provide this notice within 18 months after the covered employee’s termination of employment or reduction of hours in order to be entitled to a disability extension, and you must notify the correct Benefits Administration entity at least 30 days before the end of the 18-month period. See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60-day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, THEN THERE WILL BE NO DISABILITY EXTENSION OF COBRA COVERAGE.
Second qualifying event extension of COBRA coverage
If your family experiences another qualifying event while receiving COBRA coverage as a result of the covered employee’s termination of employment or reduction of hours (including COBRA coverage during a disability extension as described above), the covered spouse and children in your family can get up to 18 additional months of COBRA coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the correct Benefits Administration entity. This extension may be available to the spouse and any children receiving COBRA coverage if the employee or former employee dies or gets divorced or if the covered child stops being eligible under the Plan as a child. This extension is not available under the Plan when a covered employee becomes entitled to Medicare after his or her termination of employment or reduction of hours.
This extension due to a second qualifying event is available only if you notify the correct Benefits Administration entity within 60 days of the date of the second qualifying event. See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60 day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, THEN THERE WILL BE NO EXTENSION OF COBRA COVERAGE.
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 employee during a period of COBRA coverage is considered to be a qualified beneficiary provided that, if the covered employee is a qualified beneficiary, the covered employee 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).
Alternate recipients under QMCSOs
A child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order (QMCSO) received by Exxon Mobil Corporation during the covered employee's period of employment with Exxon Mobil Corporation is entitled to the same rights to elect COBRA as an eligible child of the covered employee.
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, unless the person is entitled to extended coverage due to disability. If the person becomes entitled to such extended coverage, the person may be required to contribute up to 150% of contributions after the initial 18-month's coverage until coverage ends. 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 Administration 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 Benefits Administration.
Benefits administration (contacts for COBRA rights under the ExxonMobil vision plan)
The following sets out the contact numbers based on your status under the ExxonMobil Vision Plan. Failure to notify the correct entity could result in your loss of COBRA rights.
If your status is not listed, contact ExxonMobil Benefits Administration/Health and Welfare Services for assistance or contact them at firstname.lastname@example.org.
|Employees and their covered family members:|
ExxonMobil Benefits Administration/
|ExxonMobil Benefits Administration
ATTN: Health and Welfare Services ExxonMobil
BA BSC USBA
P.O. Box 64111
Spring, TX 77387-4111
|Retirees, their survivors and covered family members:|
ExxonMobil Benefits Service Center
800-682-2847 (toll free)
|ExxonMobil Benefits Service Center
P.O. Box 1014
Totowa, NJ 07512-1014
|Former employees and retirees (who retired before October 1, 2005), their survivors and family members who have elected and are participating through COBRA:|
ExxonMobil COBRA Administration
|Wageworks National Accounts Services
ExxonMobil COBRA Administration
P. O. Box 2968
Alpharetta, GA 30023-2968
Fax: (833) 514-6416