Basic Accidental Death and Dismemberment Insurance

Q. What happens if I die or am injured in an accident?

A. The company provides insurance for accidental death and certain accident-related injuries. The benefit amount depends on a number of factors, including whether the accident is work-related. Employees may also purchase additional coverage through Voluntary Accidental Death and Dismemberment Insurance.

You are covered by this benefit for losses that are the result of an injury which is caused by certain accidents that occur on or off the job while you are a participant. An accident is a sudden, violent, unexpected, external incident.

If you die in an accident, your beneficiary receives two times your annualized monthly benefit pay. As an employee, if you have a pay change your coverage is based on your annualized monthly benefit pay beginning the first full month after the change, rather than effective with the pay change. You receive benefits for certain physical losses which occur within one year of the accident.

Example:

• For the loss of two or more limbs or for the loss of eyesight in both eyes, the Plan pays two times your pay.
• For the loss of one hand, one foot or the eyesight in one eye, the Plan pays one times your pay.
• For the loss of a thumb or index finger, but not the whole hand, the Plan pays one-quarter of your pay.

The maximum benefit paid for an accident that is not work-related is two times your annualized monthly benefit pay.

Below is the table of Losses and Benefits.

For loss of...	Basic AD&D pays this percentage of your coverage amount
Life	100%
Any combination of a hand, a foot or sight of one eye	100%
One hand by severance at or above the wrist	50%
One foot by severance at or above the ankle	50%
Sight of one eye	12.5%

Effective for losses that occur on or after December 1, 2015, the following dismemberments are included in the coverage:

For loss of...	Basic AD&D pays this percentage of your coverage amount
Quadriplegia	100%
Paraplegia	50%
Hemiplegia	50%
Speech	50%
Hearing (both ears)	50%
All four fingers on same hand	25%
Thumb and index finger on the same hand	25%
All toes on same foot	25%

Occupational accidental death

If you die in a work-related accident which would warrant workers' compensation, your beneficiary receives an additional $500,000.

Restrictions

There are some restrictions applicable to the payment of Basic Accidental Death & Dismemberment (AD&D) benefits. Benefits will not be paid if the death or injury results from:

• Your use of intoxicants;
• Your illegal use of stimulants, drugs or narcotics;
• Your unlawful act;
• Your willful intent to injure yourself or another except in self-defense;
• Your employment with another company or self-employment;
• Your lack of due care for the safety of yourself or your fellow workers;
• Your lack of compliance with safety regulations established by your employer; or
• War or any act of war occurring in the U.S., its territories and possessions, or in any nation of which you are a citizen or permanent resident.

No benefit is payable if death or injury results from:

• Full-time active duty in the armed forces; or
• Suicide or attempted suicide.

Claiming benefits

You or your beneficiary must notify the ExxonMobil Benefits Service Center within 90 days from the date of loss in order to claim benefits. When notified, Benefits Administration will ask for the following information:

• Name and Social Security number of participant;
• The date of death or accidental injury;
• The caller's name, address, telephone number and relationship to participant; and
• Participant's spouse's name, address, Social Security number and birth date, if applicable.

Once this information is provided, CGLIC will process the claim.

Under normal circumstances, CGLIC sends written notice of its decision on the claim within 90 days after receiving the completed forms. Sometimes, more time is needed due to special circumstances. If this is the case, the determination period can be extended for up to an additional 90 days. You or your beneficiary must be notified of the reason for the delay before the original 90-day period expires. You or your beneficiary also must be given a date as to when the claims administrator expects to make a decision.

How benefits are paid

Benefits are usually paid in a lump sum to your beneficiary in the event of your death, or to you in the case of a non-fatal accident. Life insurance proceeds are deposited in an interest bearing account with the insurance company and the beneficiary has the right to withdraw the proceeds as needed. In addition, the insurance company offers other settlement options such as an annuity.

When coverage ends

All AD&D coverage ends when your employment as a regular employee ends.

Coverage is available for up to 30 days during approved Leaves of Absence.

Emergency travel assistance services

Cigna Secure Travel provides emergency medical and travel services, as well as helpful pre-trip planning assistance, when traveling 100 miles or more away from home on company business or on vacation. Services are provided through Europ Assistance USA, Inc. and include: referrals to medical facilities, emergency medical transportation, return of dependent children, visit of a family member if you are expected to be hospitalized for more than 10 days, repatriation services, emergency medical payments, emergency cash advance, legal referrals to local attorneys and assistance with lost or stolen items.

For more information about Emergency Travel Assistance Services contact Cigna Secure Travel*  (see Information sources).