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Pre-Tax Spending Plan

Summary plan description of the ExxonMobil Pre-Tax Spending Plan as of January 2022

About the ExxonMobil Pre-Tax Spending Plan

This summary plan description (SPD) is a summary of the ExxonMobil Pre-Tax Spending Plan (the Plan). It does not contain all plan details. In determining specific benefits, the full provisions of the formal plan documents, as they exist now or as they may exist in the future, always govern. Copies of these documents are available for your review.

Applicability to represented employees is governed by collective bargaining agreements and any local bargaining requirements.

Information sources

When you need information, you may contact:

Claims administrator - Provides claim payment information and claim forms.

Phone numbers:
Aetna Member Services
800-255-2386
210-366-2416 (if international, call collect)

Monday - Friday 8:00 a.m. to 6:00 p.m.,
(U.S. Central Time), except certain holidays
Automated Voice Response - 24 hours a day, 7 days a week

Address:
Aetna 
P. O. Box 981106
El Paso, TX 79998-1106

To visit Aetna's website: www.aetna.com

Benefits Administration - Provides opportunity for specialized assistance from Customer Service Representatives.

ExxonMobil Benefits Service Center
Phone: 800-682-2847

Hours: 8 a.m. to 6 p.m. ET, Monday through Friday, except certain holidays
Web: www.exxonmobil.com/benefits

Address:
P.O. Box 18025
Norfolk, VA 23501-1867

ExxonMobil sponsored sites - Access to plan-related information for employees and their family members.

  • Employee Connect, the Human Resources Intranet Site - Can be accessed at work by current employees.
  • ExxonMobil Family, the Human Resources Internet Site - Can be accessed from home at www.exxonmobilfamily.com by everyone.

Introduction

The ExxonMobil Pre-Tax Spending Plan (the Plan) allows you to take advantage of significant tax savings in three ways:

  • When you elect coverage under a medical, dental and/or vision plan to which a participating ExxonMobil employer contributes, your required contributions (what you may think of as your premiums) will be on a pre-tax basis, unless you opt out of this feature every year. Pre-tax contributions for your premiums are different than your pre-tax contributions to your flexible spending account.
  • The Health Care Flexible Spending Account allows you to set aside pre-tax money for the reimbursement of out-of-pocket medical, dental or vision expenses for both you and your family members.
  • The Dependent Care Flexible Spending Account allows you to set aside pre-tax money for the reimbursement of day care charges provided for your children under age 13 or for a disabled child or adult who lives with you and depends on you financially. This account does not cover medical or dental expenses.

Most employees may participate in one, two or all three parts of the Plan:

  • You are enrolled to pay your contributions for medical, dental and vision plan coverage on a pre-tax basis. If you do not wish to pay your contributions on a pre-tax basis, you must opt out of this feature each year during Annual Enrollment. If you do not opt out each year, your contributions will be made on a pre-tax basis beginning the following plan year.
  • Each year, you must elect an annual amount to contribute in order to participate in the Health Care Flexible Spending Account and/or the Dependent Care Flexible Spending Account.

Your participation in the Plan does not reduce any ExxonMobil benefits related to pay (for example, Life Insurance or Savings Plan contributions).

To help you find specific plan information quickly and easily, these helpful tools are included:

  • Plan at a glance, a quick user's guide highlighting plan basics.
  • Charts and tables throughout this SPD providing information, examples, highlights of plan provisions, etc.
  • References to places you can get more information.

A careful reading of this SPD will help you understand how the Plan works so you can make the best use of the Plan provisions.

Plan at a glance

Enrolling 

If you are eligible, you may participate in one, two or all three parts of the Plan. See Eligibility and enrollment.

Pre-Tax contributions

You are enrolled to pay your contributions for medical, dental and vision plan coverage on a pre-tax basis. See Pre-Tax Contributions for Medical, Dental and Vision Plan coverage.

The Health Care Flexible Spending Account

You may set aside pre-tax dollars for unreimbursed, out-of-pocket medical, dental or vision expenses incurred by you and your family members during the plan year. See Health Care Flexible Spending Account.

The Dependent Care Flexible Spending Account

The Dependent Care Flexible Spending Account can help you pay for a family member's care expenses with pre-tax dollars if a qualified dependent receives day care so you, and your spouse if you are married, can work outside the home. Eligible expenses include charges for day care provided for your children under age 13 or for a disabled child or adult who lives with you and depends on you financially. See Dependent Care Flexible Spending Account.  

Getting reimbursed 

If you have available Health Care FSA funds, you will be reimbursed automatically from the Health Care Flexible Spending Account for claims processed as a participant in the ExxonMobil Medical Plan, the ExxonMobil Dental Plan and eligible claims processed by Spectera for the ExxonMobil Vision Plan. Otherwise, you must file a claim form and attach documentation of your expenses to be reimbursed from either the Health Care or Dependent Care Flexible Spending accounts. See Claiming reimbursement.

Tax implications 

The Plan provides significant tax savings. Examples show how you save taxes by participating in the Plan. See Tax implications.

Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA) 

You and your family members who lose eligibility may continue pre-tax coverage for a limited time under certain circumstances. See Continuation coverage.

Administrative and ERISA information 

The Plan is subject to rules of the federal government, including the Employee Retirement Income Security Act of 1974, as amended (ERISA), not state insurance laws. See Administrative and ERISA information.

Eligibility and enrollment

Eligibility and enrollment for the ExxonMobil Flexible Spending Plan

Most U.S. dollar payroll employees of Exxon Mobil Corporation and participating affiliates are eligible for this Plan.

Eligibility

Full-time employees not hired on a temporary basis (designated as regular employees) are eligible their first day of employment. This includes an employee who is classified as a non-regular employee, but who has been designated as an Extended Part-Time Employee under his or her employer's employment policies relating to flexible work arrangements.

Effective July 1, 2021, a regular employee whose home country is the U.S. and who is working on an expatriate assignment outside the U.S. who is eligible to participate in the ExxonMobil International Medical and Dental Plan is also eligible to participate in the Pre-Tax Spending Plan.

A regular employee whose host country is the U.S. and who is temporarily working in the U.S. is not eligible to participate in the plan.

An employee who is classified as a non-regular employee, but who has been characterized as a trainee and has graduated from high school, complies with any enrollment requirements and makes required contributions, is eligible to participate in the Plan by paying contributions on a pre-tax basis.  Trainees may not participate in the HCFSA and DCFSA.

Leased employees as defined in the Internal Revenue Code, temporary, or part-time employees (classified as non-regular employees and not on extended part-time status), barred employees or special-agreement persons are not eligible to participate in the Plan. A barred employee is an employee who is covered by a collective bargaining agreement, except to the extent participation is provided under such agreement.

A special-agreement person is, generally, a person paid on a commission or commission salary basis other than a person paid while employed by the Marketing department of ExxonMobil; an employee providing service to a non-affiliated organization that pays the person's salary or wages; or an employee working pursuant to an agreement that specifically excludes the person from coverage for benefits.

Retirees are not eligible to participate in the Plan because they do not receive taxable wages.

Initial and annual enrollment

  • Employee Contributions. Participants in the Medical, Dental and Vision Plans are automatically enrolled to pay their monthly contributions on a pre-tax basis through the Plan. You may decline this tax-savings feature, but you must decline it every year during annual enrollment period and each time you make a change to your elected benefits - e.g. if you change the level of coverage in the Dental Plan in order to continue paying all your contributions on an after-tax basis, you must elect to opt out again.
  • To participate in the Health Care Flexible Spending Account (HCFSA), you must enroll each year during the annual enrollment period.
  • Enrollment each year is not required to participate in the rollover for the Health Care Flexible Spending Account (HCFSA). The carryover applies to any unused funds in your Health Care FSA at the end of the plan year, as long as you are an employee as of January 1 of the following plan year.
  • To participate in the Dependent Care Flexible Spending Account (DCFSA), you must enroll each year during the annual enrollment period.
  • Within 60 days of your date of hire, you may enroll in the HCFSA or DCFSA parts of the Plan to cover expenses. As a newly hired employee, if you enroll within 30 days of your start date, coverage begins the first day of employment. If you enroll between 31 and 60 days from your date of hire, coverage will be effective the first day of the month following completion of the enrollment in ExxonMobil Benefits or receipt of the forms by the ExxonMobil Benefits Service Center. You must enroll again each year to participate in one or both of the flexible spending accounts. You also may decline paying your monthly medical, dental, and vision contributions on a pre-tax basis at that time.

Your election to participate in any of the accounts is irrevocable as of the close of the annual enrollment period and you may not change your election for the following year except for the events described in the following sections or for a mistake. 

Changes to Medical, Dental and Vision plans (health plans) pre-tax contributions

The following is a quick reference table that describes events which may allow changes, if the changes are submitted no later than sixty (60) days after the event, as well as the actions you may take. If you have any questions, please call the ExxonMobil Benefits Service Center prior to the expiration of sixty (60) days.

If this event occurs... You may...
Marriage Enroll yourself and spouse and any new eligible family members or change your Health Plans Options.
Divorce – Employee and spouse enrolled in ExxonMobil health plans Change your level of coverage. You are required to remove coverage for your former spouse and any stepchild(ren) but you may not remove coverage for yourself or other covered eligible family members.
Divorce – Employee loses coverage under Spouse’s vision plan Enroll yourself and other eligible family members who might have lost eligibility for Spouse’s plan.
Gain a family member through birth, adoption or placement for adoption or guardianship. Enroll yourself and any eligible family members and change Health Plans Options.
Death of a spouse or other eligible family member. Change your level of coverage. You may not cancel coverage for yourself or other covered eligible family members.
You or a family member loses eligibility under another employer's group health plan or other employer contributions cease which creates a HIPAA special enrollment right. Enroll yourself and other family members that might have lost eligibility. This only pertains to the Health Plans Options. Change your level of coverage and change Health Plans Options.
Other loss of family member's eligibility (e.g., sole managing conservatorship of grandchild ends). Change your level of coverage. You may not cancel coverage for yourself or other eligible family members.
You lose eligibility because of a change in your employment status, e.g., regular to non-regular, strike / lockout. Your plan participation will automatically be termed at the end of the month.
You gain eligibility because of a change in your employment status, e.g. non-regular to regular. Enroll yourself and add any eligible family members.
Termination of Employment by spouse or other family member or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse's or family member's plan in which you or they were enrolled. Enroll yourself and other family members that may have lost eligibility under the spouse's or family member's plan and change your Health Plans Options.
Your former spouse is ordered to provide coverage to your children through a QMSCO. End the family member's coverage, change level of coverage and terminate their participation in health plans.
Commencement of Employment by spouse or other family member or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under another employer's plan. End other family member coverage and terminate their participation in health plans if the employee represents that they have or will obtain coverage under the other employer plan. You may also cancel coverage for yourself, if health care coverage is obtained through your spouse’s employer plan.
Change in worksite or residence affecting eligibility to participate in the elected Health Plan Option (e.g. move out of a Network-only option service area). Change your Health Plans Options and change level of coverage. You may not cancel coverage for yourself or other eligible family members.
Judgment, decree or other court order requiring you to cover a family member (Begin a QMSCO). Change your Health Plans Options and change level of coverage.
Termination or end of QMSCO You may remove the affected the family member from coverage, change level of coverage and terminate their participation in health plans.
Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court. Enroll in the same health plans and Medical Plan option you had prior to termination.
Termination of employment and rehire after 30 days. Enroll in the same health plans and Health Plans options you had prior to termination.
You are covered under your spouse's Health plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year. Enroll yourself and eligible family members in the Health Plans Options.
You begin a leave of absence. Contact the ExxonMobil Benefits Service Center in advance of leave for more information.

For quick reference, payment options are:

For pre-tax treatment: you may elect to pre-pay your health plans and HCFSA contributions in a lump sum through payroll deduction from your final pre-leave paycheck. You may only contribute on a pre-tax basis for up to six months for the leave and only for the remainder of the Plan year in which your leave begins.

For post-tax treatment: you may pay on a monthly basis. You will have to send monthly checks in order to pay for your health plans premiums during the Leave of Absence.
You return from a leave of absence of more than 30 days (paid or unpaid) in same calendar year
Or
You return from a leave of absence of more than 30 days (paid or unpaid) in following calendar year.
Contact the ExxonMobil Benefits Service Center. You are eligible to make updates to your Health Plans Options. If you are on leave during Annual Enrollment, you will still have the opportunity to make new elections.
You return from expatriate assignment outside of the U.S. Change your Health Plans Options.


Changes will only be allowed if the change is made in ExxonMobil Benefits portal within 60 days of the event or the medical/dental/vision enrollment form is received within 60 days of the event.
Unless otherwise noted, the effective date will be the first of the month after the forms are received or the transaction is completed in ExxonMobil Benefits portal .

Loss of Other Health Coverage. You may enroll or add eligible family members when you or your dependent loses other health coverage. Enrollment can be requested when the individual loses eligibility for the other coverage. You must enroll within 60 days of the loss of coverage. The resulting coverage is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change Health plan options at this time.

Entitlement to Medicare or Medicaid. If you, your spouse, or family member who is enrolled becomes entitled to coverage (i.e., becomes enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) (Public Law 89-97 (79 Stat. 291)) or Title XIX of the Social Security Act (Medicaid) (Public Law 89-97 (79 Stat. 343)), other than coverage consisting solely of benefits under section 1928 of the Social Security Act (the program for distribution of pediatric vaccines), you may cancel coverage for that individual. 

Birth, Adoption or Placement for Adoption. If you gain a family member through birth, adoption or placement for adoption, you may add the new eligible family member to your current coverage. You may also enroll yourself, your spouse, and all eligible children. You also may change your plan option. Coverage is effective on the date of birth, adoption or placement for adoption provided you complete the enrollment process within 60 days. You must add the new family member within 60 days even if you already have family coverage.
If you enroll your new family member between 31 and 60 days from the birth or adoption and your coverage level changes, you will pay the cost difference on a post-tax basis until the end of the month in which the forms are received by the ExxonMobil Benefits Service Center. Beginning the first day of the following month your deduction will be on a pre-tax basis.

Marriage. You may enroll or add eligible family members after marriage. You must enroll within 60 days of the marriage and enrollment is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change health plan options at this time.

Loss of Dependent. You are responsible for ending coverage with the ExxonMobil Benefits Service Center when your enrolled spouse or family member is no longer eligible for coverage. If you do not complete your change within 60 days, any contributions you make for ineligible family members will not be refunded and your pre-tax contributions will not be reduced until the beginning of the next calendar year.

Transfer or Change in Residence. If you move from one location to another, and the move makes you no longer eligible for your selected Health Plan option, you may change from your current Health Plan option to one that is available in your new location. For more information, call the ExxonMobil Benefits Service Center.

Coverage Change. If you are covered under your spouse's health plan and the plan's coverage changes to a lesser coverage with a higher deductible mid-year, then you may enroll and add eligible family members. If the cost for coverage under your spouse's health 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 health coverage for yourself and your eligible family members. You must enroll within 60 days following the date you lose coverage under your spouse's plan.

Significant Curtailment of Benefits with Loss of Coverage. If during the year it is determined by the Administrator-Benefits that there has been a substantial decrease in the health care providers available under an option or a reduction in the benefits for a specific type of medical condition or treatment with respect to which you or your spouse or family member is currently in a course of treatment; or any other similar fundamental loss of coverage, then you may be allowed to elect to participate under another benefit package option providing similar coverage or to drop coverage if no similar benefit package option is available.

Changes to your Health Care FSA

The Plan permits you to increase, decrease, revoke or elect to participate in the Health Care FSA during the plan year only as provided in the following chart.

Changes in your elections must be consistent with the changes in status and the change must be made within 60 days of the event. 

Due to COVID-19 relief provisions, a one-time mid-year election change to reduce or stop their pre-tax election for the 2020 Plan Year was permitted for any eligible employee with an HCFSA account balance of over $500 on July 31, 2020.
 
If this event occurs... You may...
Marriage Enroll or increase your election because of the newly eligible spouse.
Divorce Revoke or decrease your election because your spouse is no longer eligible.
Divorce - Employee loses coverage under Spouse's Health Plans. Enroll or increase your election.
Gain a family member through birth, adoption or placement for adoption, marriage, or guardianship. Enroll or increase your election because of the newly eligible family member.
Move or change residence. You are not eligible to make any changes.
Change in medical or your financial condition. You are not eligible to make any changes.
Loss of family member's eligibility (e.g., no longer a tax dependent). Revoke or decrease your election.
You lose eligibility because of a change in your employment status, (e.g., regular to non-regular or you begin a leave of absence). Revoke your election. You may continue the coverage during the leave on an after-tax basis until the end of the year in which the leave commenced.
You gain eligibility because of a change in your employment status, (e.g. non-regular to regular). Enroll.
Termination of Employment by spouse or other family member or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse or family member's plan. Enroll or increase your election.
Your family member becomes eligible for Medicare or Medicaid. Revoke or decrease your election.
Commencement of Employment by spouse or other family member or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under spouse or family member's plan. May decrease or cease election if you gain eligibility under spouse's or family member's plan. Your election to cease or decrease coverage for that individual (including yourself) corresponds only if coverage for that individual becomes effective or is increased under the other employer's plan.
Job transfer requiring relocation including one affecting eligibility to participate in the Medical Plan. You are not eligible to make any changes.
Provider leaves plan option. You are not eligible to make any changes.
Termination of employee and rehire within 30 days or retroactive reinstatement ordered by court. Elections effective at termination are automatically restored unless another event has occurred which allows a change.
Termination of employment and rehire after 30 days. Enroll as a new hire.
You are covered under your spouse's medical plan and plan change's coverage to a lesser coverage with a higher deductible mid-year. You are not eligible to make any changes.
You begin a leave of absence. Contact the ExxonMobil Benefits Service Center to discuss permissible changes.
You can continue or cancel your HC FSA contributions.
If you continue, please review option payments in chart “Changes to Medical, Dental and Vision plans (health plans) pre-tax contributions”
You return from a leave of absence of more than 30 days (paid or unpaid) during the same plan year You have the right to reinstate coverage at prior coverage level (and make-up unpaid contributions) or at a level reduced pro rata for the missed contributions. The make-up contributions may be made on a pre-tax basis even if they span more than one year. In either case, you may not submit expenses for the period during which you did not continue your coverage.
If you return after the end of the plan year. You may have already made your new elections during Annual Enrollment. If no election was made during Annual Enrollment, you will be allowed to make a new election. Contact the ExxonMobil Benefits Service Center for further information.
Death of a spouse or other eligible family member. Revoke or decrease your election.
Death of a spouse where employee is covered by spouse's employer's group health plan. Enroll or increase or decrease your election.
Judgment, decree or other court order requiring you to cover a family member. (Begin a QMSCO). Enroll or Increase your election.
Another parent is ordered to provide coverage to your child through a QMSCO. Revoke or decrease your election if coverage actually provided.
Start an Expatriate assignment and change from current ExxonMobil Medical Plan option to ExxonMobil International Medical and Dental Plan You are not eligible to make any changes.
You return from expatriate assignment outside of the U.S.
 
 If you return during the same plan year
 Your prior elections are reinstated.
 If you return after the end of the plan year
 You will be allowed to make a new election upon the end of the expatriate assignment.

Changes to your Dependent Care FSA

The Plan permits an employee to increase, decrease, revoke or elect to participate in the Dependent Care FSA during the plan year only as provided in the following chart.

Changes in your elections must be consistent with the change in status and the change must be made within 60 days of the event.

If this event occurs... You may...
Marriage

Revoke or decrease your election (e.g., spouse does not work and cares for the children at home).

Enroll of increase (e.g., children are brought into family who now need daycare).

Divorce or Death of Spouse.

Enroll or increase (e.g., now need daycare).

Revoke or decrease (e.g., stepchildren no longer qualifying children).

Gain a family member through birth, adoption or placement for adoption, marriage, or guardianship. Enroll or increase your election if newly eligible family member needs care.
Move or change residence. You are not eligible to make any changes.
A family member is no longer considered an eligible family member. You can revoke or decrease your election (e.g., stepchildren no longer qualifying children).
You or your spouse change to or from part-time or full-time employment (excludes change to extended part-time status). Enroll, increase, revoke or decrease your election.
You or your spouse change work schedules which change either hours of dependent care required or the amount of dependent care costs. Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs.
Job transfer with or without relocation. Enroll, increase, revoke or decrease your election amount only if the relocation results in a change to dependent care costs.
Change in the amount paid for dependent care. Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs (e.g., awarded a scholarship or other subsidy for childcare).
Change from one dependent care center to another one that charges a different rate. Enroll, increase, revoke or decrease your election amount consistent with the change in qualified dependent care expense.
Your child reaches age 13 and is no longer a qualifying family member. Revoke or decrease your election amount consistent with the change in dependent care costs.
Change in home dependent care provider, (e.g., change to a nanny-sharing arrangement). Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs.
Loss of family member's eligibility (e.g., no longer a tax dependent). Revoke or decrease your election.
You lose eligibility because of a change in your employment status, (e.g., regular to non-regular). Revoke your election.
You begin a leave of absence. Contact the ExxonMobil Benefits Service Center
You are not eligible for the Dependent Care FSA while on a leave of absence. If you are enrolled in the DC FSA, the elections will be cancelled effective the starting date of your leave and any expenses incurred during your leave will not be eligible for reimbursement.
You return from a leave of absence of more than 30 days (paid or unpaid) during the same calendar year.
Contact the ExxonMobil Benefits Service Center. You have the right to reinstate coverage at prior coverage level or at a different level (in line with maximum annual deduction amount).
You return from a leave of absence of more than 30 days (paid or unpaid) in the following calendar year. You will be allowed to make a new election. Contact the ExxonMobil Benefits Service Center for further information.
Death of a qualifying family member. Revoke or decrease (e.g., care no longer needed).

Annual enrollment

Each year, as part of the annual enrollment process, you will receive enrollment instructions. You must enroll by the published deadline in order to participate in one or both of the flexible spending accounts for the next year.  

Changing your election

The Plan is governed by federal and state income tax laws and regulations, and the provisions of the Plan document. Once you make an election — contributions on a pre-tax or after-tax basis and/or amounts to the flexible spending accounts — your election must remain in effect for the entire plan year unless you have a change in status or you made a mistake.

When you have a change in status, you can make changes as follows:

    Election for medical, dental and vision plan contributions paid on a pre-tax or after-tax basis.
  • Your contributions are paid on a pre-tax basis when you enroll for medical, dental and vision plan coverage. You may change this election (pay after-tax) when you enroll or within 60 days of a change in status. On the other hand, if you are paying your contributions on an after-tax basis, you may elect to pay on a pre-tax basis with a change in status. Also, if you are paying on an after-tax basis and you change your level of coverage (i.e. employee to family), in order to continue paying on an after-tax basis, you must elect to opt out again.
  • Make your election on ExxonMobil Benefits portal. Your election must be done within 60 days of the event or the form must be received by the ExxonMobil Benefits Service Center within 60 days of the change in status. Depending on the event, the change to your election is effective as of the first of the month following election through ExxonMobil Benefits portal or forms received by the ExxonMobil Benefits Service Center or the actual date of the event.
  • You are not allowed to make changes after the 60-day period until the next annual enrollment period or until another change in status.

  • HCFSA and/or the DCFSA election.
  • As stated in the charts in the Changes to Medical, Dental and Vision plans pre-tax contributions, with a change in status, you may increase, decrease or cancel an election of pre-tax dollars for unreimbursed, out-of-pocket, eligible expenses in either one or both accounts - the HCFSA (medical/dental/vision expense) and/or the DCFSA (dependent care). Your elections to the HCFSA and/or DCFSA must be made separately within 60 days of the event.
  • Make your election at the ExxonMobil Benefits portal . Your election must be made within 60 days of the event or the form must be received by the ExxonMobil Benefits Service Center within 60 days of the change in status. Your adjusted spending account election is generally effective the first of the month following your election. Any change in election affecting annual contributions to the HCFSA or to the DCFSA will only change the amount available for reimbursement from the respective account for the portion of the plan year remaining following the effective date of the change. Any increase in the amount available for reimbursement under the HCFSA or the DCFSA after such an election change may not be used to reimburse expenses incurred prior to the effective date of such change. You may only reduce your election for the remainder of the year to an amount greater than or equal to the amount already contributed. If you cancel your election (reduce to zero), you may only file claims for eligible expenses incurred before you changed your election.
  • If your election is not received by the ExxonMobil Benefits Service Center within 60 days of the change in status, you may not make a new pre-tax spending account election or change your current pre-tax spending account election until you have another change in status or until the next annual enrollment period.

Special rule applies for birth, adoption or placement for adoption

Covered expenses under the Medical Plan can only be reimbursed effective from the date of the birth, adoption, or placement for adoption of a child if the event is processed by the ExxonMobil Benefits Service Center within 60 days. Retroactive increases to the HCFSA and DCFSA are only effective if the event is processed through ExxonMobil Benefits portal or if the form is received within 30 days of the date of the birth, adoption, or placement for adoption.

The plan year is the calendar year, January 1 through December 31. 

Effective date of change

Your election is effective on a pre-tax basis on the actual date of the event only for births, adoptions, and placements for adoption if the election is received by the ExxonMobil Benefits Service Center within 30 days of the event. With regard to all other events, your election is effective the first of the month following receipt of your election, but if the transaction is completed through the ExxonMobil Benefits Service Center on the first day of a month, it is effective that day. Annual elections cannot be decreased to less than the amount already contributed at the time the election is received.

Correcting enrollment mistakes

If you have elected to participate in the DCFSA when you don't have any children under the age of 13, and your written request to revoke your election is received within the first 90 days after the effective date of the election, the ExxonMobil Benefits Service Center may revoke your election if the supporting evidence clearly shows that the election was a mistake.

If you discover any other enrollment/election mistake, it may be possible to allow a change, but only if (1) there is "clear and convincing evidence" that you made a mistake, (2) the mistake is of a type that can be corrected, and (3) the correction is appropriate. Notify the ExxonMobil Benefits Service Center as soon as you realize that you made a mistake. If you fail to contact the ExxonMobil Benefits Service Center during the first 90 days after the effective date of your election, you will need to submit an appeal to the Administrator-Benefits to have the correction considered by filing an appeal as described in the section on Benefit claims procedures for HCFSA & DCFSA.

Leaves of absence and FSA

During a paid leave you may continue to participate in the HCFSA. You would continue your monthly contributions, file claims and receive reimbursement for eligible expenses, subject to claim filing deadlines.

However, during an unpaid Leave of Absence you may not continue to participate in the DCFSA. 

If you choose to continue participating in the HCFSA during an unpaid leave, you may continue to file claims and receive reimbursements for eligible expenses. Your contributions must be paid monthly on an after-tax basis during your leave or in a lump sum on a pre-tax basis (if taxable compensation is available) prior to beginning your leave.

You may also choose to revoke your election and discontinue your participation in the Plan. If you revoke your election while on leave of absence, expenses you incur during the period of revocation will not be reimbursable from the Plan. 

Leaves that last less than 30 days do not affect your eligibility to participate in either the HCFSA or the DCFSA, and such, a leave is not a change in status which permits changes. Once you return to work, contributions will be adjusted for the time you were absent. 

Upon return from a leave that lasts more than 30 days, if you return in the same calendar year, you will be reinstated to your prior coverage at a level reduced pro rata for the missed contributions. For example, assume that Maria elected $1,200 in health FSA coverage for the plan year and paid $100 per month for the coverage. On April 1, after submitting no claims for reimbursement, Maria begins a three-month leave. She does not elect to continue coverage. When Maria returns on July 1, she elects to re-enroll under Health FSA. She will have $900 reinstated ($1,200 minus $300 of paid contributions from January through March in missed contributions) at a cost of $150 per month for the remainder of the year. Expenses incurred during the period that the HCFSA was not in force are not eligible for reimbursement.

Participation when employment ends

When you leave ExxonMobil, your coverage under the Plan (Pre-Tax contributions for your premiums) will end on the last day of the month in which your termination or retirement date occurs. Reimbursement from the HCFSA for expenses you incur after your termination or retirement is not permitted unless you are offered and elect COBRA coverage for the HCFSA. Health care expenses you incur prior to termination or retirement will be reimbursed up to the amount of your projected election for the year. Dependent care expenses you incur prior to termination or retirement will be reimbursed up to the amount you contributed.

If you die as a participating employee, your surviving spouse, the executor or administrator of your estate or a court-appointed party may file claims for eligible expenses incurred before your death.

Continuation coverage (COBRA)

Under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985), you may be entitled to continue coverage in the HCFSA for the remainder of the year and to receive reimbursement for eligible expenses incurred following termination or retirement. You will be allowed to elect COBRA coverage only if the maximum amount available to you from the HCFSA for the remainder of the year is greater than or equal to your required contribution for the remainder of the year. During the period of COBRA coverage, you continue your contributions to the Plan for the amount of your current election for the HCFSA plus a two percent administrative fee. Because you would no longer be receiving taxable pay from which your elected amount can be deducted, your contributions would be made on an after-tax basis. Please see the Continuation coverage section for more information.

Pre-tax contributions

Pre-tax contribution information for medical, dental and vision plan coverage

Unless you have a change in status as defined in the Changes to medical,, dental,, and vision plans (health plans) pre-tax contributions, you may not opt out of your pre-tax election during a plan year. However, you have the opportunity to opt out once a year during the annual enrollment period.

Your new election takes effect the following January 1.

You are enrolled to pay contributions for medical, dental, and vision plan coverage on a pre-tax basis, which gives you two primary advantages:

  • Under current tax law, you do not pay federal income taxes or Social Security taxes on the amount of these contributions. In most states, you also save on your state income taxes.
  • Each year you are enrolled to pay your contributions for medical, dental, and vision plan coverage on a pre-tax basis and your election remains in effect unless you cancel it during a subsequent enrollment period or due to a change in status. The amount of your pre-tax payroll deduction will increase or decrease to reflect the amount of your contributions for medical, dental, and vision plan coverage at the beginning of each plan year and when your class of coverage changes.
  • Pre-tax contributions for your premiums are different than your pre-tax contributions to your flexible spending account.

If you opt out of paying your contributions on a pre-tax basis, you will have to renew this election to pay on an after-tax basis each time you make a change on account of a change in status and each annual enrollment.

Health Care Flexible Spending Account

Information on the Health Care Flexible Spending Account

You save money — as shown in the Examples of tax savings using the Plan— by using pre-tax dollars for unreimbursed, out-of-pocket medical, dental, and vision expenses. You cannot be reimbursed for amounts paid by any insurance provider or health care plan.

Dependents

You may claim reimbursement of eligible health care expenses for your family members even if they are not covered under ExxonMobil's medical, dental or vision plans. Your dependents for the purposes of the HCFSA include:

  • Your spouse.
  • Anyone whom you can claim as a dependent for income tax purposes.
  • A child who would otherwise qualify but you cannot claim as a dependent for income tax purposes because you do not have custody.

Your contributions

You may elect to contribute up to an amount determined by the Administrator-Benefits not to exceed the limit set forth by the Internal Revenue Service for any given taxable year to the HCFSA for the plan year. If you and your spouse both work for ExxonMobil:

  • Each of you can enroll in this account up to the $2,700 limit — a total of $5,000 for your family
  • You may file claims as an employee or as a dependent of another employee participating in the Plan, but you may not be reimbursed for more than 100% of your out-of-pocket expenses.

You can contribute up to $2,700 a year on a pre-tax basis. You may use your account for out-of-pocket expenses not covered or not fully reimbursed by any health plan. 

Availability of funds

Although your election directs funds to this account on a monthly basis, your total projected plan year contributions are available to reimburse you for expenses incurred from the beginning of the plan year. Participants may carryover up to the amount determined by the Administrator-Benefits not to exceed the limit set forth by the IRS for any given taxable year of any remaining unused health care flexible spending account funds to the immediately following plan year, except for the 2020 and 2021 plan years in which unlimited carry over is available (due to COVID-19 relief provisions). The carryover applies to any unused funds in your Health Care FSA at the end of the plan year, as long as you are an employee as of January 1 of the following plan year.

For example, if you have a > $500 unused balance from your Health Care FSA account from 2020, the full amount will be carried over to 2021 plan year, to be used to claim reimbursements for expenses incurred during 2021. The same will apply with any 2021 unused funds to be carried over to 2022 plan year. 

 

Charges spanning more than one plan year

If doctors require payment in advance for services rendered during more than one plan year, ask them to specify the dates services were rendered and the charges for those services. With adequate documentation, you may be reimbursed for expenses incurred for services provided during the plan year. Prescription reimbursement is based on the fill date and not the pick-up date.  Orthodontia, however, is treated differently. Reimbursement is based on your treatment plan, not your payment schedule, even if you pay the total cost in advance.

Orthodontia is unlike most other kinds of health care treatment because:

  • It usually spans more than one plan year, and
  • Frequently the length of treatment is different from the payment schedule.

Initial Banding Fee Reimbursement: Depending upon available FSA funds and amounts paid by the dental plan, if you pay orthodontic charges in full on the date of banding, you will receive up to 25% of the allowed amount as an initial banding fee reimbursement. If you make an initial banding fee payment (down payment), you will be reimbursed up to the total amount paid. If no banding fee is indicated on the claim or you did not make an initial banding fee payment, you will be reimbursed up to 25% of the allowed amount.

Contact Aetna when estimating your annual orthodontia election.

Eligible expenses

Only qualified medical expenses for services while you are a participant are eligible for reimbursement. These expenses include your deductible, co-payments and other out-of-pocket expenses under your group health plans. The calendar year in which a qualified medical expense may be reimbursed under the HCFSA is determined by when the expense is incurred not when you pay the expense. This is consistent with the ExxonMobil Medical Plan and ExxonMobil Dental Plan. 

The following are covered expenses:

Services provided by:

  • Acupuncturist.
  • Advanced clinical practitioners (an advanced practical registered nurse or a nurse practitioner with a master's degree).
  • Audiologists.
  • Certified social workers.
  • Chiropractors.
  • Christian Scientist practitioners.
  • Dentists.
  • Doctors of medicine.
  • Guides for a blind person.
  • Nurses.
  • Optometrists or opticians.
  • Osteopaths.
  • Physical and occupational therapists.
  • Podiatrists.
  • Psychologists.
  • Speech language therapists.

Medical and dental treatment or services:

  • Abortion.
  • Acupuncture.
  • Ambulance services.
  • Artificial insemination.
  • Artificial limbs.
  • Artificial teeth.
  • Braille books and magazines.
  • Chemical dependency treatment centers.
  • Diathermy (electromagnetic heat therapy).
  • Drug addiction treatment.
  • Fees for special homes for the mentally challenged.
  • Fertility enhancement.
  • Healing services.
  • Hydrotherapy.
  • Medical care in a nursing home. Note: Custodial care is not reimbursable.
  • Mental health services.
  • Nursing care for medical services only. Note: This excludes the care of a healthy person. It includes medical care for an elderly person unable to move about or a person subject to dizziness or seizures. It also includes board and wages for a nurse, including Social Security taxes you pay on the wages.
  • Orthodontic appliances and services (see Availability of funds, Orthodontia).
  • Over-the-counter drugs or medications, both oral and topical, whether or not they are prescribed by a physician and menstrual care products.
  • Oxygen and oxygen equipment.
  • Physical, occupational or speech therapy.
  • Radial keratotomy, laser or similar surgery to correct vision.
  • Routine eye examinations.
  • Sterilization.
  • Temporomandibular joint (TMJ/TMD) disorder.
  • Transplants.
  • Weight loss programs, when accompanied by a physician's statement documenting the medical necessity for the treatment of a specific disease and not for general health.

Equipment and supplies:

  • Canes or other walking supports.
  • Diabetic supplies including those purchased over the counter.
  • Eyeglasses and contact lenses and supplies.
  • Hearing aids, hearing aid batteries and equipment for the hearing impaired, such as closed captioned devices and special telephone equipment.
  • Medications available by prescription only and prescribed by a physician, including birth control pills and devices, allergy medications, vitamins and mineral supplements if prescribed for a particular medical condition.
  • Personal protective equipment (PPE), such as face masks, hand sanitizer and sanitizing wipes (for expenses incurred on or after January 1, 2021) 
  • Prescription orthopedic footwear, including arch supports and inlays.
  • Guide dogs.
  • Special hand controls and other equipment installed in a car in order for a disabled person to operate a car.
  • Special equipment, furniture or fixtures in your home, including installation, primarily to provide medical care for you or an eligible family member living in your home. If the improvement increases the value of your home, only the portion of the cost in excess of the increased value may be reimbursed.
  • Wheelchairs, wheelchair lifts and their installation.
  • Wigs and false eyelashes when natural hair is lost as the result of an illness.

Special schools and lessons:

  • Cardiac rehabilitation classes.
  • Charges by special schools to teach Braille to a blind child, signing/lip reading to a deaf or hearing impaired child, remedial language training to correct conditions caused by birth defects, remedial reading for children suffering from dyslexia, and speech therapy.
  • Job placement classes for handicapped family members.
  • Smoking cessation programs and prescription drugs to alleviate nicotine withdrawal symptoms.
  • Tuition and fees for special schools, if recommended by your doctor, for a child with severe learning disabilities.

Travel:

  • Transportation expenses to and from a school recommended by a doctor as a medical treatment.
  • Transportation, including air fare, when medically necessary for a spouse to accompany a spouse or one parent to accompany a child requiring surgery or medical treatment.
  • Travel expenses incurred en route to medical treatment sites, including transportation (either the actual cost or, if unsubstantiated, up to IRS limits).

Miscellaneous:

  • COBRA costs for children under any plan to which ExxonMobil contributes.
  • Capital improvements to your home to help the delivery of medical care. If the improvements increase the value of your home, only the portion of cost in excess of the increased value may be reimbursed.
  • Charges exceeding annual or lifetime maximums paid by a health care plan.
  • Fees paid to health institutes for physician prescribed exercises, massage, and similar treatments designed to alleviate a physical or mental defect or illness.
  • Halfway house residency.
  • Lead based paint removal.
  • Legal fees necessary to treat mental illness.
  • Meals and lodging provided with medical care at a hospital or similar institution.
  • Non-professional administration of patterning exercises.

Medical care items:

  • Braces and supports.
  • Diabetic supplies and equipment.
  • Ear care products.
  • Eye care products.
  • Eye drops and eye wash products.
  • First aid supplies.
  • Home diagnostic tests or kits.
  • Hot and cold packs.
  • Incontinence products.
  • Joint-support bandages and hosiery.
  • Vaporizers and humidifiers.

Be sure to budget carefully, up to $550 of carryover is allowed for the Healthcare Flexible Spending Account, however, any other unused amounts must be forfeited.

Expenses not eligible for reimbursement

The following expenses are not eligible for reimbursement under the HCFSA:

Services:

  • Antiseptic diaper services.
  • Baby-sitting fees enabling you to get medical care.
  • Cosmetic surgery.
  • Custodial care.
  • Ear piercing.
  • Electrolysis.
  • Household help.

Lessons or meetings:

  • Childbirth classes.
  • Dancing or swimming lessons, even if recommended by a doctor.
  • Recreational exercise programs or health club dues.
  • Meetings of Alcoholics Anonymous and similar groups.
  • Tuition allowing children with behavioral problems to attend a particular school for a beneficial change of environment.
  • Wellness programs for general health or nutrition courses.

Travel:

  • Depreciation of a car as part of transportation expenses.
  • Transporting a disabled person to and from work.
  • Transporting people to care for a healthy child to enable parents to be with a hospitalized child or a spouse to be with a spouse.
  • Trips for a change of environment to boost the morale of an ailing person.
  • Trips or vacations taken for a change of environment or general improvement in health, even if advised by a physician.

Equipment and supplies:

  • Air conditioners.
  • Bottled water.
  • Cosmetics.
  • Elastic hosiery.
  • Electricity or special power sources to operate equipment.
  • Exercise equipment, unless prescribed by a physician for a specific medical condition.
  • Hot tubs or whirlpool baths.
  • Maternity clothes.
  • Natural foods such as herbal tinctures and wheat grass, even when prescribed by a naturopath.
  • Non-allergic foods for individuals with allergies.
  • Occupational therapy supplies.
  • Orthopedic pillows.
  • Toothpaste and other non-prescription hygienic supplies.

Fees:

  • Auto insurance premiums, even if some portion would pay for medical coverage.
  • Concierge fees.
  • Boarding school fees paid for healthy children while a parent is recuperating from an illness.
  • Deductions from your pay for short-term disability insurance under state laws.
  • Divorce costs, even if recommended by a psychiatrist.
  • Marriage or family counseling.
  • Medicare Part A premiums.
  • Medical expenses for the natural mother of a child you adopt.
  • Scientology fees.
  • Telephone calls to a doctor, hospital or pharmacy.

Miscellaneous:

  • Contributions or premiums to health plans except those listed under Eligible expenses.
  • Earnings lost as a result of an automobile accident.
  • Expenses and premiums for long-term care.
  • Expenses reimbursed by any insurance plan or policy or by any individual, plan or company.
  • Illegal operations or drugs.
  • Medical bills for a former spouse.
  • Self-hypnosis.

Tax-deductible vs. tax-free

If you itemize on your federal tax return, you have a choice about the tax treatment of your health care expenses:

  • If you itemize your deductions the federal government offers a federal income tax deduction for unreimbursed eligible health care expenses that exceed a stated percentage of your adjusted gross income. Tax laws determine what this percentage will be. See the IRS web site for more details (www.irs.gov).
  • The HCFSA offers tax-free reimbursement from the first dollar of your eligible expenses (maximum $2,700) even if you don't itemize.

Many people find the HCFSA offers a greater advantage. However, because tax laws are complicated and change from time to time, you should consult your personal tax advisor to find out which approach is best for you. You cannot claim a tax deduction on expenses reimbursed to you from the spending account.

Dependent Care Flexible Spending Account

Information on the Dependent Care Flexible Spending Account

Most people will save money, as shown on in the Examples of tax savings using the Plan, by using pre-tax dollars for eligible dependent care expenses.

Eligible dependents

Your dependents for the purposes of the DCFSA are:

  • A child under age 13 if:
  • You are entitled to claim the child as a dependent on your federal income tax return, or
  • You have legal custody of the child for the longer portion of the year, even though you are not entitled to the federal income tax exemption.
  • Your spouse who is physically or mentally unable to care for him/herself.
  • Any other person who is physically or mentally unable to care for him/herself and who may be claimed as a dependent on your federal income tax return, or for whom you would be entitled to an exemption except that the person's income exceeded the exemption allowance.

Contribution limits

You may elect to contribute up to an amount determined by the Administrator-Benefits not to exceed the limit set forth by the Internal Revenue Service for any given taxable year to the DCFSA for the plan year.

  • $5,000 each year if you are:
  • Married filing a joint federal income tax return, or
  • Single filing a federal income tax return as a head of household.
  • $2,500 each year if you are:
  • Married filing separate returns, or
  • Single and filing a return other than as a head of household.
  • $3,000 each year for one dependent or $5,000 per year for two or more dependents if your spouse is a full-time student or disabled.

Please note: If you or your spouse earns less than $5,000 a year, you may direct no more than the earned income of the lower-earning spouse to this account. (For a spouse who is a full-time student at least five months of a calendar year, or who is disabled and temporarily unable to work, the Internal Revenue Code deems his or her earned income to be $250 a month if one family member is receiving care and $500 a month if two or more family members are receiving care.)

The Internal Revenue Code allows reimbursement only for expenses incurred during the months a spouse is a full-time student attending school during the day. Attending school at night does not meet Internal Revenue Code rules.

If you and your spouse both work, the combined annual maximum election is $5,000 (not $5,000 per person).

Availability of funds

There is a lag between the time funds are deducted from your pay and the time they are available for reimbursement.

Funds are credited to your account at the beginning of the month following the month they are deducted. For example, if you pay a care provider $200 on January 1 and direct $200 to your account during January, funds will be available to reimburse you in February.

Be sure to budget carefully because any unused amounts must be forfeited.

Due to COVID-19 relief provisions, unlimited carry over is available for 2020 and 2021 plan years. The carryover applies to any unused funds in your Dependent Care FSA at the end of the plan year, as long as you are an employee as of January 1 of the following plan year
If you have any unused balance in your Dependent Care FSA account from 2020, the full amount will be carried over to 2021 plan year, to be used to claim reimbursements for expenses incurred during 2021. The same will apply with any 2021 unused funds to be carried over to 2022 plan year. For 2023 plan year onwards, there will be no Dependent Care FSA carryover allowed, unless future plan changes are communicated.
 

For details about eligible and ineligible expenses, you may:

  • Call Aetna Member Services to ask about specific expenses; or
  • Refer to IRS Publication 503, Child and Dependent Care Expenses, available from the Internal Revenue Service and from the IRS Internet site at www.irs.ustreas.gov.

Eligible expenses

In general, the Plan lets you use pre-tax dollars to pay for the care of eligible dependents that allows you and your spouse, if married, to work outside the home. The care must be rendered during your normal working hours. To be reimbursable, expenses must be incurred during the plan year and while you are making contributions. Eligible expenses include charges for:

  • Centers providing day care for children,
  • Centers providing day care for dependent adults,
  • Helping disabled dependents with dressing and other personal care,
  • In-home care for children or dependent adults — expenses for dependent care and related household chores can be eligible when there is no clear-cut distinction between the two services. But if you pay one person to take care of a dependent, and another person to do household chores, only expenses for the care are reimbursable.

Expenses not eligible for reimbursement

Expenses must pay for care that allows you and your spouse to work outside the home. The following fail to meet the Internal Revenue Code criteria:

  • Around-the-clock baby-sitting,
  • Care allowing you or your spouse to attend meetings, participate in leisure time activities or take a vacation,
  • Care allowing you or your spouse to attend school at night or on a part-time basis,
  • Expenses for care provided by your own children under age 19 or by relatives you claim as dependents on your tax return,
  • Full-time care in a nursing home,
  • Miscellaneous charges by day care centers for things such as swimming lessons, meals and field trips,
  • Private school tuition for kindergarten and beyond,
  • Payment in advance of services not yet rendered.

Dependent care flexible spending account vs. federal tax credit

Federal law allows you to take a tax credit for eligible dependent care expenses. Under the Internal Revenue Code, the tax credit is an amount equal to a percentage of your dependent care expenses, currently limited to $3,000 for one dependent or $6,000 for two or more dependents. This amount may change from year to year and you should request this information annually from your tax advisor.

If you are considering using the DCFSA, you might want to also consider the effect of your participation on taking the tax credit. Here are your options:

  • You may take the full tax credit allowed by the IRS,
  • You may pass your expenses through the DCFSA, or
  • You may use the spending account for a portion of your dependent care expenses and take the tax credit for the remaining amount.

Please note: If you use the DCFSA, the amount you contribute to your account reduces dollar for dollar the expenses against which you can claim a tax credit. If your DCFSA amount exceeds the available tax credit, you will not be able to take advantage of a tax credit for that year.

The example shown in the Examples of tax savings using the Plan offers a comparison of these options. The payment method that is best for you depends upon your individual situation. To help you determine whether the DCFSA or the tax credit is better for your particular situation, you may want to consult a tax specialist or contact the IRS to obtain Publication 503, Child and Dependent Care Expenses.

Claiming reimbursement

Claiming reimbursement under the ExxonMobil Flexible Spending Plan 

If you are eligible for reimbursement from:

  • The HCFSA, you may be automatically reimbursed for eligible amounts resulting from claims processed as a participant in the ExxonMobil Medical Plan POS II A or B option, Aetna Select option, the ExxonMobil Dental Plan and/or claims processed by Spectera for the ExxonMobil Vision Plan. For other types of expenses, you must file a claim form and attach adequate documentation.
  • You can enroll in direct deposit through Aetna; however, if you submit incorrect direct deposit account information either online or on a paper form, you are responsible for any fees or penalties charged by the financial institution.  Direct deposit information needs to be submitted to Aetna in order to enroll.    
  • The DCFSA, you must file a claim form and attach adequate documentation.

You may print the ExxonMobil Pre-Tax Spending Plan Health and Dependent Care Flexible Spending Account Claim Form from Employee Connect or ExxonMobil Family websites. You can also file a claim online of by using the PayFlex Mobile app. Step-by-step instructions for filing claims, including where to send the paperwork, are also available on the websites. You may also call Aetna Member Services (1-800-255-2386) for forms or use the forms from the Aetna Payflex site. Call Aetna Dedicated Member Services not Payflex for questions pertaining to your HCFSA or DCFSA accounts.  

The Health Care Flexible Spending Account

Aetna processes claims for the HCFSA as well as claims for the ExxonMobil Medical Plan POS II A or B option, Aetna Select option, the ExxonMobil Dental Plan and the ExxonMobil Vision Plan. If you participate in the ExxonMobil Medical Plan POS II A or B option, Aetna Select option and/or the ExxonMobil Dental Plan, Aetna, upon receiving a medical or dental claim from you or a provider, processes the claim for the benefit due under these plans and then processes the claim for any pre-tax reimbursement. In most cases, you do not need to file a pre-tax claim form unless you have expenses not processed under these plans. You must opt out of automatic processing for pre-tax reimbursement if you have other medical or dental coverage secondary to your ExxonMobil coverage by contacting Aetna Member Services. If you are a new employee or you did not elect to participate in the HCFSA during the annual enrollment period, you must contact Aetna to enroll in the automatic rollover process. If you do not contact Aetna to enroll, you will be responsible for filing your own claims.

Spectera processes claims for the ExxonMobil Vision Plan. If you participate in this plan, and Spectera processes a claim for the benefit due, you do not need to file a pre-tax claim form for these claims. If you have other vision expenses not processed by Spectera under the ExxonMobil Vision Plan, you will have to file a claim form for pre-tax reimbursement with Aetna.

If you have eligible expenses that are not covered by a medical, dental, pharmacy or vision plan or you participate in plans other than the ExxonMobil Medical Plan POS II A or B option, Aetna Select option, the ExxonMobil Dental Plan or the ExxonMobil Vision Plan, to be reimbursed you must file a completed Pre-Tax Spending Plan claim form, and:

  • An itemized receipt,
  • A copy of that plan's explanation of benefits to show that the expense is not covered, or how much the plan paid, and
  • Documentation of the claim showing the amount the participant has paid – the documentation being either on the claim or some actual proof of out-of-pocket expense.

Please do not use highlighter on your documentation. Handwritten descriptions of the expenses are not acceptable.

Over-the-counter drug purchases

Effective January 1st, 2022, over-the-counter (OTC) purchases, both oral and topical, can be reimbursed regardless of whether or not they are prescribed by a physician.

The Dependent Care Flexible Spending Account

You must complete the Dependent Care Flexible Spending Account Claim Form  and include supporting documentation. If your caregiver completes and signs the form, you do not need to include an itemized statement. A copy of a canceled check with a fully completed claim form is sufficient if you do not have a bill, voucher or receipt. You will not need a tax identification number (TIN#) displayed in statements for eligible expenses. For questions call 1-800-255-2386 (TTY: 711).

Filing claims for both accounts

  • You must file claims for expenses incurred during the plan year (January 1 through December 31) so that they are received by Aetna no later than April 15 (or if April 15 falls on a non-business day, on the next succeeding business day) following the end of the plan year. This is the ExxonMobil deadline regardless of the IRS deadline. The Plan will not reimburse you for claims received after that date unless you have proof that the claims were to be delivered by the 15th. For example, if a facsimile, the facsimile confirmation to the correct telephone number must be before midnight April 15th. If mailed using a mail or delivery service, the delivery receipt must indicate a guaranteed date by April 15th. Special note: Due to the COVID-19 relief provisions, there is additional time to file claims for reimbursement or appeal a denied claim. Claim expenses incurred in 2019 or appeal denied claims from 2019 can be filed until April 15, 2021. For claims incurred in 2020, they can be claimed until the earlier of 60 days after the end of the National Emergency or April 15, 2022.
  • If you need to submit a claim, but do not yet have all the required supporting documents, submit the claim so Aetna receives it before the claim filing deadline. You must submit an itemized bill with your claim submission. You can then submit the supporting documentation later, but in no event can documentation be accepted after the end of the year in which the claim has been submitted. Documentation submitted to support a claim must show a description of the service or provider co-payment received for reimbursement.
  • With the exception of the $550 carryover in the Healthcare Flexible spending Account, you forfeit any funds remaining in your accounts for which valid claims have not been received by April 15 following the end of the plan year. Forfeited funds revert to the Plan. Note: this will not apply during 2020 and 2021 plan years. See special note related to the COVID-19 relief provisions in the Availability of funds section in Health Care FSA.
  • Payflex allows payments to be sent to providers. You will receive an explanation of payment and a statement showing the status of your account.
  • If you file a claim near the April 15 deadline, you may wish to use a mail or delivery service providing a receipt that will help track the claim.
  • It is advisable to make photocopies of claims and all supporting materials.

Log into PayFlex to obtain information on current balances.  You may also find current account information on the Aetna website.

Benefit claims procedures for HCFSA & DCFSA

Filing a claim 

Claim forms may be found at www.exxonmobilfamily.com

Instructions on how to submit your FSA claims for reimbursement electronically:

Members under Aetna POS options or Aetna Select may log in via Aetna.com, and click Flexible Spending Account (FSA) to get to their PayFlex member website.
  • Alternatively, any member including those under Cigna OAPIN option can log in via Payflex.com following the below steps: Sign onto your PayFlex account at www.payflex.com
  • Go to Account Actions
  • Click on File a Claim
  • Add your “Expense Type” into drop down box
  • Enter your Expense begin and end dates
  • Enter the Total Amount
  • Next you can confirm expense details submitted
  • This will take you the documentation page where you will be able to submit your EOB/itemized invoices for reimbursement
     

If you have a question or a problem with a HCFSA or DCFSA benefit, contact Aetna Member Services. You must file a claim in writing to Aetna Member Services. Aetna is responsible for determining and informing you of your entitlement to a benefit and any amounts payable to you.

Aetna will review your claim and respond within a designated response time, usually 30 days after receiving your claim. If Aetna needs additional time (an extension) to decide on your claim because of special circumstances, you will be notified within the claim response period. An additional 15 days is all that is allowed. If an extension is necessary, due to incomplete information, you must provide the additional information within 45 days from the date of receipt of the extension notice.

Denied claims

If your claim for benefits is denied completely or partially, you, your beneficiary, or designated representative will receive written notice of the decision. The notice will describe

  • The specific reason(s) for the denial, and
  • The process for requesting an appeal.

Claims Fiduciary and Appeals 

The claims fiduciary is the person to whom all appeals are filed. The claims fiduciary is Aetna for HCFSA. The Administrator-Benefits is the claims fiduciary for the DCFSA and eligibility. You may contact the claims fiduciary as follows:

 HCFSA Mandatory Appeals: HCFSA Voluntary and Eligibility Appeals: DCFSA Mandatory, 
Voluntary and Eligibility Appeals:

Aetna 
P. O. Box 981106 
El Paso, TX 79998-1106
Administrator-Benefits
ExxonMobil Medical Plan
P.O. Box 18025
Norfolk, VA 23501-1867
Administrator-Benefits
ExxonMobil Medical Plan
P.O. Box 18025
Norfolk, VA 23501-1867

 

Filing a mandatory appeal

If your claim is denied, you, your beneficiary, or your designated representative may appeal the decision to the appropriate claims fiduciary. If someone is filing a written appeal on your behalf, written authorization from you is required.

For a HCFSA mandatory appeal, please contact Aetna Member Services for information regarding the written authorization and for a DCFSA mandatory and eligibility appeals, please contact the Administrator-Benefits. Your written appeal should include the reasons why you believe the benefit should be paid and information that supports, or is relevant to, your claim (written comments, documents, records, etc.). Your written appeal may also include a request for reasonable access to, and copies of, all documents, records and other information relevant to your claim. You must submit your written appeal within 180 days from the date of the denial notice.

The review will take into account all comments, documents, records and other information submitted relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination. The claims fiduciary will respond to the appeal within 60 days.

If the claims fiduciary needs additional time to decide on your claim because of special circumstances, you will be notified within the claim response period. However, an extension may be requested, but the law stipulates that no additional time must be allowed.

If your appeal is denied, you will receive written notice of the decision. The notice will set forth in plain language:

  • The specific reason(s) for the denial and the plan provisions upon which the denial is based.
  • A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim.
  • A statement of the voluntary appeal procedure and your right to obtain information about such procedure or a description of the voluntary appeal procedure.
  • A statement of your right to bring an action under section 502(a) of the Employee Retirement Income Security Act (ERISA).

Statute of limitations

After you have received the response of the mandatory appeal, you may bring an action under section 502(a) of ERISA. Such action must be filed within one year of the date on which your mandatory appeal was decided.

Filing a voluntary appeal

If your mandatory appeal is denied, you may submit a voluntary appeal to the Administrator-Benefits. New information pertinent to the claim is required for the voluntary appeal to be considered. You must submit your voluntary appeal within 30 days of the denial of your mandatory appeal. The statute of limitations or other defense based on timeliness is suspended during the time that a voluntary appeal is pending.

If it is determined that there is new relevant information, a decision will be made within 60 days after the Administrator-Benefits receives your request for a voluntary appeal.

Tax implications

Tax implications for the ExxonMobil Flexible Spending Plan

You save federal income taxes and, in most states, state income taxes on the amount of your pre-tax contributions. Depending on your income, you may also save Social Security taxes.

Directing money to the Plan reduces your taxable income, which reduces the amount of tax you owe for:

  • Federal income taxes,
  • State income taxes (in most states),
  • Local income taxes (in most locations), and
  • Social Security.

If you earn less than the maximum Social Security wage base, plan contributions reduce the amount of pay subject to Social Security taxes. Participating in this Plan could lower your future Social Security benefits. Generally, the Plan's effect on Social Security benefits will be minimal.

Examples of tax savings using the Plan

To help you understand how you can save tax dollars with the Plan, consider the following examples. For purposes of these examples, we will assume:

  • You and your spouse earn $60,000 a year,
  • You pay 22.65% in taxes (15% federal income taxes and 7.65% Social Security taxes),
  • No state or local taxes are calculated,
  • You have two children, and
  • Your total monthly contributions for coverage are $300.

Example 1 — Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage:

In addition to the assumptions shown above, we will also assume that you pay $300 for medical, dental and vision plan coverage each month of the calendar year for a total of $3,600.

Now, let us compare the results if your contributions are deducted from your pay on a pre-tax basis or after-tax basis.

  If You Remain Enrolled in Pre-Tax for Medical/Dental/Vision Plan Contributions If You Opt Out of Pre-Tax for Medical/Dental/Vision Plan Contributions
Gross annual pay $ 60,000.00 $ 60,000.00
Less your pre-tax contributions - 3,600.00 - 0.00
Balance $ 56,400.00 $ 60,000.00
Less taxes (22.65%) - 12,774.60 - 13,590.00
Less your after-tax contributions - 0.00 - 3,600.00
Your take-home pay $ 43,625.40 $ 42,810.00


Your take-home pay increases by $815.40 during this period simply by paying your medical, dental and vision plan contributions on a pre-tax basis.

Example 2 — HCFSA Contributions:

The following example illustrates the concept of saving taxes through the use of the Health Care Flexible Spending Account. In this example, we will assume that you have tax rate of 22.65% and eligible, unreimbursed health care expenses of $2,000 for the coming year.

Here is the calculation:

  If You Elect the HCFSA If You Do Not Elect the HCFSA
Gross annual pay $ 60,000.00 $ 60,000.00
Less your pre-tax flexible spending contributions - 2,000.00 - 0.00
Balance $ 58,000.00 $ 60,000.00
Less taxes (22.65%) - 13,137.00 - 13,590.00
Less your after-tax contributions - 0.00 - 2,000.00
Your take-home pay $ 44,863.00 $ 44,410.00


Your take-home pay increases by $453 using the spending account.


However, if you pay medical, dental and vision contributions on a pre-tax basis and contribute to the HCFSA, your take-home pay increases by $1,268.40 for the year.

Example 3 — DCFSA Contributions:

Now, consider an example using the DCFSA. Before electing to participate in the DCFSA, you should consider claiming your dependent care expenses under the dependent care tax credit on your federal income tax return. Your personal financial and tax situation will determine which alternative is best for you.

In addition to the assumptions shown at the beginning of these examples, we will also assume that you have eligible dependent care expenses of $5,000 for your two children.

If you do not use the DCFSA, you may use the federal tax credit on your income tax return. The current tax credit is an amount equal to a percentage of your dependent care expenses, limited to $3,000 for one dependent or $6,000 for two or more dependents. The highest percentage is 35% decreasing to 20% with increasing income. In this example, you would have a tax credit of $1,000 - 20% of $5,000.  

  If You Use the DCFSA If You Do Not Use the DCFSA or the Tax Credit If You Use the Tax Credit
Gross annual pay $ 60,000.00 $ 60,000.00 $ 60,000.00
Less your pre-tax flexible spending contributions -$ 5,000.00 - 0 - 0
Balance $ 55,000.00 $ 60,000.00 $ 60,000.00
Less taxes (22.65%) - $ 12,457.00 - 13,590.00 -$ 13,590.00
Less your after-tax contributions - 0 - 5,000.00 - 5,000.00
Plus tax credit + 0 + 0 +$ 1,000.00
Your take-home pay $ 42,542.50 $ 41,410.00 $ 42,410.00


Your take-home pay increases by $132.50 by using the DCFSA compared to using the tax credit only.


However, if you participate in all three parts of the Plan (paying contributions on a pre-tax basis, contributing to the HCFSA and contributing to the DCFSA), your take-home pay increases $1,400.90 for the year.

These examples are illustrations only. Taxes are a personal matter and may vary a great deal depending on your situation. Consult with your personal tax advisor if you have questions or concerns about how the Plan may save taxes for you. 

Continuation coverage

Continuation coverage for the ExxonMobil Flexible Spending Plan 

Continuation coverage for the ExxonMobil Flexible Spending Plan 

Continuation coverage rights under COBRA

Introduction

You are required to be given the information in this section because you are covered under a group health plan (the Medical 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 continuation 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 or other rights 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 SPD or contact the ExxonMobil Benefits Service Center at the telephone numbers or address listed under Benefits Administration in the Contacts for COBRA rights Under the ExxonMobil Medical Plan section.

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:

  • Current ExxonMobil and XTO Employees or their covered family members should use ExxonMobil Benefits Web or contact the ExxonMobil Benefits Service Center;
  • Former Exxon, ExxonMobil or XTO Employees and their covered family members, who have elected and are participating through COBRA, contact the ExxonMobil COBRA Administration.

The contact information for each of these entities is as shown in the Contacts for COBRA Rights Under the ExxonMobil Medical Plan section.

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 the ExxonMobil Benefits Service Center, 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 (employee plus employer portions) plus a 2% administrative fee.

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 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 the ExxonMobil Benefits Service Center of any other qualifying events.

For the other qualifying events (divorce of the employee resulting in the spouse 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 ExxonMobil Benefits Service Center or ExxonMobil COBRA Administration 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. Current employees may give notice of qualifying events by logging onto ExxonMobil Benefits located on the Employee Connect intranet site. (Effective February 1, 2022, the internal EDA site has retired, so all changes and notices of qualifying events from current or former employees should be made through the ExxonMobil Benefits Service Center, where forms are also available.)

Please note:  Notice is not effective until either a change is made on ExxonMobil Benefits or the proper information is received by the ExxonMobil Benefits Service Center. If notice is not submitted during the 60-day notice period, then all qualified beneficiaries will lose their right to elect COBRA.

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 Plan coverage that lasts between 18-36 months depending on the qualifying event.

You, your spouse and covered dependents may qualify for up to 18 months of continuation coverage, if you qualify due to one of the following qualifying events:

  • Your employment ends for any reason other than termination for gross misconduct;
  • Your work hours are reduced and you are no longer eligible to participate in the Plan ; or
  • Unpaid Leave of Absence

Your covered spouse and covered dependent may qualify for up to 36 months of continuation coverage, if they qualify due to one of the following qualifying events:

  • You die;
  • You and your spouse get a divorce; or
  • An enrolled child no longer meets the definition of “child” under the terms of the Plan

Second qualifying event extension 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 continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given the COBRA Administrator. This extension may be available to the spouse and any children receiving COBRA coverage if the employee or former employee dies, 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.

Disability extension of 18-month COBRA continuation coverage

The 18-month continuation period may be extended for you and your covered family members if the Social Security Administration determines that you or another family members, who is a qualified beneficiary, is disabled at any time during the first 60 days of continuation coverage.  If all of the following requirements are met, coverage for all family members who are qualified beneficiaries as a result of the same qualifying event can be extended for up to an additional 11 months (for a total 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).
  • A copy of the Notice of Award from the Social Security Administration is provided to the COBRA Administrator [ExxonMobil Benefits Service Center] within 60 days of receipt of the notice and before the end of the initial 18 months of continuation coverage.
  • If the disabled qualified beneficiary elects continuation coverage, you must pay an increased premium of 150 percent of the monthly cost of Plan coverage that’s continued, beginning with the 19th month of continuation coverage.

Extension Due to Medicare Eligibility

Coverage may also last up 36 months for a covered spouse or covered dependent when loss of coverage is the result of a qualifying event that is the end of the employee’s 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.  In this case, COBRA coverage under the Plan for qualified beneficiaries (other than the employee) may last until up to 36 months after the date of the employee’s 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.

 

When COBRA Coverage Ends

COBRA coverage may be terminate before the maximum period if one of the following occurs:

  • The premium for your continuation coverage is not paid on time.
  • If after electing continuation coverage, you become covered by another group health plan, unless the plan contains any exclusions or limitations with respect to any pre-existing condition you or your coverage dependents may have.
  • If after electing continuation coverage, you first become eligible for and enroll in Medicare Part A , Part B or both.
  • You extend coverage for up to 29 months due to a qualified beneficiary’s disability and there has been a final determination by the Social Security Administration that the qualified beneficiary is no longer disabled. In this case, continuation coverage will end on the first of the month that begins more than 30 days after the final determination o by the Social Security Administration that the qualified beneficiary is no longer disabled. This will be the case only if the qualified beneficiary has been covered by continuation coverage for at least 18 months.
  • Exxon Mobil Corporation no longer provides group health coverage to any of its eligible employees or eligible retirees.

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 ExxonMobil during the covered employee's period of employment with ExxonMobil 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 due to disability, 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 ExxonMobil Benefits Service Center 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.

Contacts for COBRA rights under the ExxonMobil Medical Plan

The following sets out the contact numbers based on your status under the ExxonMobil Medical Plan. FAILURE TO NOTIFY THE CORRECT ENTITY COULD RESULT IN YOUR LOSS OF COBRA RIGHTS. If your status is not listed, call the ExxonMobil Benefits Service Center for help.

Employees and their covered family members:

Contact:

Address:

ExxonMobil Benefits Service Center

Phone: 1-800-682-2847

Monday – Friday 8:00 a.m. to 6:00 p.m. (U.S. Eastern Time)

Web: ExxonMobil Benefits

 

ExxonMobil Benefits Service Center

Address: P.O. Box 18025

Norfolk, VA 23501-1867

 

Former employees and family members who have elected and are participating through COBRA:

ExxonMobil COBRA Administration
Monday - Friday except certain holidays
8:00 a.m. to 7:00 p.m. (U.S. Central Time)

800-526-2720

Wageworks National Accounts Services
ExxonMobil COBRA Administration

P.O. Box 2968
Alpharetta, GA 30023-2968
Fax: 833-514-6416

Administrative and ERISA information

Administrative and ERISA information for the ExxonMobil Flexible Spending 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 Pre-Tax Spending Plan.

Plan sponsor and participating affiliates

The ExxonMobil Pre-Tax Spending Plan is sponsored by:

Exxon Mobil Corporation 

5959 Las Colinas Boulevard 
Irving, TX 75039-2298

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

Certain employees covered by collective bargaining agreements do not participate in the Plan.

Basic Plan information

Plan administrator

The Plan Administrator for the ExxonMobil Pre-Tax Spending Plan is the Administrator-Benefits. 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).

Administrator-Benefits

ExxonMobil Pre-Tax Spending Plan
P. O. Box 18025
Norfolk, VA  23501-1867

For service of legal process:

Corporation Service Co.
211 East 7th Street, Suite 620
Austin, Texas 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, to construe and interpret the terms of the Pre-Tax Spending Plan in its application to any participant or beneficiary, and to decide any and all claim appeals.

Type of plan

The Health Care Flexible Spending Account component of the ExxonMobil Pre-Tax Spending Plan, a cafeteria plan under IRC Section 125, is a welfare plan under ERISA.

Claims administrator

The claims administrator provides information about claims payment. The claims administrator is Aetna for HCFSA and DCFSA.

Plan numbers

The ExxonMobil Pre-Tax Spending Plan is identified with government agencies under two numbers: the Employer Identification Number, 13-5409005, and the Plan Number (PN), 601.

Plan year

The plan year is January 1 through December 31.

No implied promises

Nothing in this SPD says or implies that participation in the ExxonMobil Pre-Tax Spending 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 also may 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 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. If a plan cannot pay all of the incurred claims and plan expenses as of the date the Plan is changed or terminated, ExxonMobil will make sufficient contributions to the Plan to make up the difference.

Your rights under ERISA

As a participant in the ExxonMobil Pre-Tax Spending Plan, you have certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that as a plan participant, you shall be entitled to:

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 Pre-Tax Spending Plan, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Pre-Tax Spending 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 Pre-Tax Spending 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 Pre-Tax Spending 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 pre-tax spending plan fiduciaries

In addition to creating rights for Pre-Tax Spending Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Pre-Tax Spending Plan, called fiduciaries of the Pre-Tax Spending Plan, have a duty to do so prudently and in the interest of you and other Pre-Tax Spending 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 Pre-Tax Spending Plan documents or the latest summary annual report from the Pre-Tax Spending 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 state or Federal court.  Such lawsuit must be filed in the United States District Court for the Southern District of Texas, Houston, Texas, or in the United States District Court for the federal judicial district where the employee currently works.  If a retiree or terminee, the suit must be filed in the last location worked prior to termination of employment. Beneficiaries must also file in the same federal judicial district that the employee or retiree would be required to file. Any such lawsuits must be brought within one year of the date on which an appeal was denied. 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.

Assistance with your questions

If you have any questions about your Pre-Tax Spending Plan, you should contact your dedicated Aetna Member Services, or call the ExxonMobil Benefits Service Center. 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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