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Vision Plan

Summary plan description of the ExxonMobil Vision Plan as of January 2021

About the ExxonMobil Vision Plan

This guide is a summary of the rules for the ExxonMobil Vision Plan (the Plan).  This guide along with the Certificate of Coverage provided by United Health Care Insurance Company constitutes the Summary Plan Description (SPD) for the Plan.  If you do not have a copy of the certificate, go to the Spectera Vision website at www.exxonmobilvision.com. This guide does not contain all the Plan details.  In determining your specific benefits, the full provisions of the formal documents, as they exist now or as they may exist in the future, always govern. Copies of these documents are available for your review. Exxon Mobil Corporation reserves the right to change benefits in any way or terminate any benefit at any time.

The Vision Plan is fully-funded.  An insurance company collects premiums and underwrites coverage. ExxonMobil is responsible for determining the rules of eligibility for the Vision Plan. State laws that govern vision plans may affect some of the eligibility participation rules.  Please contact Spectera for further assistance. About the participation rules in this booklet you can contact Benefits Administration. See Information sources below.

Notice: The Vision Plan is an excepted benefit under Patient Protection Affordable Care Act (PPACA) and is not minimum essential coverage.  Since it is not minimum essential coverage, you may not treat it as required coverage when filing your U.S. Federal Income Tax return.

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

Information sources

When you need information, you may contact:

United Healthcare Insurance Company (UHIC)

Issues the insurance policy for Spectera, Vision Care Program

SpecteraSM Vision

. Provides specialized assistance with respect to questions about the benefit features of the Vision Plan, claims, appeals and network providers.

Spectera Vision
Customer Service Department
877-303-2415 

Monday – Friday 7:00 a.m. to 10:00 p.m. CT
Saturday 8:00 a.m. to 5:30 p.m. CT
(except certain holidays)

Spectera Vision
Claims Department
P. O. Box 30978
Salt Lake City, UT 84130

ExxonMobil vision plan web site: www.exxonmobilvision.com

The following is available on SpecteraSM Vision’s dedicated ExxonMobil Web site:
  • Benefit Summary - outlines the benefits available under the Vision Plan
  • Certificate of Coverage - provides additional detailed information about the Vision Plan
  • Provider Locator - search tool listing retail and private practice providers in Spectera Eyecare Networks
  • Provider Nomination Form - to nominate your provider to participate in Spectera Eyecare Networks
  • Frequently Asked Questions (FAQs) about the Vision Plan
  • Useful Links information to help you learn more about eye care

 

Benefits Administration

Provides specialized assistance by benefits counselors with respect to enrollment. References throughout this guide refer to either ExxonMobil Benefits Administration or ExxonMobil Benefits Service Center as listed below. Depending on your status (employee, retiree or survivor), you should contact the appropriate service center.

Employees can enroll/change benefits on the Employee Connect HR Intranet site through Employee Direct Access (EDA) when a change in status occurs. Please contact Benefits Administration if you do not have access to EDA.

Phone Numbers/Hours and Addresses:
Employees:
ExxonMobil Benefits Administration/Health and Welfare Services 
hr.health.welfare@exxonmobil.com (E-mail)
713-231-1743 (fax)

ExxonMobil Benefits Administration  
ExxonMobil BA BSC USBA
P.O. Box 64111
Spring, TX 77387-4111

Retirees:
ExxonMobil Benefits Service Center
800-682-2847 (toll free)
800-TDD-TDD4 (833-8334) for hearing impaired 

Monday – Friday 7:00 a.m. to 5:00 p.m. CT
(except certain holidays)

ExxonMobil Benefits Service Center
P.O. Box 18025
Norfolk, VA 23501-1867 

ExxonMobil sponsored sites

Provide access to plan-related information, including claim forms.

  • Employee Connect, the Human Resources Intranet site — can be accessed at work by employees.
  • ExxonMobil Family, the Human Resources Internet site — can be accessed from home by everyone at www.exxonmobilfamily.com.
  • Retiree Online Community Internet site — can be accessed from home by ExxonMobil retirees and survivors only (including Exxon and Mobil retirees and survivors) at www.emretiree.com.
  • ExxonMobil Benefits Web site — can be accessed from home by everyone at http://www.exxonmobil.com/benefits.

Introduction

The ExxonMobil Vision Plan (the Plan) encourages preventive eye care by offering coverage for comprehensive eye exams and allowances for lenses and frames or contact lenses in lieu of lenses and frames. The Plan offers you the opportunity to use optometrists and ophthalmologists who are part of Spectera Eyecare Networks. You can generally reduce your out-of-pocket expenses while maximizing the plan benefits by using this network. The Vision Plan eligibility and enrollment rules are described in detail in this booklet.  For details on your benefits coverage, please see your Certificate of Coverage or contact SpecteraVision at 1-877-303-2415.

Plan at a glance

Enrolling

Employees:
You may enroll yourself and your eligible family members within your first 60 days of employment or within 60 days of a subsequent change in status or at Annual Enrollment. See How to enroll for employees.

Retirees:
You may enroll yourself and your eligible family members within 60 days of your retirement. If you are not already enrolled as an employee and you do not enroll at this time, you will have limited opportunities to enroll at a later date. See How to enroll for retirees.

Spectera Eyecare Networks

You can visit any provider, but you save when you choose a provider who participates in the Spectera Eyecare Networks.

Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA)

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

Administrative and ERISA Information 

This 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.

Key terms 

This is an alphabetized list of words and phrases, with their definitions, used in this Information Booklet. See Key terms.

Eligibility and enrollment

Eligibility and enrollment for the ExxonMobil Vision Plan

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

Generally, you are eligible if:

Eligible family members

Eligible family members are generally your:

  • Spouse,
  • A child who is described in any one of the following paragraphs (1) through (3):

       1. has not reached the end of the month during which age 26 is attained, or

       2. is totally and continuously disabled and incapable of self-sustaining employment by reason of mental or physical disability, provided the child:

            a) meets the Internal Revenue Service's definition of a dependent, and

            b) was covered as an eligible family member under this Plan immediately prior to age 26 when the child's eligibility would have otherwise ceased, and    

            c) met the clinical definition of totally and continuously disabled before age 26 and continues to meet the clinical definition through subsequent periodic reassessment reviews, or           

       3. is recognized under a qualified medical child support order as having a right to coverage under this Plan.

A child aged 26 or over who was disabled but who no longer meets the requirements of paragraph two (2) above, ceases to be an eligible family member 60 days following the date on which the applicable requirement is not met.

Please note: An eligible employee's parents are not eligible to be covered. 

Suspended retiree

A person who becomes a retiree due to incapacity within the meaning of the ExxonMobil Disability Plan and who begins long-term disability benefits under that plan, but whose benefits stop because the person is no longer incapacitated is considered a suspended retiree and is not eligible for coverage until the earlier of the date the person:

  • Reaches age 55, or
  • Begins his or her benefit under the ExxonMobil Pension Plan at which time the person is again considered a retiree and may enroll.

The family members of a deceased suspended retiree will be eligible for coverage under this Plan only after the occurrence of the earlier of the following:

  • The date the suspended retiree would have attained age 55, or
  • The date a survivor begins receiving a benefit due to the suspended retiree's accrued benefit from the ExxonMobil Pension Plan.

Special eligibility rules

A person who otherwise is not a spouse but who, as a dependent of a former Mobil employee who participated in or received benefits under a Mobil-sponsored plan or program prior to March 1, 2000, is considered an eligible dependent as long as that person's eligibility for coverage as a dependent under a Mobil-sponsored plan would have continued.

Classes of coverage

You can choose coverage as an:

  • Employee or retiree only,
  • Employee or retiree and spouse,
  • Employee or retiree and child(ren), or
  • Employee or retiree and family.

There are also classes of coverage for extended part-time employees, surviving spouses and family members of deceased employees and retirees, and employees on certain types of leaves of absence.

For employees on an approved leaves of absence, their contribution rate will not change.

Each class of coverage has its own contribution rate.  Employees contribute to the Plan through monthly deductions from their pay on a pre-tax or after-tax basis.  Retirees and survivors receiving monthly benefit checks from ExxonMobil pay by deductions from these checks on an after-tax basis.  Other retirees or survivors and participants with continuation coverage pay by check or monthly draft on their bank account.

Double coverage

No one can be covered more than once in the Vision Plan. You and spouse family member cannot both enroll as employees (or retirees) and elect coverage for each other as eligible family members. If you and your spouse or adult child work for the company or are both retirees you may both be eligible for coverage. Each of you can be covered as an individual employee (or retiree), or one of you can be covered as the employee (or retiree) and the other can be an eligible family member. Also, if you and your spouse have children, each child can only be covered by one of you.

In addition, a marriage between two ExxonMobil employees does not allow enrollment or cancellation in any of the ExxonMobil health plans. In order to change your coverage you need to wait until you experience a change in status that allows coverage changes or annual enrollment.

How to enroll

Employees:

As a newly hired employee, if you enroll in the Vision Plan 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 enrollment in EDA or receipt of the forms by Benefits Administration.

If you are eligible for the ExxonMobil Pre-Tax Spending Plan, you will be enrolled to pay your monthly contributions on a pre-tax basis unless you annually decline this feature. Your monthly pre-tax contributions and class of coverage must remain in effect for the entire plan year, unless you experience a change in status. (See the Annual enrollment and Changing your coverage sections.)

You can enroll eligible family members only if you are enrolled in this plan. You can enroll in the Plan using Employee Direct Access (EDA) available on the Employee Connect HR intranet site. Enrollment forms are also available from Benefits Administration for those who do not have access to EDA.

You may be requested to provide documents at some future date to prove that the family members you enrolled were eligible (e.g., marriage certificate, birth certificate). If you fail to provide such requested documents within 90 days of the request, coverage for the family members will be cancelled the first of the following month and you may be subject to discipline up to and including termination of employment for falsifying company records.

Under the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009 you may change your Plan election for yourself and any eligible family members within 60 days of either (1) termination of Medicaid or CHIP coverage due to loss of eligibility, or (2) becoming eligible for a state premium assistance program under Medicaid or CHIP coverage.  In either case, coverage is effective the first of the month following receipt of the forms by Benefits Administration.

Retirees:

Effective January 1, 2019, retirees have three opportunities to enroll in the Vision Plan:

  1. At retirement, or
  2. Upon loss of other employer coverage, or
  3. When first eligible to be enrolled in Medicare as your primary plan.

There is no opportunity to enroll yourself in the Vision Plan at any other time, including during annual enrollment.

If you were enrolled in the Vision Plan as an employee, you and your eligible covered family members will continue to be enrolled in the Plan at retirement. However, as a retiree, you will pay your contributions on an after-tax basis via payroll deduction (if eligible), check, or bank draft.

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

All enrollments must be completed within 60 days of the enrollment event. Coverage is effective the first of the month following receipt of your election by the ExxonMobil Benefits Service Center (EMBSC), except in the case of a birth or adoption of a child when changes will be effective on the date of the birth or adoption.

You can enroll either online or by phone. To enroll online go to www.exxonmobil.com/benefits. To enroll by phone contact the ExxonMobil Benefits Service Center at 800-682-2847. 

You may be requested to provide documents at some future date to prove that the family members you enrolled were eligible (e.g. marriage certificate, birth certificate). If you fail to provide such requested documents within the required time period, coverage for the family members will be cancelled the first of the following month. If you enroll family members who are not eligible for the Plan, for instance, by covering children who do not meet the eligibility requirements, you may lose eligibility for yourself and your family under all ExxonMobil health plans.

You may cancel your coverage at any time; however, you may not re-enroll unless you experience a corresponding change in status or you wait until one of the enrollment opportunities listed above. Coverage will be terminated at the end of the month in which your elected change has been received.

Eligible family members may also be removed from your coverage at any time; however, they may not be reinstated unless you experience a corresponding change in status or you wait until one of the enrollment opportunities listed above.

Note: You are required to remove family members who are no longer eligible for coverage at the time of loss of eligibility. To remove an ineligible family member (a divorced spouse for example) you must notify the Benefits Service Center within 60 days of the loss of eligibility or your ineligible family members will not be entitled to COBRA benefits continuation. If you fail to notify the Benefits Service Center, you may also lose eligibility for yourself and your family under all ExxonMobil health plans. In addition, you will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person(s).

Annual enrollment

Note: Effective January 1, 2019, retirees cannot enroll in or make changes to their Vision Plan coverage during annual enrollment.

Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, employees can make changes to coverage by adding or removing family members. Family members may be added or removed for any reason during annual enrollment. However, family members must be removed as soon as they are no longer eligible. Changes elected during annual enrollment take effect the first of the following year.

Note: You should not wait until annual enrollment to remove a family member who loses eligibility; they should be removed at the time eligibility is lost. For consequences for covering an ineligible family member, see Loss of Eligibility.

Employees are automatically enrolled in the Pre-Tax Spending Plan to pay monthly contributions on a pre-tax basis unless this feature is declined each time. This choice is only available during the annual enrollment period or with a change in status.

If you do not want to make any changes, you don’t have to do anything during annual enrollment to continue with your current plan selection for the following year. However, if as an employee you want to participate in a Flexible Spending Account (FSA), you must enroll each year, even if you are currently enrolled in an FSA.

If as an employee you pay your monthly contributions on an after-tax basis and would like to continue making contributions on an after-tax basis for the following year, you must elect to do so each year during annual enrollment and after each change in status. Otherwise, your contributions will be switched to a pre-tax basis beginning the first day of the following year.

Changing your coverage

Employees:

To make a change to your coverage after your initial enrollment you must wait until annual enrollment or until you experience one of the following Changes in status.

Note: Changes in coverage associated with a change in status are effective the first day of a month after enrollment is completed, except in the case of a birth or adoption of a child when changes will be effective on the date of the birth or adoption. If the change is made during annual enrollment, changes are effective the first day of the following year.

Retirees:

To make a change to your coverage after your retirement you must wait until you experience a Post-Retirement Change in Status.

Changes in Status during employment

Retirees and survivors please see Post-Retirement Changes in Status.

This section explains which events are considered changes in status during your employment and what changes you may make as a result. If you have a change in status, you are required to complete your change within 60 days. If you do not complete your change within 60 days, changes to your coverage may be limited. If you fail to remove an ineligible family member within 60 days of the event that causes the person to be no longer eligible, (e.g., divorce) you are required to continue to pay the same pre-tax contribution for coverage even though you have removed the ineligible person(s).  Your pre-tax contribution for coverage will remain the same until you have another change in status or the first of the plan year following the next annual enrollment period. The only exception is death of an eligible family member. In addition, you will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person(s).

Important Note: Your election due to a change in status cannot be changed after the transaction is completed in EDA or the form is received by Benefits Administration. If you make a mistake in EDA, contact Benefits Administration at hr.health.welfare@exxonmobil.com immediately or no later than the first work day following the day on which the mistake was made.

The following is a quick reference guide to the Changes in Status during employment discussed in more detail after the table.

If this event occurs... As an employee you may...
Marriage Enroll yourself and spouse and any new eligible family members.
Divorce – Employee enrolled in the Vision Plan Change your level of coverage. You are required to remove coverage for your former spouse and 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 vision plan.
Gain a family member through birth, adoption or placement for adoption or guardianship. Enroll yourself and any eligible family members.
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.
Other loss of family member’s eligibility (e.g., sole managing conservatorship). 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, lockout / strike. Your Vision 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 or any eligible family members in the Vision Plan.
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 who may have lost eligibility under the spouse's or family member's plan in the Vision Plan.
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 the Vision Plan.
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's coverage and terminate their participation in the Vision Plan 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.
Judgment, decree or other court order requiring you to cover a family member. (Begin a QMCSO) Change your level of coverage.
Termination or end of QMCSO You may remove affected family member.
Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court. Vision coverage is reinstated.
Termination of employment and rehire after 30 days. Enroll in the Vision Plan as a new hire.
You are covered under your spouse’s vision plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year. Enroll yourself and eligible family members in the Vision Plan.
You begin a leave of absence. Contact Benefits Administration
You return from a leave of absence of more than 30 days (paid or unpaid). Contact Benefits Administration 

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

Marriage

If you are enrolled in the Vision Plan, you can enroll your new spouse and his or her eligible family members (including your stepchildren) for coverage. If you are not already enrolled for coverage, you can sign up for vision coverage for yourself, your new spouse, and your stepchildren. If you gain coverage under your spouse's vision plan, you can cancel your coverage. You must make these changes within 60 days, following the date of your marriage or wait until annual enrollment or another change in status.

Divorce

In the case of divorce:

  • Your former spouse and any stepchildren are only eligible for coverage through the end of the month in which the divorce is final.
  • You are required to remove coverage for your former spouse and stepchild(ren) within 60 days of your divorce.
  • You must notify and provide any requested documents to Benefits Administration as soon as your divorce is final.
  • If you do not to notify and provide requested forms to Benefits Administration within 60 days will result in your former spouse and stepchild(ren) not being entitled to elect COBRA.
  • If you fail to remove your spouse and any stepchild(ren) within 60 days of the event you will continue to have pay the same pre-tax contribution for coverage even though you have removed your former spouse and stepchild(ren).
  • Your pre-tax contribution for coverage will remain the same until you have experienced another change in status or the first of the plan year following the next annual enrollment period.
  • You will be required to reimburse the Plans for any claims paid after the loss of eligibility for any ineligible person.

There may also be consequences for falsifying company records. Please see the Continuation coverage section of this SPD.

You may not make a change to your coverage if you and your spouse become legally separated because there is no impact on eligibility.

If you lose coverage under your spouse's health plan on account of divorce, you can sign up for vision 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 or wait until annual enrollment or another change in status.

Birth, adoption or placement for adoption

If you gain a family member through birth, adoption or placement for adoption, you may add the newly eligible family member to your current coverage. You may also enroll yourself, your spouse, and all eligible children. 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.

See the Changing your coverage section for additional circumstances in which changes can be made.

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 enrollment is completed in EDA or the forms are received by Benefits Administration. Beginning the first day of the following month your deduction will be on a pre-tax basis.

Death of a spouse

If you lose coverage under your spouse’s vision plan, you can sign up for vision coverage for yourself and your eligible family members. You must make these changes within 60 days following the date you lose coverage or wait until Annual Enrollment or another change in status. If you and your family members are enrolled in the Vision Plan, any stepchildren will cease to be eligible upon your spouse's death unless you are their court appointed guardian or sole managing conservator. 

Sole legal guardianship or sole managing conservatorship

If you (or your spouse, separately or together) become the sole court appointed legal guardian or sole managing conservator of a child and the child meets all other requirements of the definition of an eligible family member, you have 60 days from the date the judgment is signed to enroll the child for coverage. You must provide a copy of the court document signed by a judge appointing you (or your spouse separately or together) guardian or sole managing conservator. 

When a child is no longer eligible 

If an enrolled family member is no longer an eligible family member, coverage continues through the end of the month in which they cease to be eligible. In some cases, continuation coverage under COBRA may be available. You must notify and provide the appropriate forms to Benefits Administration as soon as a family member is no longer eligible. If you fail to notify and provide the appropriate forms to Benefits Administration within 60 days, the family member will not be entitled to elect COBRA. While we have an administrative process to remove dependent children reaching the maximum eligibility age, you remain responsible for ensuring that the child is removed from coverage. If you fail to ensure that a family member is removed in a timely manner, there may be consequences for falsifying company records.  

Leave of absence

If you are on an approved leave of absence, you can continue coverage by making required contributions directly to the Plan by check or, if applicable, pre-pay your benefits. If you choose not to continue your coverage while on leave, your coverage ends on the last day of the month in which your cancelation form is received by Benefits Administration and you will be required to pay for the entire month’s contributions.  If you fail to make required contributions while on leave, your coverage will end.

If the company should make any payment on your behalf to continue your coverage while you are on leave and you decide not to return to work, you will be required to reimburse the company for required contributions.

If you were on a leave that meets the requirements of the Family and Medical Leave Act of 1993 (FMLA) or the Uniformed Services Employment and Reemployment Rights Act (USERRA), and your coverage ended, re-enrollment is subject to FMLA or USERRA requirements.

For more information, contact Benefits Administration. 

Post-Retirement Changes in Status

Employees please see Changes in Status during employment.

If this event occurs... As a retiree you may...
Marriage Add your spouse and any new eligible family members. 
Divorce – Retiree and spouse enrolled in ExxonMobil health plans. You are required to remove coverage for your former spouse and any stepchild(ren).
Divorce – Retiree loses coverage under spouse’s health plans. Enroll yourself and add other eligible family members who might have lost eligibility for spouse’s plan.
Gain a family member through birth, adoption or placement for adoption or guardianship. Add new eligible family members.
Death of a spouse. You must remove coverage for any stepchild(ren) unless you are their court appointed guardian or sole managing conservator.
You or a family member loses eligibility under another employer's group health plan. Enroll yourself and add eligible family members.
You become entitled to enroll in Medicare as your primary medical plan whether or not you enroll in Medicare. Enroll yourself and add eligible family members.
Your disabled child becomes entitled to enroll in Medicare as their primary medical plan whether or not they enroll in Medicare. You must remove coverage for your child.
Judgment, decree or other court order requiring you to cover a family member. (Begin a QMCSO) Add new eligible family members.


Other changes that may affect your coverage

Change in coverage costs or significant curtailment

If the cost for coverage charged to you significantly increases or decreases during a plan year, you may be able to make a corresponding prospective change in your election, including cancellation of your election. This provision also applies to a significant increase in the vision deductible or copayment.

If the cost for coverage under your spouse’s vision plan significantly increases or there is a significant curtailment of coverage that permits revocation of coverage during a plan year and you cancel that coverage, you will be able to sign up for vision coverage for yourself and your eligible family members.

If you are an extended part-time employee

If you terminate employment as an extended part-time employee, you are not eligible to continue to participate in the Plan. You may be eligible to elect continuation coverage for yourself and your eligible family members under COBRA provisions. (See Continuation coverage for details.)

If you die

If you die while enrolled, your covered eligible family members can continue coverage. Their eligibility continues under the Plan with the payment of required contributions for a specified amount of time:

  • If you have 15 or more years of benefit service at the time of your death, eligibility continues until your spouse remarries or dies.
  • If you have less than 15 years of benefit service, eligibility continues for twice your length of Benefit Service or until the spouse remarries or dies, whichever occurs first.

Children of deceased employees or retirees may continue participation as long as they are an eligible family member and are not eligible to be enrolled in Medicare as their primary medical plan. If your surviving spouse remarries, eligibility for your stepchildren also ends. Special rules may apply to family members of individuals who become retirees due to disability. (See If you become a suspended retiree section below.)

Eligible family members of deceased extended part-time employees are not eligible to continue to participate in the Plan. These family members may be eligible to elect continuation coverage under COBRA provisions. (See Continuation coverage for details.)

If you become a suspended retiree

If you are a retiree and you would otherwise lose coverage because you have become a suspended retiree under the ExxonMobil Disability Plan, you may continue coverage for yourself and all your family members who were eligible for plan participation before you became a suspended retiree for either 12 or 18 months..

Coverage continues for 12 months from the date coverage would otherwise end if you received transition benefits under the ExxonMobil Disability Plan. However, if you did not receive transition benefits under the ExxonMobil Disability Plan, coverage continues for 18 months from the date coverage would otherwise end. The cost of this continued coverage is 102% of the participant contributions.

When coverage ends

When coverage ends for the ExxonMobil Vision Plan

Coverage for you and/or your family members ends on the earliest of the following dates:

  • The last day of the month in which:
  • You terminate employment (except as a retiree or due to disability),
  • You elect not to participate,
  • A family member ceases to be eligible (for example, a child reaches age 26), or
  • A retiree becomes a suspended retiree,
  • You are no longer eligible for benefits under this Plan (e.g., employment classification changes from regular employee to non-regular employee or from non-represented to represented where you are no longer eligible for this Plan),
  • You do not make any required contribution,
  • A Qualified Medical Child Support Order is no longer in effect for a covered family member,

OR

  • The date:
  • You die,
  • The Vision Plan ends,
  • Your employer discontinues participation in the Plan, or
  • You enrolled an ineligible family member and in the opinion of the Administrator-Benefits, the enrollment was a result of fraud or a misrepresentation of a material fact.

You are responsible for ending coverage with Benefits Administration 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.

For employees and eligible family members, if your participation in any group health plan (e.g., Medical, Dental, Vision), to which ExxonMobil contributed, was suspended for non-payment of required contributions, in order to enroll in this Plan you must repay all required contributions retroactively to the date of suspension. If you are a retiree and have missed payments during 2021, contact immediately the ExxonMobil Benefits Service Center (EMBSC) for guidance in order to regularize your situation before year end.

Effective January 1, 2022, cancellation and reinstatement process for retirees in any group health plan - - Dental, Vision, any of the ExxonMobil Retiree Medical Plan (EMRMP) options - will be as follows:

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

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

Reinstatement for good cause will occur only when:

                  1) Reinstatement is requested no later than 60 calendar days following the effective date of disenrollment (in the example, 60 days from April 1)
                  2) The individual has been determined to meet the criteria specified below (i.e., receives a favorable determination); and
                  3) Within three (3) months of disenrollment for nonpayment of plan premiums, the individual pays in full the plan premiums owed at the time they were disenrolled (in the example, within 3 months from April 1).
 
If you fail to pay premiums within the grace period, your coverage is terminated, and you fail to show good cause, you and your eligible dependents will not have an opportunity to re-enroll at a future date in the applicable ExxonMobil Health Plan. You are still responsible for paying all owed premiums incurred during the grace period in which you were still part of the applicable ExxonMobil Health Plan.

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

  • A serious illness, institutionalization, and/or hospitalization of the member or their authorized representative (i.e. the individual responsible for the member’s financial affairs), that lasted for a significant portion of the grace period for plan premium payment;
  • Prolonged illness that is not chronic in nature, a serious (unexpected) complication to a chronic condition or rapid deterioration of the health of the member, a spouse, another person living in the same household, person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs) that occurs during the grace period for the plan premium payment;
  • Recent death of a spouse, immediate family member, person living in the same household or person providing caregiver services to the member, or the member’s authorized representative (i.e., the individual responsible for the member’s financial affairs); or
  • Home was severely damaged by a fire, natural disaster, or other unexpected event, such that the member or the member’s authorized representative was prevented from making arrangement for payment during the grace period for plan premium;
  • An extreme weather-related, public safety, or other unforeseen event declared as a Federal or state level of emergency prevented premium payment at any point during the plan premium grace period. For example, the member’s bank or U.S. Post Office closes for a significant portion of the grace period; or 
  • There may be situations in addition to those listed above that result in favorable good cause determinations. If an individual presents a circumstance which is not captured in the listed examples, it must meet the regulatory standards of being outside of the member’s control or unexpected such that the member could not have reasonably foreseen its occurrence, and this circumstance must be the cause for the non-payment of plan premiums. The Plan expects non-listed circumstances will be rare.

    Examples of circumstances that do not constitute good cause include:

  • Allegation that bills or warning notices were not received due to unreported change of address, out of town for vacation, visiting out of town family, etc.;
  • Authorized representative did not pay timely on member’s behalf;
  • Lack of understanding of the ramifications of not paying plan premiums;
  • Could not afford to pay premiums during the grace period; or
  • Need for prescription medicines or other plan services.
  • The ExxonMobil Business Service Center is the appointed designee reviewing reinstatement requests and making good cause determinations.

    Loss of eligibility

    Fraud against the plan

    Everyone in your family may lose eligibility for plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the Plan, for instance, by filing claims for benefits to which you are not entitled. Coverage may also be terminated if you refuse to repay amounts erroneously paid by the Plan on your behalf or that you recover from a third party. Your participation may be terminated if you fail to comply with the terms of the Plan and its administrative requirements. You may also lose eligibility if you enroll persons who are not eligible, for instance, by covering children who do not meet the eligibility requirements. This includes failing to provide timely notification of when a covered family member loses eligibility, e.g., spouse loses eligibility due to divorce.

    Extended benefits at termination

    You are entitled to extended coverage for as much as a year if you are terminated due to disability with fewer than 15 years of service. This coverage is provided at no cost to you. This is considered a portion of the COBRA continuation period. In order to assure coverage beyond this extension period, you must elect COBRA upon termination of employment.

    Several conditions must be met:

    • The disability must exist when your employment terminates.
    • The extension lasts only as long as the disability continues, but no longer than 12 months.
    • This extension applies only to the employee who is terminated because of a disability. Continuation coverage for eligible family members may be available through COBRA.

    Continuation coverage

    Continuation coverage for the ExxonMobil Vision Plan

    The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) entitles you and your covered family members to extend vision benefits beyond the date your coverage would normally end.

    Continuation coverage rights under COBRA

    Introduction

    You are required to be given the information in this section because you are covered under a group health plan (the Plan). This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan under certain circumstances when coverage would otherwise end. This section generally explains COBRA coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. 

    The right to COBRA coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to your spouse and children, if they are covered under the Plan, when they would otherwise lose their group health coverage under the Plan. This section does not fully describe COBRA coverage or other rights under the Plan. For additional information about your rights and obligations under the Plan and under federal law, you should review this Information Booklet or contact ExxonMobil Benefits Administration at the telephone numbers or address listed under Benefits Administration on page 3.

    You, your spouse and your family members may have other options available when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace.  By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs.  Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

    Determination of Benefits Administration entity to contact:

    IMPORTANT: Benefits Administration references throughout this notice change depending on your status. Unless specifically stated otherwise, you should refer to the correct Benefits Administration entity using the list below. If your status is not listed, contact ExxonMobil Benefits Administration/Health and Welfare Services for assistance.

    • Current Employees or their covered family members should use EDA or contact ExxonMobil Benefits Administration/ Health and Welfare Services,
    • Exxon, ExxonMobil, Mobil, XTO or Superior Oil Retirees, or their Survivors, or their covered family members contact ExxonMobil Benefits Service Center, and
    • Former Exxon, ExxonMobil or XTO Employees and Exxon and ExxonMobil Retirees (who retired before October 1, 2005) and their Survivors, or covered family members, who have elected and are participating through COBRA, contact ExxonMobil COBRA Administration.

    What is COBRA coverage?

    COBRA coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this section. If a specific qualifying event occurs and any required notice of that event is properly provided to Benefits Administration, COBRA coverage must be offered to each person losing coverage who is a qualified beneficiary.  You, your spouse and your children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Certain newborns, newly adopted children, and alternate recipients under QMCSOs may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below. Under the Plan, qualified beneficiaries who elect COBRA coverage must pay the entire cost of COBRA coverage.

    Who is entitled to elect COBRA?

    If you are an employee, you will be entitled to elect COBRA, if you lose your coverage under the Plan because either one of the following qualifying events happens:

    • Your hours of employment are reduced, or
    • Your employment ends for any reason other than your gross misconduct.

    If you are the spouse of an employee, you will be entitled to elect COBRA if you lose coverage under the Plan because any of the following qualifying events happens:

    • Your spouse dies,
    • Your spouse's hours of employment are reduced,
    • Your spouse’s employment ends for any reason other than his or her gross misconduct,
    • You become divorced from your spouse.  Also, if your spouse (the employee) reduces, or eliminates your group health coverage in anticipation of a divorce, and a divorce later occurs, then the divorce may be considered a qualifying event for you even though your coverage was reduced or eliminated before the divorce.

    A person enrolled as the employee’s child will be entitled to elect COBRA if he or she loses coverage under the Plan because any of the following qualifying events happens:

    • The parent-employee or parent-retiree dies,
    • The parent-employee's hours of employment are reduced,
    • The parent-employee's employment ends for any reason other than his or her gross misconduct, or
    • The child stops being eligible for coverage under the Plan as a child.

    When is COBRA coverage available?

    When the qualifying event is the end of employment or reduction of hours of employment or death of the employee, the Plan will offer COBRA coverage to qualified beneficiaries.  You need to notify Benefits Administration of any other qualifying events.

    You must give notice of some qualifying events

    For the other qualifying events (divorce or a child losing eligibility for coverage), a COBRA election will be available to you only if you notify and provide the appropriate forms to the Benefits Administration entity within 60 days after the later of (1) the date of the qualifying event or (2) the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the qualifying event. In providing this notice, you must notify the correct Benefits Administration entity based on your status and follow the procedures outlined in this section.  If these procedures are not followed or if the wrong entity is notified during the 60-day notice period, THEN ALL QUALIFIED BENEFICIARIES WILL LOSE THEIR RIGHT TO ELECT COBRA.

    Notice procedures for qualifying events

    Notices of qualifying events from current employees must be made by logging onto Employee Direct Access (EDA) located on the Employee Connect HR intranet site. Forms are also available from ExxonMobil Benefits Administration/ Health and Welfare Services for those individuals who do not have access to EDA. Notices of these qualifying events from retirees and survivors must be made via the ExxonMobil Benefits Web or by calling the ExxonMobil Benefits Service Center. Notice is not effective until either EDA or the ExxonMobil Benefits Web change is made or the properly completed form is received.

    Election of COBRA

    Each qualified beneficiary will have an independent right to elect COBRA. Covered employees and spouses (if the spouse is a qualified beneficiary) may elect COBRA on behalf of all qualified beneficiaries, and parents may elect COBRA on behalf of their children. Any qualified beneficiary for whom COBRA is not elected within the 60-day election period specified in the Plan’s COBRA election notice WILL LOSE HIS OR HER RIGHT TO ELECT COBRA.

    How long does COBRA coverage last?

    COBRA coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the covered employee’s divorce or a child's losing eligibility as a child, COBRA coverage under the Plan can last for up to a total of 36 months.

    When the qualifying event is the end of employment or the reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA coverage under the Plan for qualified beneficiaries (other than the employee) who lose coverage as a result of the qualifying event can last until up to 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA coverage for his spouse and children who lost coverage as a result of his termination can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). This COBRA coverage period is available only if the covered employee becomes entitled to Medicare within 18 months BEFORE termination or reduction of hours.

    Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA coverage under the Plan generally can last for only up to a total of 18 months.

    The COBRA coverage periods described above are maximum coverage periods.  COBRA coverage can end before the end of the maximum coverage periods described in this notice for several reasons, which are described in the Plan’s summary plan descriptions.

    There are two ways (described in the following paragraphs) in which the period of COBRA coverage resulting from a termination of employment or reduction of hours can be extended.

    Disability extension of COBRA coverage

    If a qualified beneficiary is determined by the Social Security Administration to be disabled and you notify the correct Benefits Administration entity, in a timely fashion, all of your qualified beneficiaries in your family may be entitled to receive up to an additional 11 months of COBRA  coverage, for a total maximum of 29 months. This extension is available only for qualified beneficiaries who are receiving COBRA coverage because of a qualifying event that was the covered employee’s termination of employment or reduction of hours. The disability must have started at some time before the 61st day after the covered employee’s termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above).

    The disability extension is only available if you notify Benefits Administration in writing of the Social Security Administration’s determination of disability within 60 days after the latest of:

    • The date of the Social Security Administration’s disability determination,
    • The date of the covered employee’s termination or reduction of hours, and
    • The date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee’s termination of employment or reduction of hours.

    You must also provide this notice within 18 months after the covered employee’s termination of employment or reduction of hours in order to be entitled to a disability extension, and you must notify the correct Benefits Administration entity at least 30 days before the end of the 18-month period. See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60-day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, THEN THERE WILL BE NO DISABILITY EXTENSION OF COBRA COVERAGE.

    Second qualifying event extension of COBRA coverage

    If your family experiences another qualifying event while receiving COBRA coverage as a result of the covered employee’s termination of employment or reduction of hours (including COBRA coverage during a disability extension as described above), the covered spouse and children in your family can get up to 18 additional months of COBRA coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the correct Benefits Administration entity. This extension may be available to the spouse and any children receiving COBRA coverage if the employee or former employee dies or gets divorced or if the covered child stops being eligible under the Plan as a child. This extension is not available under the Plan when a covered employee becomes entitled to Medicare after his or her termination of employment or reduction of hours.

    This extension due to a second qualifying event is available only if you notify the correct Benefits Administration entity within 60 days of the date of the second qualifying event.  See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60 day notice period and within 18 months after the covered employee’s termination of employment or reduction of hours, THEN THERE WILL BE NO EXTENSION OF COBRA COVERAGE.

    Are there other coverage options besides COBRA continuation coverage?

    Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a special enrollment period. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

    More information about individuals who may be qualified beneficiaries during COBRA

    A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is considered to be a qualified beneficiary provided that, if the covered employee is a qualified beneficiary, the covered employee has elected COBRA coverage for himself or herself. The child's COBRA coverage begins when the child is enrolled in the Plan, whether through special enrollment or open enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the Plan, the child must satisfy the otherwise-applicable Plan eligibility requirements (for example, regarding age).

    Alternate recipients under QMCSOs

    A child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order (QMCSO) received by Exxon Mobil Corporation during the covered employee's period of employment with Exxon Mobil Corporation is entitled to the same rights to elect COBRA as an eligible child of the covered employee.

    Cost of COBRA coverage

    A person who elects continuation coverage may be required to pay 102% of the cost to the Plan to maintain the coverage, unless the person is entitled to extended coverage due to disability. If the person becomes entitled to such extended coverage, the person may be required to contribute up to 150% of contributions after the initial 18-month's coverage until coverage ends. A person who elects continuation coverage must pay the required contributions within 45 days from the date coverage is elected, retroactively to the date benefits terminated under the Plan.

    If you have questions

    Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below.  For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa.  (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)  For more information about the Marketplace, visit www.healthcare.gov

    Keep your plan informed of address changes

    In order to protect your family's rights, you should keep the correct Benefits Administration entity informed of any changes in your address as well as the addresses of family members.  You should also keep a copy, for your records, of any notices you send to Benefits Administration.

    Benefits administration (contacts for COBRA rights under the ExxonMobil vision plan)

    The following sets out the contact numbers based on your status under the ExxonMobil Vision Plan.  Failure to notify the correct entity could result in your loss of COBRA rights.

    If your status is not listed, contact ExxonMobil Benefits Administration/Health and Welfare Services for assistance or contact them at hr.health.welfare@exxonmobil.com.

    Contacts: Address:
    Employees and their covered family members:

    ExxonMobil Benefits Administration/
    Health and Welfare Services

    hr.health.welfare@exxonmobil.com 

    713-231-1743 (fax)

    ExxonMobil Benefits Administration
    ATTN: Health and Welfare Services ExxonMobil
    BA BSC USBA

    P.O. Box 64111
    Spring, TX 77387-4111
    Retirees, their survivors and covered family members:

    ExxonMobil Benefits Service Center
    Monday – Friday except certain holidays
    8:00 a.m. to 6:00 p.m. (U.S. Eastern Time)

    800-682-2847 (toll free)
    800-TDD-TDD4 (833-8334) for the hearing impaired

    ExxonMobil Benefits Service Center
    P.O. Box 1014
    Totowa, NJ 07512-1014
    Former employees and retirees (who retired before October 1, 2005), their survivors and family members who have elected and are participating through COBRA:

    ExxonMobil COBRA Administration
    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 Vision Plan

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

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

    Plan sponsor and participating affiliates

    The ExxonMobil Vision Plan is sponsored by:
    Exxon Mobil Corporation
    5959 Las Colinas Blvd
    Irving, Texas 75039-2298

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

    Basic Plan information

    Plan administrator

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

    For appeals of eligibility or enrollment issues:

    Administrator-Benefits
    P.O. Box 64111
    Spring, TX 77387-4111

    For service of legal process:

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

    Authority of administrator-benefits

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

    Claims administrator

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

    Claims fiduciary and appeals

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

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

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

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

    Standard service appeal 

    Determination will be made within 14 calendar days.

    Standard claim appeal 

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

    Type of plan

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

    Plan numbers

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

    Plan year

    The plan year is the calendar year.

    Plan funding

    Benefits are funded through participant contributions.

    No implied promises

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

    Future of the Plan 

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

    Your rights under ERISA

    As a participant in the ExxonMobil Vision 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 Vision Plan, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Vision 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 Vision 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 Vision 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 Vision Plan fiduciaries

    In addition to creating rights for Vision Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan.  The people who operate your Vision Plan, called fiduciaries of the Vision Plan, have a duty to do so prudently and in the interest of you and other Vision 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 Vision Plan documents or the latest Summary Annual Report from the Vision Plan and do not receive them within 30 days, you may file suit in a Federal court. In such a case, the court may require the Administrator-Benefits to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator.
    • If you have a claim and an appeal for benefits, which are denied or ignored, in whole or in part, you may file suit in a Federal court. If it should happen that Vision Plan fiduciaries misuse the plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. Any such lawsuit must be brought within 1 year of when you first had the right to sue. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.
    • You may contact the Texas Department of Insurance if you have any complaints at 800-252-3439 or you may write the Texas Department of Insurance PO Box 149104, Austin, TX 78714-9104, fax 512-475-1771 (not toll free).

    Assistance with your questions

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

    Key terms

    List of key terms in the ExxonMobil Vision Plan

    Barred employee

    An employee who is covered by a collective bargaining agreement except to the extent participation in the Vision Plan is provided under such agreement.

    Benefits Administration

    Benefits Administration references throughout this document change depending on your status as an employee, retiree or survivor. Unless specifically stated otherwise, you should contact the Benefits Administration entity as indicated in Information Sources section (see page 3).

    Benefit service

    Generally, all the time from the first day of employment until you leave the company's employment. Excluded are:

    • unauthorized absences,
    • leaves of absence of over 30 days (except military leaves or leave under the Federal Family and Medical Leave Act),
    • certain absences from which you do not return,
    • periods when you work as a non-regular employee, as an extended part-time employee, as a special agreement person, in a service station, car wash, or car-care center operations, or
    • when you are covered by a contract that requires the company to contribute to a different benefit program, unless a special authorization credits the service.

    Change in status

    Life or work event that allows you to make changes to your elections during the plan year and outside of the annual enrollment period.

    Child 

    A person under age 26 who is:

    • A natural or legally adopted child of a regular employee or retiree,
    • A grandchild, niece, nephew, cousin, or other child related by blood or marriage over whom a regular employee, retiree, or the spouse of a regular employee or retiree (separately or together) is the sole court appointed legal guardian or sole managing conservator,
    • A child for whom the regular employee or retiree has assumed a legal obligation for support immediately prior to the child's adoption by the regular employee or retiree, or
    • A stepchild of a regular employee or retiree.
    • Child does not include a foster child.

    Claims administrator/processor 

    Spectera Vision, the third party administrator for UHIC, or affiliates, for claims.

    Eligible employees 

    Most U.S. dollar payroll employees of Exxon Mobil Corporation and participating affiliates. Full-time employees not hired on a temporary basis (also called regular employees) are eligible. Extended part-time employees, as classified on the employer's books and records, are also eligible.

    The following are not eligible to participate in the Plan:  leased employees as defined in the Internal Revenue Code, barred employees, or special agreement persons as defined in the plan document. Generally, special agreement persons are persons paid by the company on a commission basis, persons working for an unaffiliated company that provides services to the company, and persons working for the company pursuant to a contract that excludes coverage of benefits.

    Eligible family members

    Eligible family members are generally your:

    • Spouse
    • A child who is described in any one of the following paragraphs (1) through (4):
    • 1. has not reached the end of the month during which age 26 is attained, or

      2. is totally and continuously disabled, meaning:

      (a) He or she can't engage in any substantial gainful activity because of a physical or mental condition.

      (b) A physician determines that the disability has lasted or can be expected to last continuously for at least a year or can lead to death.

      3. incapable of self-sustaining employment by reason of mental or physical disability, provided the child:

      (a) meets the Internal Revenue Service's definition of a dependent, and

      (b) was covered as an eligible family member under this Plan immediately prior to age 26 when the child's eligibility would have otherwise ceased, and

      (c) met the clinical definition of totally and continuously disabled before age 26 and continues to meet the clinical definition through subsequent periodic reassessment reviews, or

      4. is recognized under a qualified medical child support order as having a right to coverage under this Plan.

    A child who was disabled but who no longer meets the requirements of paragraphs two (2) to four (4), ceases to be an eligible family member 60 days following the date on which the applicable requirement is not met.

    Please note: An eligible employee or retiree's parents are not eligible to be covered.

    Extended part-time employee 

    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.

    Qualified Medical Child Support Order 

    A Qualified Medical Child Support Order (QMCSO) is a court decree under which a court order mandates health coverage for a child. A QMCSO must include, at a minimum:

    • Name and address of the employee covered by the health plan.
    • The name and address of each child for whom coverage is mandated.
    • A reasonable description for the coverage to be provided.
    • The time period of coverage.
    • The name of each health plan to which the order applies.

    You may obtain, without charge, a copy of the Plan's procedures governing QMCSO determinations by written request to the Administrator-Benefits.

    Regular employee 

    An employee of a participating employer, whether or not the person is a director, who, as determined by the participating employer, regularly works a full-time schedule, and is not employed on a temporary basis.  The definition includes a person who regularly works a full-time schedule but who, for a limited period of time, is approved for a part-time regular work arrangement under the participating employer’s work rules relating to part-time work for regular employees.

    Retiree

    Generally, a person at least 55 years old who retires as a regular employee with 15 or more years of benefit  service and who has not thereafter recommenced employment as a covered employee or a non-regular employee.  Retiree status may also be attained by someone who is retired by the company and entitled to long-term disability benefits under the ExxonMobil Disability Plan after 15 or more years of benefit service, regardless of age.

    Employees who terminate while non-regular (including extended part-time employees) are not eligible for retiree status regardless of age or service.

    Special-agreement person 

    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.

    Spouse; marriage 

    All references to marriage shall mean a marriage that is legally recognized under the laws of the state or other jurisdiction in which the marriage takes place, consistent with U.S. federal tax law. All references to a spouse or a married person shall refer to individuals who have such a marriage.

    Surviving spouse/survivor

    A surviving unmarried spouse or child of a deceased ExxonMobil regular employee or retiree.

    Suspended retiree 

    A person who becomes a retiree due to incapacity within the meaning of the ExxonMobil Disability Plan and who begins long-term disability benefits under that Plan, but whose benefits stop because the person is no longer incapacitated. A person remains a suspended retiree until the earlier of the date the person:

    • Reaches age 55, or
    • Begins his or her retirement benefit under the ExxonMobil Pension Plan, at which time the person is again considered a retiree.

    The family members of a deceased suspended retiree will be eligible for coverage under this Plan only after the occurrence of the earlier of the following:

    • The date the suspended retiree would have attained age 55, or
    • The date a survivor begins receiving a benefit due to the suspended retiree's accrued benefit from the ExxonMobil Pension Plan.

    Trainee

    An employee who is classified as a non-regular employee, but who has been characterized as a Trainee and has graduated from high school.

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