Grandfathered plan intent
Exxon Mobil Corporation believes that most options available under the ExxonMobil Medical Plan (EMMP) are “grandfathered health plans” under the Patient Protection and Affordable Care Act (PPACA). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect on March 23, 2010. Grandfathered plan options under the EMMP may not include all consumer protections of the Affordable Care Act that apply to other plans. For example, most options under the EMMP cover some, but not all, preventive health services without any cost sharing.
Questions regarding which protections apply to the EMMP and what might cause the EMMP or one or more of its options to change from grandfathered health plan status can be directed to the Plan Administrator at Administrator-Benefits, P.O. Box 2283, Houston, Texas 77252-2283. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
Coverage for maternity hospital stay
Under federal law, the Plan may not restrict benefits for hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a caesarean section, or require that a provider obtain authorization from the Plan for prescribing a length of stay not in excess of the above periods. The law generally does not prohibit an attending provider of the mother or newborn, in consultation with the mother, from discharging the mother or newborn earlier than 48 or 96 hours, as applicable.
The Women’s Health and Cancer Rights Act
If you have a mastectomy, at any time, and decide to have breast reconstruction, based on consultation with your attending physician, the following benefits will be subject to the same percentage co-payment and deductibles which apply to other plan benefits:
- Reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Services for physical complications in all stages of mastectomy, including lymphedema.
The above benefits will be provided subject to the same deductibles, co-payments and limits applicable to other covered services.
If you have any questions about your benefits please contact Aetna Member Services.