Q. What other information do I need to know about the Plan?
A. 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 Employee Health Advisory Program.
Plan sponsor and participating affiliates
The ExxonMobil Employee Health Advisory Program is sponsored by:
Exxon Mobil Corporation
5959 Las Colinas Boulevard
Irving, Texas 75039-2298
All of Exxon Mobil Corporation's divisions and most of the major U.S. affiliates participate in the ExxonMobil Health Advisory Program. 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
The Plan Administrator for the ExxonMobil Health Advisory Program 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 Exxon Mobil Corporation by serving the Corporation's Registered Agent for Service of Process, Corporation Service Company (CSC).
ExxonMobil Medical Plan
P.O. Box 2283
Houston, Texas 77252-2283
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 Employee Health Advisory Program in its application to any participant or beneficiary, and to decide any and all claim appeals.
Claims Fiduciary and appeals
The Claims Fiduciary is the person to whom all appeals are filed. For the ExxonMobil Employee Health Advisory Program, the Claims Fiduciary is the Care Manager, Magellan Healthcare. The Care Manager will decide all appeals for denied benefits. File any appeals with:
P.O. Box 2128
Maryland Heights MO 63043
Type of plan
The ExxonMobil Employee Health Advisory Program is a welfare plan under ERISA providing professional counseling for personal problems requiring limited intervention and referral services for more complicated problems.
The ExxonMobil Employee Health Advisory Program is identified with government agencies under two numbers: the Employer Identification Number 13-5409005 and the Plan Number 609.
The Plan year is the calendar year, January 1 through December 31.
Benefits are funded through employer contributions.
If Magellan determines that you need Urgent Care, Magellan will provide telephonic crisis counseling and make an appropriate referral to your benefit plan and/or emergency resources in the community. The EHAP does not provide urgent care.
Because Magellan pays all EHAP providers directly, you should not make any payment to a provider for EHAP services. In the event that you mistakenly pay a provider for EHAP services, Magellan will make a determination on your request for reimbursement within 15 days after receipt of the Claim (if EHAP services have not yet been received) or with 30 days after receipt of the Claim (if the EHAP services have already been received). Magellan will notify you of its determination telephonically, and, if you consent to written notice, in writing, within the 15 day or 30 day period, as applicable.
To use EHAP, call Magellan toll free. You do not pay for or file claim forms for your EHAP counseling sessions. If you require additional services beyond that provided by EHAP, those services may be provided under your medical plan.
If you have a problem with a plan benefit, contact Magellan. The Care Manager is responsible for determining and informing you of your entitlement to a benefit.
The following categories of claims for benefits apply to the ExxonMobil Employee Health Advisory Program, and according to the type of claim submitted, Magellan will review your claim and respond within a designated response time. If Magellan needs additional time (an extension) to decide on your claim because of special circumstances, you will be notified within the claim response period.
Urgent care means care needed to avoid serious jeopardy to your life or health or to regain maximum function (or required to avoid severe pain), as determined by Magellan or your treating physician. Magellan does not make Claim determinations relating to Urgent Care.
Pre-service claims are any claims for benefits where the Plan provisions require approval before care is obtained.
Post-service claims are claims made after care is received and apply to claims under the ExxonMobil Employee Health Advisory Program.
If your claim for benefits is denied completely or partially, and you authorize written communication to you, Magellan will provide written notice to you, your beneficiary, or designated representative. The notice will describe:
- The specific reason(s) for the denial for the denial decision,
- Identify Plan provisions on which the decision is based;
- Describe any additional material or information necessary for an appeal review and an explanation of why it is necessary;
- Explain the review procedure, including time limits for appealing the decision and to sue in federal court;
- Identify your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol or similar criterion relied on in making the decision;
- Identify your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EHAP services are not clinically appropriate).
If you do not authorize written notice, Magellan will furnish this information to you or your Authorized Representative by telephone.
Filing a mandatory appeal
If you believe your Claim for EHAP benefits was denied in error, you may appeal the decision. Your appeal must be submitted in writing to Magellan within 180 days following your receipt of a denial notice.
Your appeal should state the reasons why you feel your Claim for EHAP benefits is valid and include any additional documentation that you feel supports your Claim for EHAP benefits. You can also include any additional questions or comments. You may submit written comments, documents, records and other information relating to your appeal, whether or not the comments, documents, records or information were submitted in connection with the initial Claim for EHAP benefits. On your request, Magellan will make relevant documents available to you.
The review of the initial decision will consider all new information, whether or not it was presented or available for the initial decision. The person who conducts the appeal review will be different from the person(s) who originally denied your Claim for EHAP benefits and will not report directly to the original decision maker or prior reviewer.
You or your Authorized Representative will be notified of the appeal decision within the following time frames:
- If the case involves an adverse determination on a request for EHAP services or a pre-service adverse determination relating to reimbursement, within thirty (30) days of Magellan's receipt of the request for appeal;
- If the case involves a post-service adverse determination relating to reimbursement, within sixty (60) days of Magellan's receipt of the request for appeal.
If Magellan 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 will be allowed.
If you authorize written communication, Magellan will give you or your Authorized Representative the decision on the appeal in writing. If the denial is upheld on appeal, the notice will set forth:
- 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.
- Notice of your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol or similar criterion relied on in making the decision.
- Notice of your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EHAP services are not clinically appropriate).
- A statement of your right to bring an action under section 502(a) of the Employee Retirement Income Security Act (ERISA).
If you do not authorize written notification, Magellan will furnish this information to you or your Authorized Representative by telephone.
If you do not agree with the final decision of Magellan, you may bring a lawsuit in federal district court within one year of the final decision. You cannot bring legal action unless your Claim has been reviewed and denied by Magellan.
No action at law or in equity to recover benefits under the Plan shall be brought unless the mandatory appeal process has been completed. In any event, no such action shall be brought after the expiration of one year from the time an appeal is decided by Magellan.
No implied promises
Nothing in the ExxonMobil Employee Health Advisory Program gives you a right to remain in employment or affects ExxonMobil’s right to terminate your employment at any time and for any reason (which is hereby reserved).
Future of the ExxonMobil Employee Health Advisory Program
ExxonMobil expects to continue the Plan. However, ExxonMobil has the right to change or terminate the Plan 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.
For health plans, certain rules apply regarding what happens when a plan is changed, terminated or merged.
Claims incurred before the effective date of a plan change or termination will not be affected. Claims incurred after a plan is terminated won't be covered.
Your rights under ERISA
As a participant in EHAP, 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 EHAP, including collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by EHAP 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 EHAP, 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 EHAP'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 EHAP fiduciaries
In addition to creating rights for EHAP participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate EHAP, called "fiduciaries", have a duty to do so prudently and in the interest of you and other EHAP 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 EHAP documents or the latest summary annual report from the EHAP 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. Any such lawsuits must be brought within one year of the date on which an appeal was denied. 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. 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 EHAP, you should contact the Care Manager or call Benefits Administration. 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.