Administrative and ERISA information

Administrative and ERISA information for the ExxonMobil medical fully-insured HMO Plan

Basic Plan information

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.

Plan name

ExxonMobil Medical Plan.

Plan sponsor and participating affiliates

The ExxonMobil Medical Plan is sponsored by:

Exxon Mobil Corporation
5959 Las Colinas Blvd.
Irving, Texas 75039-2298

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

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

Plan administrators

The ExxonMobil Medical Plan-HMO Option is administered by the insurance company. (See Appendix A at the end of this SPD.) The Administrator-Benefits is the Manager-Global Benefits Design, Exxon Mobil Corporation. You may contact the Administrator-Benefits for appeals of eligibility or enrollment issues as follows:

Administrator-Benefits

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

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 Medical Plan in its application to any participant or beneficiary, and to decide any and all claim appeals.

Type of plan

The ExxonMobil Medical Plan is a welfare plan under ERISA providing medical benefits.

Plan numbers

The ExxonMobil Medical Plan is identified with government agencies under two numbers:

The Employer Identification Number (EIN), 13-5409005, and the Plan Number (PN), 538.

Plan year

The Plan's fiscal year ends on December 31.

Funding

The Plan is funded through contributions by the Employer and/or plan participants. Benefits under the EMMP are funded through participant and company contributions. Each year, Exxon Mobil Corporation determines the rates of required participant contributions to the Exxon Mobil Medical Plan. These rates are based on past and projected plan experience. The HMOs available under EMMP-HMO option are funded as either fully-insured HMOs or self-insured HMOs. A fully-insured HMO option is a health insurance agreement purchased by ExxonMobil from an insurance company in which the HMO is responsible for funding payment of health service claims. Further information is provided in the definition of fully-insured HMO located in the Glossary of this guide.

For all fully-insured HMO options, these rates are also based on the annual premium charges established by each HMO. If upon plan termination, participant contributions remain in the plan those amounts would be refunded to the participant who made those contributions. All refunds would be made on a pro-rated basis.

Financial stability

If, during the course of the Plan Year, your HMO is unable to continue providing you with coverage due to financial solvency reasons, you will be permitted to switch to any other medical option available to you under the Plan.

Claims processor 

For all HMOs, fully-insured and self-insured, the insurance company is the claims processor and claims fiduciary. Please refer to Appendix A located at the end of this SPD for contact information.

No implied promises

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

If the ExxonMobil medical plan is amended or terminated

The company reserves the right at any time and for any reason to terminate, suspend, withdraw, amend or modify the ExxonMobil Medical Plan or any of its provisions. If any reductions in benefits are made in the future, you will be notified within sixty (60) days of the signing of the amendment. In the event the ExxonMobil Medical Plan is terminated, you will have the right to elect continuation coverage in any other health plan maintained by Exxon Mobil Corporation or its controlled group. If you participate in a fully-insured HMO option, you may have independent rights as mandated by state insurance law. You do not have any rights to continue a benefit that is changed or eliminated.

Claims and appeals

The EMMP has contracted with the HMO to process claims for medical and mental health care. See Appendix A at the end of this SPD for the HMO's Member Services address.

You or your providers may file claims. Please refer to your HMO Benefits information included in this packet for your HMO's claim filing procedures. Claims should not be filed with ExxonMobil for any reason. The HMO Benefits information also explains your HMO's appeal procedures and your right to appeal the denial in the event your HMO denies you benefits. Your HMO's schedule of benefits is included for your convenience. Please contact the HMO Member Services department for more information or for more up to date HMO Benefits Information that is available upon request and free of charge. (See Appendix A for a complete list of HMO contact information.)

Your rights under ERISA

As a participant in the ExxonMobil Medical 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 Medical Plan, including contracts and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Medical 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 Medical 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 Medical Plan's annual financial report. The Administrator-Benefits is required by law to furnish each participant with a copy of the Summary Annual Report.

Prudent actions by plan fiduciaries

In addition to creating rights for Medical Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Medical Plan, called "fiduciaries," of the Medical Plan, have a duty to do so prudently and in the interest of you and other Medical 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 Medical Plan documents or the latest Summary Annual Report from the Medical 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 both 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.  If it should happen that Medical 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. 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 the Medical Plan, you should contact the Plan Administrator. If you have any questions 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.