Eligibility and enrollment

Eligibility and enrollment details for the ExxonMobil Employee Medical POS II 'A' and POS II 'B' Plans

Q. What are the Medical Plan's eligibility requirements?

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

Generally, you are eligible if:

You are not eligible if:

  • You are eligible for coverage under the ExxonMobil Retiree Medical Plan.
  • You participate in any other employer medical plan to which ExxonMobil contributes.
  • You fail to make any required contribution toward the cost of the Plan.
  • You fail to comply with general administrative requirements including but not limited to enrollment requirements.
  • You lost eligibility as described under the Loss of eligibility section.

Eligible family members

You may also elect coverage for your eligible family members including:

  • Your spouse. When you enroll your spouse for coverage, you may be required to provide proof that you are legally married.
  • Your child(ren) under age 26. Coverage ends at the end of the month in which they reach age 26. If your situation involves a family member other than your biological or legally adopted child, call Benefits Administration.
  • Your totally and continuously disabled child(ren) who is incapable of self-sustaining employment by reason of mental or physical disability, that occurred prior to otherwise losing eligibility and meets the Internal Revenue Service's definition of a dependent.

Refer to Key terms for definitions of eligible family member, child, spouse, and Qualified Medical Child Support Order.

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

There are also classes of coverage for extended part-time employees and employees on certain types of leaves of absence.

For employees on an approved leave of absence, their contribution rate will change from the employee contribution rate to the Leave of Absence contribution rate as shown in the table below. 

Each class of coverage described in this section has its own contribution rate. Employees contribute to the Medical Plan through monthly deductions from their pay on a pre-tax or after-tax basis.

Double coverage

No one can be covered more than once in the Medical Plan. You and a family member cannot both enroll as employees and elect coverage for each other as eligible family members. If you and your spouse or adult child work for the company you may both be eligible for coverage. Each of you can be covered as an individual employee, or one of you can be covered as the employee 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 if either employee is then making contributions on a pre-tax basis. 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

As a newly hired employee, if you enroll in the Medical 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 receipt of the forms by Benefits Administration. You must enroll everyone in the same option.

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 Changing your coverage.

As a current employee, if you are not covered by a medical plan to which ExxonMobil contributes you may enroll at the next Annual Enrollment. You may also enroll if you experience a Change in Status which will allow you to enroll in the ExxonMobil Pre-Tax Spending Plan. Coverage is effective the first of the month following completion of enrollment in EDA, or receipt of the forms by Benefits Administration. You can enroll eligible family members only if you are enrolled in an EMMP option. You can enroll in a Medical Plan option by using Employee Direct Access (EDA) available on the ExxonMobil Me HR Intranet site. Enrollment forms are also available from Benefits Administration for those individuals 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 the requested time period, 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.  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.

If you are declining enrollment for yourself or your family members (including your spouse) because of other group health plan coverage, you may enroll yourself and your family members in any available EMMP option if you or your family members lose eligibility for that other group health plan coverage (or if the employer stops contributing toward your and/or your family member(s)' other coverage). In addition, you may enroll yourself or your family members in any available EMMP option within 60 days after marriage (with coverage effective the first of the following month) or after birth, adoption or placement for adoption (with coverage retroactive to the birth, adoption or placement for adoption).

Under the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009 you may change your EMMP 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.

Annual enrollment

Each year, usually during the fall, ExxonMobil offers an annual enrollment period. During this time, you can switch from your current option to another available option. This is also the time to make changes to coverage by adding or deleting family members. Family members may be added or removed for any reason but they must be removed if 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.

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

If 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.

During Annual Enrollment, changes to your EMMP coverage (option or contributions) do not automatically adjust your coverage or contributions to other plans such as the ExxonMobil Dental Plan, ExxonMobil Vision Plan or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes to those plans must be made separately during Annual Enrollment.

Changing your coverage

An employee may add a family member effective the first day of a month if required contributions are made on a pre-tax basis and adding the family member does not change the coverage level. If you are enrolled on an after-tax basis, you may add an eligible family member to your existing option effective the first of the following month following receipt of your written election by Benefits Administration.

To make a change to your coverage you may also wait until Annual Enrollment or until you experience one of the following Changes in Status.

Changes in status

This section explains which events are considered changes in status and what changes you may make as a result. If you have a change in status, you must 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 will have to continue to pay the same pre-tax contribution for coverage even though you have removed that ineligible person.  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.

Important Note: Your election due to a change in status cannot be changed after the form is received by Benefits Administration or the transaction is completed in EDA if it changes your pre-tax contributions.  If you make a mistake in EDA, call Benefits Administration at 1-800-262-2363 immediately or no later than the same day or first work day following the day on which the mistake was made.

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

Changes during the year - medical/dental/vision (health plans)
 

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

Birth, adoption or placement for adoption

If you gain a family member through birth, adoption, or placement for adoption you may add the new eligible family member to your current coverage. You may also enroll yourself, your spouse, and all eligible children. You also may change your plan option. Coverage is effective on the date of birth, adoption or placement for adoption. 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 an after-tax basis until the end of the month in which the forms are received by Benefits Administration.  Beginning the first day of the following month your deduction will be on a pre-tax basis. 

CAUTION: SHOULD YOU DECIDE TO RETROACTIVELY CHANGE TO A DIFFERENT EMMP OPTION, SUCH AS FROM AN AETNA SELECT OR CIGNA OPTION TO A POS II OPTION, YOUR BENEFITS FOR ANY MEDICAL SERVICES WHICH WERE RECEIVED ON OR AFTER THE EFFECTIVE DATE OF COVERAGE FOLLOWING THE BIRTH, ADOPTION OR PLACEMENT FOR ADOPTION MAY NOT BE COVERED OR MAY BE REIMBURSED RETROACTIVELY AT A LOWER BENEFIT LEVEL. MAKE SURE YOU FULLY UNDERSTAND THE IMPACT OF CHANGING OPTIONS BEFORE MAKING YOUR ELECTION.

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.

Marriage

If you are enrolled in the Medical Plan, you can enroll your new spouse and his or her eligible family members (your stepchildren) for coverage. You also may change your plan option. If you are not already enrolled for coverage, you can sign up for medical coverage for yourself, your new spouse, and your stepchildren. If you gain coverage under your spouse's health 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.

Death of a spouse

If you lose coverage under your spouse's health plan, you can sign up for Medical Plan 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 ExxonMobil Medical Plan, any stepchildren will cease to be eligible upon your spouse's death unless you are their court appointed 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. (See Continuation coverage for more details about COBRA.) 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 dependents reaching the maximum eligibility age, you remain responsible for ensuring that the dependent 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.

Divorce

In the case of divorce, your former spouse and any stepchildren are eligible for coverage only through the end of the month in which the divorce is final. You must notify and provide any requested documents to Benefits Administration as soon as your divorce is final. If you fail to notify and provide the appropriate forms to Benefits Administration within 60 days, the former spouse and stepchildren will not be entitled to elect COBRA.

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 because of divorce, you can sign up for medical 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.

Transfer or change residence

If you move from one location to another, and the move makes you no longer eligible for your selected Medical Plan option (e.g., move out of the OAPIN service area), you may change from your current Medical Plan option to one that is available in your new location. For more information, call Benefits Administration.  NOTE:  If you are enrolled in a POS option, you may not elect a different option based on your change in location.

Leave of absence

If you are on an approved leave of absence, you can continue coverage by making required contributions directly to the Medical Plan by check. If you chose not to continue your coverage while on leave, your coverage ends on the last day of the month in which your leave began and you will be required to pay for the entire month's contributions. If you fail to make required contributions while on leave, 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 are on an approved leave of absence and the Leave of Absence Contribution Rate begins, you may continue your coverage by making your required contribution.

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, call Benefits Administration.

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 the cancellation of your election. If you choose to cancel your elected coverage option, you may be able to elect coverage under another Medical Plan option. This provision also applies to a significant increase in health care deductible or co-payment.

If the cost for coverage under your spouse's health plan significantly increases or there is a significant curtailment of coverage that permits revocation of coverage during a plan year and you drop that coverage, you will be able to sign up for medical 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.

Addition or improvement of medical plan options

If a new Medical Plan option is added or if benefits under an existing option are significantly improved during a plan year, you may be able to cancel your current election in order to make an election for coverage under the new or improved option.

Loss of option

If a service area under the plan is discontinued, you will be able to elect either to receive coverage under another Medical Plan option providing similar coverage or to cancel medical coverage altogether if no similar option is available. For example, if an option is discontinued, you may elect another option that has service in your area or you may elect to participate in the POS II option.  You may also cancel medical coverage altogether.

Remember, if you make your contributions on a pre-tax basis and you experience any of the events mentioned previously, or if you are newly eligible as a result of a change or loss of coverage under your spouse's health plan, it is your responsibility to complete your change within 60 days of experiencing the event. If you miss the 60-day notification period, you will not be able to make changes until Annual enrollment or until you experience another change in status.

Other situations that may affect your coverage

If you retire

If you retire as a regular employee on or after age 55 with 15 or more benefit years of service, you are eligible for the Retiree Medical Plan (RMP) or you may elect COBRA to stay in the ExxonMobil Medical Plan for the duration of COBRA Coverage. If you retire as a regular employee and are Medicare-eligible, you are eligible to enroll in the Medicare Supplement Plan (MSP).

If a covered family member lives away from home

Coverage is dependent upon whether the plan option offers service in that area. If your covered family member does not live with you (for instance, you have a child away at school), please contact Member Services to confirm whether service is available. (See service area in Definitions.)

If you work beyond when you become eligible for medicare

If you continue to work for ExxonMobil after you become eligible for Medicare, although you are eligible for Medicare, your ExxonMobil coverage remains in effect for you and eligible family members and the Medical Plan is your primary plan. Medicare benefits, if you sign up for them, will be your secondary benefits.

If your covered family members become medicare eligible for any reason

Employees or family members of an employee who becomes Medicare eligible, either due to age or Social Security disability status, are eligible to participate in any Medical Plan option as long as they employee remains as a regular employee.  If the employee retires or dies, Medicare eligible covered family members must change to the ExxonMobil Medicare Supplement Plan and enroll in Medicare Parts A and B.

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 Medical 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 may be eligible for the ExxonMobil Retiree Medical Plan. They are not eligible to continue to participate in the Plan except through COBRA. Their eligibility continues with the EMRMP 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, becomes eligible for Medicare or dies.  Upon eligibility for Medicare, your spouse can continue coverage through the ExxonMobil Medicare Supplement Plan.
  • If you have less than 15 years of benefit service, eligibility continues for twice your length of benefit service or until your spouse remarries, becomes eligible for Medicare, or dies, whichever occurs first.  Upon eligibility for Medicare, your spouse can continue coverage through the ExxonMobil Medicare Supplement Plan.

Children of deceased employees or retirees may continue participation as long as they are an eligible family member. If your surviving spouse remarries, eligibility for your children also ends.

Eligible family members of deceased extended part-time employees are only eligible to elect continuation coverage under COBRA provisions. See Continuation of coverage for details.

When coverage ends

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, retire, or die
  • You elect not to participate;
  • A family member ceases to be eligible (for example, a child reaches age 26);
  • You are no longer eligible for benefits under this Plan (e.g., from non-represented to represented where you are no longer eligible for this Plan);
  • You terminate employment after being rehired by ExxonMobil as an employee following retirement
  • A Qualified Medical Child Support Order is no longer in effect for a covered family member;
  • Your employer discontinues participation in the Plan
  • An expatriate employee's assignment to the United States ends;

OR

  • The date:

  • The Medical Plan ends;

  • You do not make any required contribution;

  • 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.

Loss of eligibility

Fraud against the plan 

Everyone in your family may lose eligibility for Medical Plan coverage, and you may be subject to disciplinary action up to and including termination of employment if you commit fraud against the Medical 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 Medical Plan on your behalf or that you recover from a third party. Additionally, coverage may be terminated if you fail to reimburse the Plan for any amount owed to the Plan, or if you receive and fail to report to the Claims Processor any discounts, write-offs or other arrangements with providers that result in misrepresentation of your out-of-pocket costs. Your participation may be terminated if you fail to comply with the terms of the Medical 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 coverage 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.

During Annual Enrollment, changes to your EMMP coverage (option or contributions) do not automatically adjust your coverage or contributions to other plans such as the ExxonMobil Dental Plan, ExxonMobil Vision Plan or the flexible spending accounts under the ExxonMobil Pre-Tax Spending Plan. Changes to those plans must be made separately during Annual Enrollment.