When coverage ends

When coverage ends for the ExxonMobil Retiree Medical HMO - Aetna Select 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 die;
  • A family member ceases to be eligible (for example, a child reaches age 26);
  • A retiree becomes a suspended retiree;
  • You are no longer eligible for benefits under this Plan (e.g. as a surviving spouse, you re-marry);
  • You, as a retiree, or your eligible family member becomes eligible for Medicare and for the ExxonMobil Medicare Supplement Plan;
  • Your former employer discontinues participation in the Plan;

OR

The date:

  • You do not make any required contribution;
  • You are rehired by Exxon Mobil Corporation after retirement as an employee or non-regular employee;
  • The Retiree Medical Plan ends;
  • 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 the Benefits Service Center 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

Everyone in your family may lose eligibility for Retiree Medical Plan coverage if you file claims for benefits to which you are not entitled. Coverage may also be terminated if you refuse to repay amounts erroneously paid by the Retiree Medical 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 Retiree 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. Termination may be retro-active to the date of coverage.

A participant’s coverage under the Aetna Select may be terminated for cause. “For cause” is defined as:

  • Untenable relationship: After reasonable efforts, Aetna and/or the Plan’s participating providers are unable to establish and maintain a satisfactory provider-patient relationship with you or a plan participant of your family. You will be given 31 days advance written notice of the termination of coverage.
  • Failure to make co-payments: You or a member of your family fails to make any required co-payment or any other payment that you are obligated to pay. You will be given 31 days advance written notice of the termination of coverage.
  • Refusal to provide Coordination of Benefits (COB) information: You or a member of your family refuses to cooperate and provide any facts necessary for Aetna to administer the Plan’s COB provision. You will be given 31 days advance written notice of the termination of coverage.
  • Furnishing incorrect or incomplete information: You or a member of your family willfully furnishes incorrect or incomplete information in a statement made for the purpose of enrolling in, or obtaining benefits from, the Plan. Termination of coverage under the Aetna Select will be effective immediately.
  • Fraud against the Plan: This may include, but is not limited to, allowing a person who is not a participant of the Plan to use your Aetna, Medco or Express Scripts ID card. Termination of coverage under the Aetna Select will be effective immediately.
  • Misconduct: You or a covered member of your family abuses the system, including (but not limited to) theft, damage to the property of a participating provider, or forgery of drug prescriptions. Termination of coverage under the Aetna Select will be effective immediately.

No benefits will be provided to you and your family members once coverage is terminated for cause.

Any termination for cause is subject to review in accordance with the Plan’s grievance process.

You may request that Aetna conduct a grievance hearing within 15 working days after receiving notice that coverage has been or will be terminated.

Coverage will be continued until a final decision on the grievance is rendered, provided you continue to make required contributions. Termination may be retroactive to the original date of termination if the final decision is in favor of Aetna.

In the event a retiree is rehired and is eligible for the ExxonMobil Medical Plan, the retiree and eligible family members are no longer eligible for the EMRMP and coverage is rescinded for all periods during which the retiree is employed. The rehired retiree and eligible family members will be enrolled retroactively in the EMMP until the earlier of failure to comply with the administrative requirements of the EMMP or re-employment ends.  Any claims paid during such periods of employment under the EMRMP will be reprocessed under the EMMP.