POS II 'A' and POS II 'B' Options

Summary plan descriptions of the ExxonMobil Retiree Medical POS II 'A' and POS II 'B' Options as of January 2017

About the Retiree Medical Plan

This summary plan description (SPD) summarizes the ExxonMobil Retiree Medical Plan (the Plan) POS II “A” and “B” options. It does not contain all benefit details. In determining your specific benefits, the full provisions of the formal plan documents, as they exist now or as they may exist in the future, always govern. You may obtain copies of these documents by making a written request to the Administrator-Benefits. Exxon Mobil Corporation reserves the right to change benefits in any way or terminate the Plan at any time.  These options are governed by federal laws, not by state insurance laws.

Both POS II (Point of Service) options are self-insured. There is no insurance company to collect premiums or underwrite coverage. Instead, contributions from you and ExxonMobil pay all benefits and expenses. Prior claims experience and forecasted expenses are used to determine the amount of money needed to pay future benefits.

If you enroll in any option other than the RMP POS II “A” or “B” option, you may access an additional SPD for that option. If you do not enroll in any option, you are still eligible for certain Culture of Health programs.

Information sources

When you need information, you may contact:

Claims, retiree medical POS II administrator, and pre-service reviews - Aetna provides information about claims payment, providers participating in the Medical POS II (Aetna Choice® POS II) network, claims forms, and benefit pre-determinations. Aetna provides hospital pre-certification review for inpatient medical service as well as pre-certification for certain medical services, tests and equipment.

Phone numbers:

Aetna Member Services 
800-255-2386
210-366-2416 (if international, call collect)
Monday – Friday 8:00 a.m. to 6:00 p.m. 
(U.S. Central Time), except certain holidays
Automated Voice Response - 24 hours a day, 7 days a week

Address:

Aetna 
P. O. Box 981106 
El Paso, TX 79998-1106

Check DocFind® on Aetna's Web site at www.aetna.com/docfind to locate medical (non-behavioral health) network providers. The Aetna POS II network is not used for behavioral health or substance abuse care. Contact Magellan Healthcare for network information and pre-certification of behavioral health or substance abuse care.

Mental health and substance abuse pre-certification and mental health PPO - Magellan provides pre-certification, case management, and information about providers participating in the Mental Health PPO network.

Phone numbers:

Magellan Healthcare
800-442-4123
314-387-4700 (international, call collect)
24 hours a day, 7 days a week

Address:

Magellan Healthcare
14100 Magellan Plaza Drive
Maryland Heights, MO 63043

Check Magellan's Web site at www.magellanhealth.com/member for Life Assistance Resource information such as community resources links, health and wellness tips, and behavioral health Internet sites. The Aetna network is not used for behavioral health or substance abuse care.  The Plan provides for behavioral health and substance abuse care through a nationwide mental health PPO (MHPPO) administered by Magellan. Magellan provides pre-certification of inpatient treatment, provider referral, ongoing consultation and review, and case management for mental health and substance abuse treatment. Once you have accessed this site:

  • Sign in under Member Sign In (new users click on New or unregistered user)
  • Enter toll free number: 800-442-4123 (user identification and password not necessary)
  • At this point, you may register or continue as unregistered

Prescription drug program - Claims processor for outpatient prescription drugs provided through mail order for long-term prescriptions or a local retail pharmacy for short-term prescriptions.

Phone numbers:

Express Scripts Pharmacy – Mail-order Pharmacy
800-695-4116
800-497-4641 (international, use appropriate country access code depending on country from which you are calling)

For questions regarding Retail Prescriptions – Express Scripts:
800-695-4116 
800-497-4641 (international, use appropriate country access code depending on the country from which you are calling)

Addresses:

Express Scripts Pharmacy – Mail-order Pharmacy
P.O. Box 650322
Dallas, TX 75265-0322 

Non-network and Coordination of Benefits Retail Prescriptions Claims Processing:
Express Scripts
ATTN: Commercial Claims
P.O. Box 2872
Clinton, IA 52733-2872
Another way to locate retail network pharmacies and order refills is through the Express Scripts web site at www.express-scripts.com.

Benefits Service Center - Customer Service Representatives can provide specialized assistance. References to Benefits Administration throughout this SPD pertain to the ExxonMobil Benefits Service Center as listed below.

Phone numbers:
Retirees and Survivors call:
ExxonMobil Benefits Service Center
Monday – Friday 8:00 a.m. to 6:00 p.m. 
(U.S. Eastern Time), except certain holidays 
Toll-Free: 1-800-682-2847
or 800-TDD-TDD4 (833-8334) for hearing impaired

Address:
ExxonMobil Benefits Service Center 
P.O. Box 18025
Norfolk, VA 23501-1867

ExxonMobil sponsored sites - Access to plan-related information including claim forms for retirees, survivors, and their family members.

  • ExxonMobil Family, the Human Resources Internet Site — Can be accessed by everyone at www.exxonmobilfamily.com.
  • Retiree Online Community Internet Site — Can be accessed by retirees and survivors only at www.emretiree.com.
  • ExxonMobil Benefits Service Center Internet Site — Can be accessed by everyone at www.exxonmobil.com/benefits.

Introduction

The ExxonMobil Retiree Medical Plan (EMRMP) consists of the Retiree Medical POS II options, Aetna Select, and Cigna OAPIN for Pre-Medicare eligible participants (RMP), and the Medicare Supplement Plan (MSP) for Medicare-eligible participants.  This SPD is a summary of benefits under the RMP POS II options only. It does not contain all the details about the RMP POS II options nor does it contain any information about the MSP. If you enroll in any option other than the RMP POS II options, you may access an SPD for that option. Even if you do not enroll in any option, you are still eligible for certain Culture of Health programs.

The Retiree Medical POS II is a network of physicians, hospitals, and other health care providers whose credentials have been reviewed by the network manager and who have agreed to provide their services at negotiated rates. The POS II "A" and "B" are different plan designs utilizing the same network.

The network for medical care covered under the POS II option – referred to as the Retiree Medical POS II in this SPD – is offered by Aetna. Aetna Life Insurance Company (Aetna) is the network manager and claims administrator for the Retiree Medical POS II.

Aetna does not render medical services or treatments.  Neither the Plan nor Aetna is responsible for the health care that is delivered by providers participating in the Retiree Medical POS II (Aetna Choice® POS II) and those providers are solely responsible for the health care they deliver. Providers are not the agents or employees of the Plan or Aetna.

The PPO for mental health and substance abuse care covered under the Retiree Medical POS II options – referred to as the Mental Health PPO (MHPPO) in this SPD – is managed by Magellan.

The Retiree Medical POS II options offer you the ability to use physicians and other health care providers that are part of a network. You can generally reduce your out-of-pocket expenses by using network providers.

If you elect the Retiree Medical POS II "A" or "B" option and you live outside one of the network areas, you are provided benefits on an out-of-network area basis. However, if you live within the network area and choose to use a non-network provider, specific limitations apply to the benefits you are provided.

These tools can help you find specific information quickly and easily:

  • Plan at a glance, a user's guide highlighting plan basics.
  • Charts and tables throughout this SPD provide information, examples and highlights of plan provisions, including Benefit Summary charts.
  • References to places where you can get more information.
  • A list of Key terms containing definitions of some words and terms used in this SPD. Terms are underlined and linked for easy identification.

A careful reading of this SPD will help you understand how the Retiree Medical POS II options work so you can make the best use of the plan provisions. You may obtain additional information through the sources shown in the About the Retiree Medical Plan section.

Plan at a glance

Enrolling

You may enroll yourself and your eligible family members at retirement if you were enrolled immediately prior to your retirement. See the Eligibility and enrollment section for more information.

Basic plan features

The Plan covers medically necessary and preventive treatment, care and services, that are not otherwise excluded. You can save money and time if you use a provider who participates in the Retiree Medical POS II network. When you receive care through the Retiree Medical POS II network, the provider files claims and obtains necessary pre-certifications, expenses are within reasonable and customary limits, and the negotiated rates generally lower your out-of-pocket costs. See the Basic Plan features section.

The prescription drug program

The Plan offers you two cost-saving ways to buy prescription drugs – at a local participating network pharmacy for short-term prescriptions and through a mail-order program for long-term prescriptions. See the Prescription drug program section.

Mental health and substance abuse care 

The Plan provides for mental health and substance abuse care through Magellan's nationwide mental health PPO. All inpatient care must be pre-certified in order to avoid a $500 penalty for failure to pre-certify. See the Mental health and substance abuse care section.

Covered and excluded expenses 

The Plan provides benefits for many, but not all medically necessary, treatment, care and services. See Covered expenses and Exclusions.

Payments

You and the Retiree Medical Plan share costs for covered treatment and services. You pay a fixed co-payment for covered items such as a POS II network doctor's office visit and most related lab work. For other types of care, you must first satisfy a deductible before Plan begins paying. If you meet your annual out-of-pocket limit, Plan pays 100% of most covered costs for the rest of that calendar year. See Payments section.

Claims 

Retiree Medical POS II network providers file claims for you. You are responsible for ensuring that claims for non-network care are filed. See Claims section. 

Culture of Health 

Tools and resources are available to you and your family members to help you better manage your health and health care. The health portal (Internet site), personal health assessment, and lifestyle health coaching are available to retirees if enrolled in an RMP option. Participants who are enrolled in the RMP POS II option, Aetna Select or Cigna Open Access Plus – In Network options and who meet certain qualifications have access to several additional programs — Health Advocate, Health Management and Centers of Excellence Programs — to help access the best available treatment. See the Culture of Health section. 

Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA) 

You and your family members who lose eligibility may continue medical coverage for a limited time under certain circumstances. See Continuation coverage section. 

Administrative and ERISA information

This Plan is subject to rules of the federal government, including the Employee Retirement Income Security Act of 1974, as amended (ERISA), not state insurance laws. See Administrative and ERISA information Section.

Key terms 

This is an alphabetized list of words and phrases, with their definitions, used in this SPD. These words are underlined and linked throughout the SPD for easy identification. See Key terms section.

Benefit summaries

Brief summaries of benefits for the RMP POS II "A" and "B" options. See Benefit summary.