Q. What are the Medical Plan's eligibility requirements?
A. Most U.S. retirees and eligible family members of Exxon Mobil Corporation and participating affiliates are eligible for the POS II Options.
Generally, you are eligible if:
- You are a retiree
- You are a surviving spouse, which means an eligible family member of a deceased retiree or employee
- You are a Long Term Disability Retiree and are not eligible for Medicare Part A or B.
You are not eligible for the Retiree Medical Plan if:
- You participate in any other employer medical plan to which ExxonMobil contributes.
- You are eligible for coverage under the ExxonMobil Medical Plan.
- 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 the Benefits Service Center.
- 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.
- A child or spouse of a Medicare-eligible retiree or survivor enrolled in the ExxonMobil Medicare Supplement Plan, as long as that spouse or child is not eligible for Medicare.
A person who becomes a retiree due to incapacity within the meaning of the ExxonMobil Disability Plan and who begins long-term disability benefits under that plan, but whose benefits stop because the person is no longer incapacitated is a suspended retiree and not eligible for coverage until the earlier of the date the person:
- Reaches age 55; or
- Begins his or her benefit under the ExxonMobil Pension Plan at which time the person is again considered a retiree and may enroll.
The family members of a deceased suspended retiree will be eligible for coverage under this Plan only after the occurrence of the earlier of the following:
- The date the suspended retiree would have attained age 55; or
- The date a survivor begins receiving a benefit due to the suspended retiree's accrued benefit from the ExxonMobil Pension Plan.
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:
- Individual only (Retiree, Spouse, Surviving Spouse, Surviving Child);
- Retiree and spouse;
- Individual and child(ren); or
- Retiree and family.
There are also classes of coverage for surviving spouses and family members of deceased employees and retirees, and spouses and family members of retirees covered by the ExxonMobil Medicare Supplement Plan.
Each class of coverage described in this section has its own contribution rate. Retirees and survivors receiving monthly benefit checks from ExxonMobil pay by deductions from these checks on an after-tax basis. Other retirees or survivors and participants with continuation coverage pay by check or by monthly draft on their bank account. You must complete the forms required for payment of contributions within 60 days of enrollment in the Plan. If you fail to do so, coverage will be retroactively suspended and you will be prevented from enrolling at a future date until you pay past contributions.
No one can be covered more than once in the Retiree Medical Plan. You and your spouse cannot both enroll as retirees and elect coverage for each other as eligible family members. If you and your spouse are both retirees you may both be eligible for coverage. Each of you can be covered as an individual retiree, or one of you can be covered as the retiree and the other can be an eligible family member. Also, if you have children, each child can only be covered by one of you.
How to enroll
If you were enrolled in the ExxonMobil Medical Plan, your enrollment and your covered family members will transfer to the ExxonMobil Retiree Medical Plan. If you were in a POS II option, you will maintain claims, deductibles and out of pocket history (e.g. If you were in the ExxonMobil Medical Plan enrolled in the POS II A option as an employee, and you enroll in the POS II B option as a retiree) are transferred. You may make a new selection within 60 days of your retirement date, or you will be defaulted to the RMP POS II B.
If you are not covered by a medical plan to which ExxonMobil contributes and would like to enroll in the Retiree Medical Plan, you may do so within 60 days of your retirement date or at Annual Enrollment. Coverage is effective the first of the month following completion of enrollment.
You can enroll eligible family members if you are enrolled in an RMP option or in the Medicare Supplement Plan. As a retiree, you are enrolled on an after-tax basis, therefore you may add an eligible family member to your existing plan option at any time. Coverage is effective the first of the month following receipt of your written election by the Benefits Service Center. Call the ExxonMobil Benefits Service Center at 800-682-2847 or visit the ExxonMobil Benefits Service Center Internet Site in order to enroll. Individuals who do not have web access can use enrollment forms provided by the Benefits Service Center.
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. 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.
Under the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009 you may change your RMP 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 the Benefits Service Center.
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. Family members may be added or deleted for any reason but they must be deleted as soon as 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 of loss of eligibility and not at Annual Enrollment. Failure to timely remove an ineligible dependent can subject the retiree and all covered family members to loss of coverage.
As a retiree, you pay your contributions on an after-tax basis through payroll deduction (if eligible), check, or bank draft.
During Annual Enrollment, changes to your RMP coverage (option or contributions) do not automatically adjust your coverage or contributions to other plans such as the ExxonMobil Dental Plan, ExxonMobil Vision Plan. Changes to those plans must be made separately during Annual Enrollment.
Changing your coverage
To make a change to your retiree medical plan option, you must wait until Annual Enrollment or until you experience one of the following Changes in Status.
Since, as a retiree, you are enrolled on an after-tax basis, you may add an eligible family member to your existing plan option at any time. Coverage is effective the first of the month following receipt of your written election by the Benefits Service Center and payment of contributions.
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, forms should be completed within 60 days.
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 - retiree medical
The medical enrollment form should be received within 60 days of the event by the Benefits Service Center. Unless otherwise noted, the effective date will be the first of the month after the forms are received.
If you are enrolled in the Retiree 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.
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 the Benefits Service Center as soon as your divorce is final. If you fail to notify and provide the appropriate forms to the Benefits Service Center within 60 days, the former spouse and stepchildren will not be entitled to elect COBRA. Failure to timely remove a divorced spouse may result in loss of eligibility for the retiree and all other eligible family members. Please see the Continuation coverage section of this SPD.
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.
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. See the Changing your coverage section for additional circumstances in which changes can be made.
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 the Benefits Service Center as soon as a family member is no longer eligible. If you fail to notify and provide the appropriate forms to the Benefits Service Center 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.
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 child, you may 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.
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 Retiree Medical Plan option.
This provision also applies to a significant increase in plan option 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 retiree medical coverage for yourself and your eligible family members.
Addition or improvement of plan options
If a new Retiree 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 Retiree 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 RMP POS II option. You may also cancel medical coverage altogether.
Other situations that may affect your coverage
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 for your plan option to confirm whether service is available. (See service area).
If you become eligible for Medicare
If you are a retiree, you and your family members who are not eligible for Medicare can continue to participate in the Retiree Medical Plan. When you (as a retiree) or a covered family member of a retiree becomes eligible for Medicare, Medicare becomes your primary plan and benefits will be coordinated. You then are no longer eligible for the POS II and HMO options in the Retiree Medical Plan, but you may be eligible to enroll in the Medicare Supplement Plan (EMMSP). If you fail to enroll in the MSP when first eligible, then you will not be able to enroll at a later time without proof of having other employer provided coverage immediately prior to enrollment.
If a covered family member becomes eligible for Medicare
When a covered family member becomes eligible for Medicare, Medicare becomes their primary plan. Your family member will not be eligible for coverage under the Retiree Medical Plan, but you will be able to enroll them as a primary participant in the Medicare Supplement Plan (MSP). If you fail to enroll your family member in the MSP when first eligible, then you will not be able to enroll them at a later date without proof of having other employer provided coverage immediately prior to enrollment. Refer to the Medicare Supplement SPD for more information on eligibility rules.
If you die
If you die while enrolled, your covered eligible family members can continue coverage through the ExxonMobil Retiree Medical Plan. Eligibility continues for your spouse until your spouse remarries, or becomes eligible for Medicare. Upon eligibility for Medicare, your spouse can continue coverage through the ExxonMobil Medicare Supplement Plan.
Children of deceased employees or retirees may continue participation in the Retiree Medical Plan as long as they are an eligible family member. If your surviving spouse remarries, eligibility for your children also ends. Special rules may apply to family members of individuals who become retirees due to disability. See Suspended retiree below.
If you become a suspended retiree
If you are a retiree and you would otherwise lose coverage because you have become a suspended retiree under the ExxonMobil Disability Plan, you may continue coverage for yourself and all your family members who were eligible for Medical Plan participation before you became a suspended retiree for either 12 or 18 months.
Coverage continues for 12 months from the date coverage would otherwise end if you received transition benefits under the ExxonMobil Disability Plan. However, if you did not receive transition benefits under the ExxonMobil Disability Plan, coverage continues for 18 months from the date coverage would otherwise end. The cost of this continued coverage is 102% of the combined participant and company contributions.
If you return to work at ExxonMobil as an employee after retirement
If you are rehired by ExxonMobil and are eligible for the ExxonMobil Medical Plan, your Retiree Medical coverage will be cancelled effective with the date of rehire. When your employment ends, you will be eligible to re-join the ExxonMobil Retiree Medical Plan.
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 die;
- A family member ceases to be eligible (for example, a child reaches age 26);
- You become 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;
- 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. To end coverage for your spouse or family member when no longer eligible, contact the ExxonMobil Benefits Service Center. 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. 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 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.
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.