Vision Plan

Summary plan description of the ExxonMobil Vision Plan as of January 2017

About the ExxonMobil Vision Plan

This guide is a summary of the rules for the ExxonMobil Vision Plan (Vision Plan, SPD) established and administered by ExxonMobil.  This guide along with the Certificate of Coverage provided by United Health Care Insurance Company constitutes the Summary Plan Description for the Plan.  If you do not have a copy of the certificate, go to the Spectera Vision website at www.exxonmobilvision.com. This guide does not contain all the plan details.  In determining your specific benefits, the full provisions of the formal documents, as they exist now or as they may exist in the future, always govern. Copies of these documents are available for your review. Exxon Mobil Corporation reserves the right to change benefits in any way or terminate any benefit at any time.

The Vision Plan is fully-insured.  An insurance company collects premiums and underwrites coverage. ExxonMobil is responsible for determining the rules of eligibility for the Vision Plan. State laws that govern vision plans may affect some of the eligibility participation rules.  Please contact Spectera if you have questions.  If you have questions about participation rules in this booklet, please call Benefits Administration. See Information sources below.

Notice: The Vision Plan is an excepted benefit under Patient Protection Affordable Care Act (PPACA) and is not minimum essential coverage.  Since it is not minimum essential coverage, you may not treat it as required coverage when filing your U.S. Federal Income Tax return.

Applicability to represented employees is governed by collective bargaining agreements and any local bargaining requirements.

Information sources

When you need information, you may contact:

United Healthcare Insurance Company (UHIC)

Issues the insurance policy for Spectera, Vision Care Program

SpecteraSM Vision (Claims Department of Spectera)

Is the third party administrator for UHIC. Provides specialized assistance with respect to questions about the benefit features of the Vision Plan, claims, appeals and network providers.

Spectera Vision
Customer Service Department
877-303-2415 

Monday – Friday 7:00 a.m. to 10:00 p.m. CT
Saturday 8:00 a.m. to 5:30 p.m. CT
(except certain holidays)

Spectera Vision
Claims Department
P. O. Box 30978
Salt Lake City, UT 84130

ExxonMobil vision plan web site: www.exxonmobilvision.com

The following is available on SpecteraSM Vision’s dedicated ExxonMobil Web site:
  • Benefit Summary - outlines the benefits available under the Vision Plan
  • Certificate of Coverage - provides additional detailed information about the Vision Plan
  • Provider Locator - search tool listing retail and private practice providers in Spectera Eyecare Networks
  • Provider Nomination Form - to nominate your provider to participate in Spectera Eyecare Networks
  • Frequently Asked Questions (FAQs) about the Vision Plan
  • Useful Links information to help you learn more about eye care

 

Benefits Administration

Provides specialized assistance by benefits counselors with respect to enrollment. References throughout this information booklet refer to either ExxonMobil Benefits Administration or ExxonMobil Benefits Service Center as listed below. Depending on your status (employee, retiree or survivor), you should contact the appropriate service center.

Phone Numbers/Hours:
Employees call:
ExxonMobil Benefits Administration/Health Plan Services 
800-262-2363 (toll free outside Houston)
262-314-2752 (fax) 

Monday – Friday 8:00 a.m. to 3:00 p.m. CT
(except certain holidays)

Address:
ExxonMobil Benefits Administration  
ExxonMobil BA BSC USBA
HHL – W.02.S196
1735 Hughes Landing Blvd (West Building)
The Woodlands, TX, 77380

Retirees and survivors call:
ExxonMobil Benefits Service Center
800-682-2847 (toll free)
800-TDD-TDD4 (833-8334) for hearing impaired 

Monday – Friday 7:00 a.m. to 5:00 p.m. CT
(except certain holidays)

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

Note: Employees can enroll/change benefits on the ExxonMobil Me HR Intranet site through Employee Direct Access (EDA) when there is a change in status. Please contact Benefits Administration if you do not have access to EDA.

ExxonMobil sponsored sites

Provide access to plan-related information, including claim forms.

  • ExxonMobil Me, the Human Resources Intranet site — can be accessed at work by employees.
  • ExxonMobil Family, the Human Resources Internet site — can be accessed from home by everyone at www.exxonmobilfamily.com.
  • Retiree Online Community Internet site — can be accessed from home by ExxonMobil retirees and survivors only (including Exxon and Mobil retirees and survivors) at www.emretiree.com.
  • ExxonMobil Benefits Web site — can be accessed from home at http://www.exxonmobil.com/benefits by Exxon, ExxonMobil, Mobil & Superior Oil retirees and survivors only.

Introduction

The Vision Plan (the Plan) encourages preventive eye care by offering coverage for comprehensive eye exams and allowances for lenses and frames or contact lenses in lieu of lenses and frames. The Plan offers you the opportunity to use optometrists and ophthalmologists who are part of Spectera Eyecare Networks. You can generally reduce your out-of-pocket expenses while maximizing the plan benefits by using this network. The Vision Plan eligibility and enrollment rules are described in detail in this booklet.  For details on your benefits coverage, please see your Certificate of Coverage or contact SpecteraVision at 1-877-303-2415.

Plan at a glance

Enrolling

You may enroll yourself and your eligible family members within your first 60 days of employment or within 60 days of a subsequent change in status or at Annual Enrollment. See How to enroll.

Spectera Eyecare Networks

You can visit any provider, but you save when you choose a provider who participates in the Spectera Eyecare Networks.

Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA)

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

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.

Key terms 

This is an alphabetized list of words and phrases, with their definitions, used in this Information Booklet. See Key terms.