How the ExxonMobil medical plan fully-insured HMO option works
The term fully-insured Health Maintenance Organization (HMO) identifies both the organized system for delivering comprehensive health care services from a network and the insurance company that provides the benefits for that network. The network is comprised of physicians, other professional providers and health care facilities. The ExxonMobil Medical Plan (EMMP) offers fully-insured HMOs to accommodate the needs of participants located within a zip code defined service area.
When you elect a fully-insured HMO option under the EMMP, the HMO is responsible for providing your benefits for health services. Those benefits will generally be provided through a network of health care providers under the direction of your primary care physician. For example, the HMO will require that you receive your medical care through your primary care physician. If you need to see a specialist, your primary care physician may refer you to the specialist who participates in the HMO. Also, the HMO requires that you receive your prescription drugs and mental health care from participating pharmacists, mail-order drug companies, or mental health professionals in the network. The number and type of providers participating in the HMO are subject to change throughout the year. If you have questions regarding health care coverage as allowed by the HMO, contact HMO Member Services directly. (See Appendix A).
ExxonMobil is responsible for determining the rules of eligibility of the EMMP and its options. Each fully-insured HMO determines what medical services are covered. This guide is a summary of the rules established and administered by ExxonMobil. State laws that govern fully-insured HMOs may affect some of the eligibility participation rules. Please contact the HMO Member Services directly. If you have questions about participation rules in this SPD, please contact Benefits Administration. (See Appendix A).