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

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

About the Employee Medical Plan

This summary plan description (SPD) summarizes the ExxonMobil Medical Plan (the Plan) POS II ‘A’ and ‘B’ Options. It does not contain all plan 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. 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 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 program benefits.

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

Information sources

When you need information, you may contact:

Claims, 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 Magellan: Substance Abuse. Contact Magellan Healthcare for network information and pre-certification of behavioral health or Magellan: Substance Abuse. 

Mental Health and Magellan: 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 Magellan: Substance Abuse.  The Plan provides for behavioral health and Magellan: Substance Abuse 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 behavioral 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 Administration - Customer Service Representatives can provide specialized assistance. References to Benefits Administration throughout this SPD pertain to the contact information listed below.

Employees can enroll/change benefits on the ExxonMobil Me HR Intranet site through Employee Direct Access (EDA) when a change in status occurs. Enrollment forms are also available through ExxonMobil Benefits Administration for those without access to EDA.

Phone numbers:


ExxonMobil Benefits Administration/Health Plan Services

Monday – Friday 8:00 a.m. to 3:00 p.m. 
(U.S. Central Time), except certain holidays
800-262-2363 (toll free outside Houston)
262-314-2752 (fax) 
hr.medical.dental.questions@exxonmobil.com (E-mail)

Address:

ExxonMobil Benefits Administration
HHL – W.02.S196

1735 Hughes Landing Blvd (West Building)

The Woodlands, TX, 77380

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

  • ExxonMobil Me, the Human Resources Intranet Site — Can be accessed at work by employees.
  • ExxonMobil Family, the Human Resources Internet Site — Can be accessed by everyone at www.exxonmobilfamily.com
  • ExxonMobil Benefits Service Center at Xerox Internet Site – Can be accessed by everyone at www.exxonmobil.com/benefits
  • ExxonMobil Benefits Web (Single Sign On) – Can be accessed by U.S. dollar paid active employees without an SSN and PIN after authenticating to the ExxonMobil network from a Company issued PC, laptop or mobile device. Click here for access.

Introduction

The ExxonMobil Medical Plan is made up of POS II options and other options, including both self-insured and fully-insured options. This SPD is a summary of your benefits under the POS II options only. It does not contain all the details about the POS II options nor does it contain any information about the other options. If you enroll in any option other than the 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 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 Medical POS II in this SPD – is offered by Aetna. Aetna Life Insurance Company (Aetna) is the network manager and claims administrator for the 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 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 POS II options – referred to as the Mental Health PPO (MHPPO) in this SPD – is managed by Magellan.

The 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 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 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 Medical Plan’ section.

Plan at a glance

Enrolling

You may enroll yourself and your eligible family members within 60 days of hire or within 60 days of a subsequent change-in-status or at Annual Enrollment. See the Eligibility and enrollment section.

Basic Plan features

The Medical 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 POS II network . When you receive care through the 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 Medical 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 Medical Plan provides benefits for many, but not all medically necessary, treatment, care and services. See Covered expenses and Exclusions.

Payments

You and the 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 the Medical Plan begins paying. If you meet your annual out-of-pocket limit, the Medical Plan pays 100% of most covered costs for the rest of that calendar year. See the Payments section. 

Claims

POS II network providers file claims for you. You are responsible for ensuring that claims for non-network care are filed.  The Plan does not recognize the assignment of benefits to non-network providers. See the Claims section.

Culture of health and partners in health programs

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 everyone. Participants who are enrolled in the 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 POS II "A" and "B" options. See Benefit summary.