HMO - Aetna Select

Summary plan description of the ExxonMobil Retiree Medical HMO - Aetna Select Option as of January 2017

Important information

This is your guide to the benefits available through the Retiree Medical Plan Aetna Select Self-Insured Option (Aetna Select, or the Plan). Please read it carefully and refer to it when you need information about how the Plan works, to determine what to do in an emergency situation, and to find out how to handle service issues. It is also an excellent source for learning about many of the special programs available to you as a plan participant.

If you cannot find the answer to your question(s) in the booklet, call the Member Services toll-free number on your ID card. For more information, go to the “Member Services” section in this guide.

THIS IS NOT AN INSURED BENEFIT PLAN. THE BENEFITS DESCRIBED IN THIS GUIDE OR ANY RIDER ATTACHED HERETO ARE SELF-FUNDED BY EXXON MOBIL CORPORATION WHICH IS RESPONSIBLE FOR THEIR PAYMENT. AETNA LIFE INSURANCE COMPANY (AETNA) PROVIDES CLAIM ADMINISTRATION SERVICES TO THE PLAN, BUT AETNA DOES NOT INSURE THE BENEFITS DESCRIBED.

All services, plans and benefits are subject to and governed by the terms (including exclusions and limitations) of the agreement between Aetna Life Insurance Company (Aetna) and the ExxonMobil Retiree Medical Plan (EMRMP). The information herein is believed accurate as of the date of publication and is subject to change without notice.

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, govern.  Part 4 of the EMRMP is intended as the sole document that sets out the benefits provided through the Aetna Select option. You may obtain copies of these documents by making a written request to the Administrator-Benefits. ExxonMobil reserves the right at any time to change in any way or terminate any benefit.

This guide covers the major features of the Aetna Select administered by Aetna Life Insurance Company, effective January 1, 2017. The plan description has been designed to provide a clear and understandable summary of the Plan, and with the Provider directory serves as the Summary Plan Description (SPD) required for plans subject to ERISA.

The Aetna Select option administered by Aetna Life Insurance Company is self-funded. 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. This option is governed by federal laws, not state insurance laws.

Information sources

When you need information, you may contact:

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 website at www.aetna.com/docfind to locate network providers.

Mental health and substance abuse and mental health PPO - Magellan Healthcare provides precertification, 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. 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 - Express Scripts is the 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
P.O. Box 14711
Lexington, KY 40512
64063-2277

Another way to locate retail network pharmacies and order refills is through the Express Scripts web site at www.express-scripts.com.