ExxonMobil Pre-Tax Spending Plan. Summary Plan Description

Transcription

1 ExxonMobil Pre-Tax Spending Plan Summary Plan Description 201

2 About Pre-Tax Spending - Information Sources - Introduction - Plan at a Glance Eligibility and Enrollment Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage Health Care Flexible Spending Account Dependent Care Flexible Spending Account Claiming Reimbursement Tax Implications Continuation Coverage Administrative and ERISA Information ExxonMobil Pre-Tax Spending Plan SPD As of 2015 About The Pre-Tax Spending Plan This summary plan description (SPD) is a summary of the ExxonMobil Pre-Tax Spending Plan (the Plan). It does not contain all plan details. In determining specific benefits, the full provisions of the formal plan documents, as they exist now or as they may exist in the future, always govern. Copies of these documents are available for your review. 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 Administrator Provides claim payment information and claim forms. Phone Numbers: Aetna Member Services (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 El Paso, TX To visit Aetna's Web site: Benefits Administration Provides opportunity for specialized assistance from Customer Service Representatives. 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.

3 2 Phone Numbers: ExxonMobil Benefits Administration/Health Plan Services (toll free outside Houston) (fax) Monday - Friday 8:00 a.m. to 3:00 p.m. (U.S. Central Time), except certain holidays Address: ExxonMobil Benefits Administration ExxonMobil BA BSC USBA 4300 Dacoma or "BH1" Houston, Texas ExxonMobil Sponsored Sites Access to plan-related information for employees and their family members. ExxonMobil Me, the Human Resources Intranet Site Can be accessed at work by current employees. ExxonMobil Family, the Human Resources Internet Site Can be accessed from home at by everyone. Introduction The ExxonMobil Pre-Tax Spending Plan (the Plan) allows you to take advantage of significant tax savings in three ways: When you elect coverage under a medical, dental and/or vision plan to which a participating ExxonMobil employer contributes, your required contributions (what you may think of as your premiums) will be on a pre-tax basis, unless you opt out of this feature every year. The Health Care Flexible Spending Account allows you to set aside pre-tax money for the reimbursement of out-of-pocket medical, dental or vision expenses for both you and your family members. The Dependent Care Flexible Spending Account allows you to set aside pretax money for the reimbursement of day care charges provided for your children under age 13 or for a disabled child or adult who lives with you and depends on you financially. This account does not cover medical or dental expenses. Most employees may participate in one, two or all three parts of the Plan: You are enrolled to pay your contributions for medical, dental and vision plan coverage on a pre-tax basis. If you do not wish to pay your contributions on a pre-tax basis, you must opt out of this feature each year during Annual Enrollment. If you do not opt out each year, your contributions will be made on a pre-tax basis beginning the following plan year. Each year, you must elect an annual amount to contribute in order to participate in the Health Care Flexible Spending Account and/or the Dependent Care Flexible Spending Account. Your participation in the Plan does not reduce any ExxonMobil benefits related to pay (for example, Life Insurance or Savings Plan contributions).

4 3 To help you find specific plan information quickly and easily, these helpful tools are included: Plan at a Glance, a quick user's guide highlighting plan basics. Charts and tables throughout this SPD providing information, examples, highlights of plan provisions, etc. References to places you can get more information. A careful reading of this SPD will help you understand how the Plan works so you can make the best use of the plan provisions. Plan at a Glance Enrolling If you are eligible, you may participate in one, two or all three parts of the Plan. See page 4. Pre-Tax Contributions You are enrolled to pay your contributions for medical, dental and vision plan coverage on a pre-tax basis. See page 14. The Health Care Flexible Spending Account You may set aside pre-tax dollars for unreimbursed, out-of-pocket medical, dental or vision expenses incurred by you and your family members during the plan year. See page 15. The Dependent Care Flexible Spending Account The Dependent Care Flexible Spending Account can help you pay for a family member's care expenses with pre-tax dollars if a qualified dependent receives day care so you, and your spouse if you are married, can work outside the home. Eligible expenses include charges for day care provided for your children under age 13 or for a disabled child or adult who lives with you and depends on you financially. See page 22. Getting Reimbursed If you have available Health Care FSA funds, you will be reimbursed automatically from the Health Care Flexible Spending Account for claims processed as a participant in the ExxonMobil Medical Plan POS II "A" or "B" option, Aetna Select option, the ExxonMobil Dental Plan and eligible claims processed by Spectera for the ExxonMobil Vision Plan. Otherwise, you must file a claim form and attach documentation of your expenses to be reimbursed from either the Health Care or Dependent Care Flexible Spending accounts. See page 25. Tax Implications The Plan provides significant tax savings. Examples show how you save taxes by participating in the Plan. See page 29. Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA) You and your family members who lose eligibility may continue pre-tax coverage for a limited time under certain circumstances. See page 32. Administrative and ERISA Information The 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 page 37.

5 About Pre-Tax Spending Eligibility and Enrollment - Eligibility - Initial and Annual Enrollment - Changes to Medical, Dental and Vision Plans (Health Plans) Pre- Tax Contributions - Changes to Your Health Care FSA - Changes to Your Dependent Care FSA - Changing Your Election - Correcting Enrollment Mistakes - Leaves of Absence and FSA - Participation When Employment Ends - Continuation Coverage (COBRA) Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage Health Care Flexible Spending Account Dependent Care Flexible Spending Account Claiming Reimbursement Tax Implications Continuation Coverage Administrative and ERISA Information Eligibility and Enrollment Q. Who is eligible to enroll in the ExxonMobil Pre-Tax Spending Plan? A. Most U.S. dollar payroll employees of Exxon Mobil Corporation and participating affiliates are eligible for this Plan. Eligibility Full-time employees not hired on a temporary basis (designated as "regular employees") are eligible their first day of employment. This includes an employee who is classified as a non-regular employee, but who has been designated as an Extended Part-Time Employee under his or her employer's employment policies relating to flexible work arrangements. An employee who is classified as a non-regular employee, but who has been characterized as a trainee and has graduated from high school, complies with any enrollment requirements and makes required contributions, is eligible to participate in the Plan by paying contributions on a pre-tax basis. Trainees may not participate in the HCFSA and DCFSA. Leased employees as defined in the Internal Revenue Code, temporary or part-time employees (classified as "non-regular employees"), barred employees or special agreement persons are not eligible to participate in the Plan. A barred employee is an employee who is covered by a collective bargaining agreement, except to the extent participation is provided under such agreement. A special-agreement person is, generally, a person paid on a commission or commission salary basis other than a person paid while employed by the Marketing department of ExxonMobil; an employee providing service to a non-affiliated organization that pays the person's salary or wages; or an employee working pursuant to an agreement that specifically excludes the person from coverage for benefits. Retirees are not eligible to participate in the Plan because they do not receive taxable wages. Initial and Annual Enrollment Employee Contributions. Participants in the Medical, Dental and Vision Plans are automatically enrolled to pay their monthly contributions on a pre-tax basis through the Plan. You may decline this tax-savings feature, but you must decline it every year during annual enrollment period and each time you make a change to your elected benefits - e.g. if you change the level of coverage in the Dental Plan in order to continue paying all your contributions on an aftertax basis, you must elect to opt out again.

6 5 To participate in the Health Care Flexible Spending Account (HCFSA), you must enroll each year during the annual enrollment period. To participate in the Dependent Care Flexible Spending Account (DCFSA), you must enroll each year during the annual enrollment period. Within 60 days of your date of hire, you may enroll in the HCFSA or DCFSA parts of the Plan to cover expenses. Coverage will be effective as of the first day of employment if the form is received within the first 30 days or completed through EDA. If you enroll between 31 and 60 days following your hire date, coverage will be effective the first of the month following receipt of the forms and applies for the balance of the plan year. You must enroll again each year to participate in one or both of the flexible spending accounts. You also may decline paying your monthly medical, dental and vision contributions on a pretax basis at that time. Your election to participate in any of the accounts is irrevocable as of the close of the annual enrollment period and you may not change your election for the following year except for the events described in the following sections or for a mistake. Changes to Medical, Dental and Vision Plans (Health Plans) Pre-Tax Contributions The following is a quick reference table that describes events which may allow changes, if the changes are submitted no later than sixty (60) days after the event, as well as the actions you may take. If you have any questions, please call Health Plan Services prior to the expiration of sixty (60) days. If this event occurs... Marriage Divorce - Employee enrolled in Health Plans Divorce - Employee loses coverage under Spouse's health plans Gain a family member through birth, adoption or placement for adoption or guardianship. Death of a spouse or other eligible family member. You or a family member loses eligibility under another employer's group health plan or other employer contributions cease which creates a "HIPAA special enrollment" right. Other loss of family member's eligibility (e.g., sole managing conservatorship of grandchild ends). You lose eligibility because of a change in your employment status, e.g., regular to non-regular. You may... Enroll yourself and spouse and any new eligible family members or change your Medical Plan Option. Change your level of coverage. You must drop coverage for your former spouse but you may not drop coverage for yourself or other covered eligible family members. Enroll yourself and other family members that might have lost eligibility for Spouse's health plans. Enroll any eligible family members and change Medical Plan Option. Change your level of coverage. You may not drop coverage for yourself or other covered eligible family members. Enroll yourself and other family members that might have lost eligibility. This only pertains to the Medical Plan. Change your level of coverage and change Medical Plan Option. Change your level of coverage. You may not drop coverage for yourself or other eligible family members. Your Medical Plan participation will automatically be termed at the end of the month.

7 You gain eligibility because of a change in your employment status, e.g. nonregular to regular. Termination of Employment by spouse or other family member or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse's or family member's plan in which you or they were enrolled. Your former spouse is ordered to provide coverage to your children through a QMSCO. Commencement of Employment by spouse or other family member or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under another employer's plan. Change in worksite or residence affecting eligibility to participate in the elected Medical Plan Option (e.g. move out of an HMO option service area). Judgment, decree or other court order requiring you to cover a family member (Begin a QMSCO). Termination of employment and rehire within 30 days or retroactive reinstatement ordered by court. Termination of employment and rehire after 30 days. You are covered under your spouse's medical plan and plan changes coverage to a lesser coverage level with a higher deductible mid-year. You begin a leave of absence. You return from a leave of absence of more than 30 days (paid or unpaid). Enroll yourself or any eligible family members in Medical Plan. Enroll yourself and other family members that may have lost eligibility under the spouse's or family member's plan in Medical Plan and change your Medical Plan Option. End the family member's coverage, change level of coverage and terminate their participation in Health plans. End other family member coverage and terminate their participation in Health Plans if the employee represents that they have or will obtain coverage under the other employer plan. You may also cancel coverage for yourself, if health care coverage is obtained through your spouse s employer plan. Change your Medical Plan Option and change level of coverage. You may not drop coverage for yourself or other eligible family members. Change your Medical Plan Option and change level of coverage. Enroll in the same Medical Plan you had prior to termination. Enroll in Medical Plan as a new hire. Enroll yourself and eligible family members in the Medical Plan. Call Benefits Administration at to discuss permissible changes. Call Benefits Administration at to discuss permissible changes. 6 Changes will only be allowed if the medical/dental/vision enrollment form is received within 60 days of the event by the Benefits Administration Office or the change is made in EDA within 30 days. Unless otherwise noted, the effective date will be the first of the month after the forms are received or the transaction is completed in EDA. Subject to any enrollment rules applicable to a Medical Plan Option, an employee may add a family member effective the first day of a month if required contributions are made on a pre-tax basis and adding the family member does not change the amount of required contributions. Loss of Other Health Coverage. You may enroll or add eligible family members when you or your dependent loses other health coverage. Enrollment can be requested when the individual loses eligibility for the other coverage. You must enroll within 60 days of the loss of coverage. The resulting coverage is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change Medical plan options at this time.

8 7 Entitlement to Medicare or Medicaid. If you, your spouse, or family member who is enrolled becomes entitled to coverage (i.e., becomes enrolled) under Part A or Part B of Title XVIII of the Social Security Act (Medicare) (Public Law (79 Stat. 291)) or Title XIX of the Social Security Act (Medicaid) (Public Law (79 Stat. 343)), other than coverage consisting solely of benefits under section 1928 of the Social Security Act (the program for distribution of pediatric vaccines), you may cancel coverage for that individual. 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 provided you complete the enrollment process within 60 days. You must add the new family member within 60 days even if you already have family coverage. If you enroll your new family member between 31 and 60 days from the birth or adoption and your coverage level changes, you will pay the cost difference on a posttax basis until the end of the month in which the forms are received by Benefits Administration. Beginning the first day of the following month your deduction will be on a pre-tax basis. Marriage. You may enroll or add eligible family members after marriage. You must enroll within 60 days of the marriage and enrollment is effective on the first day of the first calendar month beginning after the date the completed request for enrollment is received. You may also change Medical plan options at this time. Loss of Dependent. You are responsible for ending coverage with Benefits Administration when your enrolled spouse or family member is no longer eligible for coverage. If you do not complete your change within 60 days, any contributions you make for ineligible family members will not be refunded and your pre-tax contributions will not be reduced until the beginning of the next calendar year. Transfer or Change in Residence. If you move from one location to another, and the move makes you no longer eligible for your selected Medical Plan option, you may change from your current Medical Plan option to one that is available in your new location. For more information, call Benefits Administration. Coverage Change. If you are covered under your spouse's medical plan and the plan's coverage changes to a lesser coverage with a higher deductible mid-year, then you may enroll and add eligible family members. 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 medical coverage for yourself and your eligible family members. You must enroll within 60 days following the date you lose coverage under your spouse's plan. Significant Curtailment of Benefits with Loss of Coverage. If during the year it is determined by the Administrator-Benefits that there has been a substantial decrease in the medical care providers available under an option or a reduction in the benefits for a specific type of medical condition or treatment with respect to which you or your spouse or family member is currently in a course of treatment; or any other similar fundamental loss of coverage, then you may be allowed to elect to participate under another benefit package option providing similar coverage or to drop coverage if no similar benefit package option is available. Changes to Your Health Care FSA The pre-tax Plan permits you to increase, decrease, revoke or elect to participate in the Health Care FSA during the Plan year only as provided in the following chart. Changes in your elections must be consistent with the changes in status and the change must be made within 60 days of the event.

9 If this occurs... Marriage Divorce Divorce - Employee loses coverage under Spouse's Health Plans. Gain a family member through birth, adoption or placement for adoption, marriage or guardianship. Move or change residence. Change in medical or your financial condition. Loss of family member's eligibility (e.g., no longer a tax dependent). You lose eligibility because of a change in your employment status, (e.g., regular to non-regular or you begin a leave of absence). You gain eligibility because of a change in your employment status, (e.g. nonregular to regular). Termination of Employment by spouse or other family member or other change in their employment status (e.g., change from full-time to part-time) triggering loss of eligibility under spouse or family member's plan. Your family member becomes eligible for Medicare or Medicaid. Commencement of Employment by spouse or other family member or other change in their employment status (e.g., change from part-time to full-time) triggering eligibility under spouse or family member's plan. Job transfer requiring relocation including one affecting eligibility to participate in the Medical Plan. Provider leaves plan option. Termination of employee and rehire within 30 days or retroactive reinstatement ordered by court. Termination of employment and rehire after 30 days. You are covered under your spouse's medical plan and plan change's coverage to a lesser coverage with a higher deductible mid-year. You begin a leave of absence. You may... Enroll or increase your election because of the newly eligible spouse. Revoke or decrease your election because your spouse is no longer eligible. Enroll or increase your election. Enroll or increase your election because of the newly eligible family member. You are not eligible to make any changes. You are not eligible to make any changes. Revoke or decrease your election. Revoke your election. You may continue the coverage during the leave on an after-tax basis until the end of the year in which the leave commenced. Enroll. Enroll or increase your election. Revoke or decrease your election. May decrease or cease election if you gain eligibility under spouse's or family member's plan. Your election to cease or decrease coverage for that individual (including yourself) corresponds only if coverage for that individual becomes effective or is increased under the other employer's plan. You are not eligible to make any changes. You are not eligible to make any changes. Elections effective at termination are automatically restored unless another event has occurred which allows a change. Enroll as a new hire. You are not eligible to make any changes. Call Benefits Administration at to discuss permissible changes. 8

10 You return from a leave of absence of more than 30 days (paid or unpaid). Death of a spouse or other eligible family member. Death of a spouse where employee is covered by spouse's employer's group health plan. Judgment, decree or other court order requiring you to cover a family member. (Begin a QMSCO). Another parent is ordered to provide coverage to your child through a QMSCO. 9 Call Benefits Administration at Upon return, you have the right to reinstate coverage at prior coverage level (and make-up unpaid contributions) or at a level reduced pro rata for the missed contributions. The make-up contributions may be made on a pre-tax basis even if they span more than one year. In either case, you may not submit expenses for the period during which you did not continue your coverage. Revoke or decrease your election. Enroll or increase or decrease your election. Enroll or Increase your election. Revoke or decrease your election if coverage actually provided. Changes to Your Dependent Care FSA The pre-tax Plan permits an employee to increase, decrease, revoke or elect to participate in the Dependent Care FSA during the Plan year only as provided in the following chart. Changes in your elections must be consistent with the change in status and the change must be made within 60 days of the event. If this occurs... You may... Marriage Revoke or decrease your election (e.g., spouse does not work and cares for the children at home). Divorce or Death of Spouse. Gain a family member through birth, adoption or placement for adoption, marriage or guardianship. Move or change residence. A family member is no longer considered an eligible family member. You or your spouse change to or from part-time or full-time employment (excludes change to extended part-time status). Enroll of increase (e.g., children are brought into family who now need daycare). Enroll or increase (e.g., now need daycare). Revoke or decrease (e.g., stepchildren no longer qualifying children). Enroll or increase your election if newly eligible family member needs care. You are not eligible to make any changes. You can revoke or decrease your election (e.g., stepchildren no longer qualifying children). Enroll, increase, revoke or decrease your election.

11 You or your spouse change work schedules which change either hours of dependent care required or the amount of dependent care costs. Job transfer with or without relocation. Change in the amount paid for dependent care. Change from one dependent care center to another one that charges a different rate. Your child reaches age 13 and is no longer a qualifying family member. Change in home dependent care provider, (e.g., change to a nannysharing arrangement). Loss of family member's eligibility (e.g., no longer a tax dependent). You lose eligibility because of a change in your employment status, (e.g., regular to non-regular). You begin a leave of absence. You return from a leave of absence of more than 30 days (paid or unpaid). Death of a qualifying family member. 10 Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs. Enroll, increase, revoke or decrease your election amount only if the relocation results in a change to dependent care costs. Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs (e.g., awarded a scholarship or other subsidy for childcare). Enroll, increase, revoke or decrease your election amount consistent with the change in qualified dependent care expense. Revoke or decrease your election amount consistent with the change in dependent care costs. Enroll, increase, revoke or decrease your election amount consistent with the change in dependent care costs. Revoke or decrease your election. Revoke your election. Call Benefits Administration at to discuss permissible changes. Call Benefits Administration at to discuss permissible changes. Revoke or decrease (e.g., care no longer needed). Annual Enrollment Each year, as part of the annual enrollment process, you will receive enrollment instructions. You must enroll by the published deadline in order to participate in one or both of the flexible spending accounts for the next year. Be sure to budget carefully because any amounts in the HCFSA and/or DCFSA at the end of the plan year that are not used to reimburse eligible expenses will be forfeited. The key to using the Plan wisely is carefully estimating all your eligible expenses. You will forfeit funds directed to the Plan that are not used at the end of the year. Changing Your Election The Plan is governed by federal and state income tax laws and regulations, and the provisions of the Plan document. Once you make an election contributions on a pre-tax or after-tax basis and/or amounts to the flexible spending accounts your election must remain in effect for the entire plan year unless you have a change in status or you made a mistake.

12 11 When you have a change in status, you can make changes as follows: Election for medical, dental and vision plan contributions paid on a pre-tax or after-tax basis. Your contributions are paid on a pre-tax basis when you enroll for medical, dental and vision plan coverage. You may change this election (pay after-tax) when you enroll or within 60 days of a change in status. On the other hand, if you are paying your contributions on an after-tax basis, you may elect to pay on a pre-tax basis with a change in status. Also, if you are paying on an after-tax basis and you change your level of coverage (i.e. employee to family), in order to continue paying on an after-tax basis, you must elect to opt out again. Make your election on EDA or by submitting a Medical, Dental and Vision Authorization Form. Your EDA election must be done within 30 days of the event or the form must be received by Benefits Administration within 60 days of the change in status. Depending on the event, the change to your election is effective as of the first of the month following election through EDA or forms received by Benefits Administration or the actual date of the event. You are not allowed to make changes after the 60-day period until the next annual enrollment period or until another change in status. HCFSA and/or the DCFSA election. As stated in the charts on page 5, with a change in status, you may increase, decrease or cancel an election of pre-tax dollars for unreimbursed, out-of-pocket, eligible expenses in either one or both accounts - the HCFSA (medical/dental/vision expense) and/or the DCFSA (dependent care). Your elections to the HCFSA and/or DCFSA must be made separately within 60 days of the event. Be sure to budget carefully because any unused amounts in the HCFSA and/or DCFSA must be forfeited. Make your election using Employee Direct Access (EDA) or submit your Flexible Spending Account - Enrollment/Change Form. Your EDA election must be made within 30 days of the event or the form must be received by Benefits Administration within 60 days of the change in status. Your adjusted spending account election is generally effective the first of the month following your election. Any change in election affecting annual contributions to the HCFSA or to the DCFSA will only change the amount available for reimbursement from the respective account for the portion of the plan year remaining following the effective date of the change. Any increase in the amount available for reimbursement under the HCFSA or the DCFSA after such an election change may not be used to reimburse expenses incurred prior to the effective date of such change. You may only reduce your election for the remainder of the year to an amount greater than or equal to the amount already contributed. If you cancel your election (reduce to zero), you may only file claims for eligible expenses incurred before you changed your election. If your election is not received by Benefits Administration within 60 days of the change in status, you may not make a new pre-tax spending account election or change your current pre-tax spending account election until you have another change in status or until the next annual enrollment period. Special Rule Applies for Birth, Adoption or Placement for Adoption Covered expenses under the Medical Plan can only be reimbursed effective from the date of the birth, adoption or placement for adoption of a child if Benefits Administration receives your Enrollment/ Change Form within 60 days. Retroactive increases to the HCFSA and DCFSA are only effective if received within 30 days of the date of the birth, adoption or placement for adoption. The plan year is the calendar year, January 1 through December 31.

13 12 You may only make changes to your elections through EDA (located on the ExxonMobil Me HR Intranet site) if they are made within 30 days after the event. Otherwise, you must contact Benefits Administration to obtain an enrollment form to make a change. Forms are also available from Benefits Administration for those individuals who do not have access to EDA. Effective Date of Change Your election is effective on a pre-tax basis on the actual date of the event only for births, adoptions, and placements for adoption if the election is received by Benefits Administration within 30 days of the event. With regard to all other events, your election is effective the first of the month following receipt of your election, but if the transaction is completed in EDA or the form is received by the Benefits Administration Office on the first day of a month, it is effective that day. Annual elections cannot be decreased to less than the amount already contributed at the time the election is received. Correcting Enrollment Mistakes If you have elected to participate in the DCFSA when you don't have any children under the age of 13, and your written request to revoke your election is received within the first 90 days after the effective date of the election, Benefits Administration may revoke your election if the supporting evidence clearly shows that the election was a mistake. If you discover any other enrollment/election mistake, it may be possible to allow a change, but only if (1) there is "clear and convincing evidence" that you made a mistake; (2) the mistake is of a type that can be corrected; and (3) the correction is appropriate. Notify Health Plan Services as soon as you realize that you made a mistake. If you fail to contact Health Plan Services during the first 90 days after the effective date of your election, you will need to submit an appeal to the Administrator- Benefits to have the correction considered by filing an appeal as described in the section on Claims and Appeals on page 27. Leaves of Absence and FSA During a paid leave you may continue to participate in the HCFSA. You would continue your monthly contributions, file claims and receive reimbursement for eligible expenses, subject to claim filing deadlines. However, during an unpaid Leave of Absence you may not continue to participate in the DCFSA. If you choose to continue participating in the HCFSA during an unpaid leave, you may continue to file claims and receive reimbursements for eligible expenses. Your contributions must be paid monthly on an after-tax basis during your leave or in a lump sum on a pre-tax basis (if taxable compensation is available) prior to beginning your leave. You may also choose to revoke your election and discontinue your participation in the Plan. If you revoke your election while on leave of absence, expenses you incur during the period of revocation will not be reimbursable from the Plan.

14 13 Leaves that last less than 30 days do not affect your eligibility to participate in either the HCFSA or the DCFSA and such a leave is not a change in status which permits changes. Once you return to work, contributions will be adjusted for the time you were absent. Upon return from a leave that lasts more than 30 days; if you return in the same calendar year, you will be reinstated to your prior coverage at a level reduced pro rata for the missed contributions. For example, assume that Maria elected $1,200 in health FSA coverage for the plan year and paid $100 per month for the coverage. On April 1, after submitting no claims for reimbursement, Maria begins a three-month leave. She does not elect to continue coverage. When Maria returns on July 1, she will have $900 reinstated ($1,200 minus $300 in missed contributions) at a cost of $100 per month for the remainder of the year. Expenses incurred during the period that the HCFSA was not in force are not eligible for reimbursement. Participation When Employment Ends When you leave ExxonMobil, your coverage under the Plan will end on the last day of the month following your termination or retirement date. Reimbursement from the HCFSA for expenses you incur after your termination or retirement is not permitted unless you are offered and elect COBRA coverage for the HCFSA. Health care expenses you incur prior to termination or retirement will be reimbursed up to the amount of your projected election for the year. Dependent care expenses you incur prior to termination or retirement will be reimbursed up to the amount you contributed. If you die as a participating employee, your surviving spouse, the executor or administrator of your estate or a court-appointed party may file claims for eligible expenses incurred before your death. Continuation Coverage (COBRA) Under COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985), you may be entitled to continue coverage in the HCFSA for the remainder of the year and to receive reimbursement for eligible expenses incurred following termination or retirement. You will be allowed to elect COBRA coverage only if the maximum amount available to you from the HCFSA for the remainder of the year is greater than or equal to your required contribution for the remainder of the year. During the period of COBRA coverage, you continue your contributions to the plan for the amount of your current election for the HCFSA plus a two percent administrative fee. Because you would no longer be receiving taxable pay from which your elected amount can be deducted, your contributions would be made on an after-tax basis. Please see the Continuation Coverage section on page 32 for more information.

15 About Pre-Tax Spending Eligibility and Enrollment Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage Health Care Flexible Spending Account Dependent Care Flexible Spending Account Claiming Reimbursement Tax Implications Continuation Coverage Administrative and ERISA Information Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage Q. Can I change or cancel my contribution election during the year? A. Unless you have a change in status as defined on page 5, you may not opt out of your pre-tax election during a plan year. However, you have the opportunity to opt out once a year during the annual enrollment period. Your new election takes effect the following January 1. You are enrolled to pay contributions for medical, dental and vision plan coverage on a pre-tax basis, which gives you two primary advantages: Under current tax law, you do not pay federal income taxes or Social Security taxes on the amount of these contributions. In most states, you also save on your state income taxes. Each year you are enrolled to pay your contributions for medical, dental and vision plan coverage on a pre-tax basis and your election remains in effect unless you cancel it during a subsequent enrollment period or due to a change in status. The amount of your pre-tax payroll deduction will increase or decrease to reflect the amount of your contributions for medical, dental and vision plan coverage at the beginning of each plan year and when your class of coverage changes. If you opt out of paying your contributions on a pre-tax basis, you will have to renew this election to pay on an after-tax basis each time you make a change on account of a change in status and each annual enrollment.

16 About Pre-Tax Spending Eligibility and Enrollment Pre-Tax Contributions for Medical, Dental and Vision Plan Coverage Health Care Flexible Spending Account - Dependents - Your Contributions - Availability of Funds - Eligible Expenses - Expenses Not Eligible for Reimbursement - Tax-Deductible vs. Tax-Free Dependent Care Flexible Spending Account Claiming Reimbursement Tax Implications Continuation Coverage Administrative and ERISA Information Health Care Flexible Spending Account Q. What is the advantage of using the Health Care Flexible Spending Account (HCFSA)? A. You save money as shown on pages by using pre-tax dollars for unreimbursed, out-of-pocket medical, dental and vision expenses. You cannot be reimbursed for amounts paid by any insurance provider or health care plan. Dependents You may claim reimbursement of eligible health care expenses for your family members even if they are not covered under ExxonMobil's medical, dental or vision plans. Your dependents for the purposes of the HCFSA include: Your spouse. Anyone whom you can claim as a dependent for income tax purposes. A child who would otherwise qualify but you cannot claim as a dependent for income tax purposes because you do not have custody. Your Contributions You may elect to contribute up to $2,500 to the HCFSA for the plan year. If you and your spouse both work for ExxonMobil: Each of you can enroll in this account up to the $2,500 limit a total of $5,000 for your family You may file claims as an employee or as a dependent of another employee participating in the Plan, but you may not be reimbursed for more than 100% of your out-of-pocket expenses. You can contribute up to $2,500 a year on a pre-tax basis. You may use your account for out-of-pocket expenses not covered or not fully reimbursed by any health plan.

17 16 Availability of Funds Although your election directs funds to this account on a monthly basis, your total projected plan year contributions are available to reimburse you for expenses incurred from the beginning of the plan year. Charges Spanning More than One Plan Year If doctors require payment in advance for services rendered during more than one plan year, ask them to specify the dates services were rendered and the charges for those services. With adequate documentation, you may be reimbursed for expenses incurred for services provided during the plan year. Orthodontia, however, is treated differently. Reimbursement is based on your treatment plan, not your payment schedule, even if you pay the total cost in advance. Orthodontia is unlike most other kinds of health care treatment because: It usually spans more than one plan year; and Frequently the length of treatment is different from the payment schedule. Initial Banding Fee Reimbursement: Depending upon available FSA funds and amounts paid by the dental plan, if you pay orthodontic charges in full on the date of banding, you will receive up to 25% of the allowed amount as an initial banding fee reimbursement. If you make an initial banding fee payment (down payment), you will be reimbursed up to the total amount paid. If no banding fee is indicated on the claim or you did not make an initial banding fee payment, you will be reimbursed up to 25% of the allowed amount. Contact Aetna when estimating your annual orthodontia election. Eligible Expenses Only qualified medical expenses for services while you are a participant are eligible for reimbursement. These expenses include your deductible, co-payments and other outof-pocket expenses under your group health plans. The calendar year in which a qualified medical expense may be reimbursed under the HCFSA is determined by when the expense is incurred not when you pay the expense. This is consistent with the ExxonMobil Medical Plan and ExxonMobil Dental Plan. The following are covered expenses: Services provided by: Acupuncturist. Advanced clinical practitioners (an advanced practical registered nurse or a nurse practitioner with a master's degree). Audiologists. Certified social workers. Chiropractors. Christian Scientist practitioners. Dentists. Doctors of medicine. Guides for a blind person. Nurses. Optometrists or opticians. Osteopaths. Physical and occupational therapists. Podiatrists. Psychologists.

18 17 Speech language therapists. Medical and dental treatment or services: Abortion. Acupuncture. Ambulance services. Artificial insemination. Artificial limbs. Artificial teeth. Braille books and magazines. Chemical dependency treatment centers. Diathermy (electromagnetic heat therapy). Drug addiction treatment. Fees for special homes for the mentally challenged. Fertility enhancement. Healing services. Hydrotherapy. Medical care in a nursing home. Note: Custodial care is not reimbursable. Mental health services. Nursing care for medical services only. Note: This excludes the care of a healthy person. It includes medical care for an elderly person unable to move about or a person subject to dizziness or seizures. It also includes board and wages for a nurse, including Social Security taxes you pay on the wages. Orthodontic appliances and services (see page 16, Orthodontia). Oxygen and oxygen equipment. Physical, occupational or speech therapy. Radial keratotomy, laser or similar surgery to correct vision. Routine eye examinations. Sterilization. Temporomandibular joint (TMJ/TMD) disorder. Transplants. Weight loss programs, when accompanied by a physician's statement documenting the medical necessity for the treatment of a specific disease and not for general health.

19 18 Equipment and supplies: Canes or other walking supports. Diabetic supplies including those purchased over the counter. Eyeglasses and contact lenses and supplies. Hearing aids, hearing aid batteries and equipment for the hearing impaired, such as closed captioned devices and special telephone equipment. Medications available by prescription only and prescribed by a physician, including birth control pills and devices, allergy medications, vitamins and mineral supplements if prescribed for a particular medical condition which cannot be available as an over-the-counter medication. Prescription orthopedic footwear, including arch supports and inlays. Guide dogs. Special hand controls and other equipment installed in a car in order for a disabled person to operate a car. Special equipment, furniture or fixtures in your home, including installation, primarily to provide medical care for you or an eligible family member living in your home. If the improvement increases the value of your home, only the portion of the cost in excess of the increased value may be reimbursed. Wheelchairs, wheelchair lifts and their installation. Wigs and false eyelashes when natural hair is lost as the result of a disease. Special schools and lessons: Cardiac rehabilitation classes. Charges by special schools to teach Braille to a blind child, signing/lip reading to a deaf or hearing impaired child, remedial language training to correct conditions caused by birth defects, remedial reading for children suffering from dyslexia, and speech therapy. Job placement classes for handicapped family members. Smoking cessation programs and prescription drugs to alleviate nicotine withdrawal symptoms. Tuition and fees for special schools, if recommended by your doctor, for a child with severe learning disabilities. Travel: Transportation expenses to and from a school recommended by a doctor as a medical treatment. Transportation, including air fare, when medically necessary for a spouse to accompany a spouse or one parent to accompany a child requiring surgery or medical treatment. Travel expenses incurred en route to medical treatment sites, including transportation (either the actual cost or, if unsubstantiated, up to IRS limits).

20 19 Miscellaneous: COBRA costs for children under any plan to which ExxonMobil contributes. Capital improvements to your home to help the delivery of medical care. If the improvements increase the value of your home, only the portion of cost in excess of the increased value may be reimbursed. Charges exceeding annual or lifetime maximums paid by a health care plan. Fees paid to health institutes for physician prescribed exercises, rubdowns and similar treatments designed to alleviate a physical or mental defect or illness. Halfway house residency. Lead based paint removal. Legal fees necessary to treat mental illness. Meals and lodging provided with medical care at a hospital or similar institution. Non-professional administration of patterning exercises. Medical care items other than over the counter drugs and medications: Braces and supports. Diabetic supplies and equipment. Ear care products. Eye care products. Eye drops and eye wash products. Feminine care. First aid supplies. Home diagnostic tests or kits. Hot and cold packs. Incontinence products. Joint-support bandages and hosiery. Vaporizers and humidifiers. Be sure to budget carefully because any unused amounts must be forfeited. For more details about eligible and ineligible expenses, you may call Aetna Member Services to ask about specific expenses.