ExxonMobil Employee Health Advisory Program. Summary Plan Description

Transcription

1 ExxonMobil Employee Health Advisory Program Summary Plan Description 201

2 About the Employee Health Advisory Program - How to Get the Care You Need - Information Sources - Introduction - Plan at a Glance Eligibility and Enrollment How the Plan Works Continuation Coverage Administrative and ERISA Information Key Terms ExxonMobil EHAP SPD As of January 2015 About EHAP This summary plan description (SPD) of the ExxonMobil Employee Health Advisory Program (EHAP) does not contain all the plan details. In determining your specific benefits, the full provisions of the EHAP plan document, 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. Grandfathered Plan Intent ExxonMobil Corporation believes that EHAP is a "grandfathered health plan" under the Patient Protection and Affordable Care Act (PPACA). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect on March 23, Notice: EHAP is an excepted benefit under 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. Questions regarding which protections apply to the EHAP and what might cause the EHAP to change from grandfathered health plan status can be directed to the Plan Administrator at Administrator-Benefits, P.O. Box 2283, Houston, Texas You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at or This website has a table summarizing which protections do and do not apply to grandfathered health plans. How to Get the Care You Need If you or an eligible family member needs help dealing with a mental health or substance abuse problem or other personal issues, follow these steps to get the care needed: Step 1: Call Magellan Behavioral Health (Magellan) at and select the appropriate option to get the name of an EHAP counselor who can help you. An EHAP consultant -- a licensed counselor -- will ask you questions so that he or she can assess your situation. Then, the EHAP consultant will give you the names and telephone numbers of EHAP counselors in your area who are part of the Magellan network.

3 2 Step 2: Call the EHAP counselor to make an appointment. Mention that you're a member of the Plan. After you have made your appointment, call Magellan to confirm which EHAP counselor you have chosen. Step 3: Go to your appointment. You don't have to file a claim form. (If you need inpatient care or longer term treatment, your EHAP counselor, or EHAP consultant, will make arrangements for you and tell you what you need to do.) EHAP professional counselors are located away from your workplace location, and Magellan does not reveal to the company the names of or reasons for individuals seeking EHAP assistance. You may also select an EHAP provider through the online self-referral process at To use the online self-referral process: 1. Enter the URL and sign in with your user name and password (or follow the instructions for creating a user name and password) 2. Follow the online directions. 3. Under "Online EHAP Referral" select "EAP Self Referral" 4. Follow the online directions. At your request, Magellan will send you a hard copy of the directory information; contact Magellan at If there are no network EHAP counselors near your home, Magellan will locate a qualified provider for you. Information Sources Care Manager Arranges for and provides counseling services. Phone Numbers: Magellan Behavioral Health (if international, call collect) 24 hours a day, seven days a week Address: Magellan Behavioral Health Magellan Plaza Drive Maryland Heights MO Check Magellan's Web site at 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: (user ID and password not necessary) At this point, you may register or continue as unregistered Benefits Administration Provides plan-related information. Phone Numbers: (toll free outside Houston) Monday - Friday 8:00 a.m. to 3:00 p.m. (U.S. Central Time), except certain holidays Address: Benefits Administration ExxonMobil BA BSC USBA 4300 Dacoma or "BH1" Houston, Texas ExxonMobil Sponsored Sites Provides employees and their family members access to plan-related information. 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 by everyone at

4 3 Introduction EHAP Services The ExxonMobil Employee Health Advisory Program (EHAP) offers professional counseling in a confidential environment for personal problems requiring limited intervention and referral services for more complicated problems. You may call the service at any time, for any reason. Reasons for seeking assistance are as varied as the individuals calling. Some of the types of problems for which you may seek help include: Crisis in the family, such as balancing career and family responsibilities, stress, relocation issues, divorce or separation, problems with children at school, serious illness, family violence, child abuse, problems with the legal system, death, or being a victim of crime. Ongoing problems, such as chemical dependency, anxiety, depression, family conflict, job dissatisfaction and single parent responsibilities. Referral services to resources in your community that can help you find home health care, nursing homes, legal services, consumer credit and financial information are also available through Magellan's Life Assistance Resources. Coverage is automatic for eligible employees and their eligible family members. The company currently pays the full cost of this Plan. EHAP is described in this SPD. These tools help you find specific information quickly and easily. Information Sources, places where you can get more information. Plan at a Glance, highlighting plan basics. A list of Key Terms containing definitions of some words and terms used in this SPD. A careful review of this SPD will help you understand how the Plan works so you can make the best use of it. You may obtain additional information through the sources shown on page 2.

5 4 Plan at a Glance Eligibility and Enrollment You do not need to enroll coverage begins for you and your eligible family members as soon as you meet the eligibility requirements regardless of enrollment in the ExxonMobil Medical Plan. See page 5. How the Plan Works This Plan helps pay for family counseling, and counseling to help you with relationships and developmental or other personal issues. Benefits are paid for outpatient counseling for you and your eligible family members. You can call Magellan for a referral to an EHAP counselor. See page 7. If you are not enrolled in the ExxonMobil Medical Plan, because of EHAP, you will have access to a limited amount of benefits even though you are not enrolled in that plan. The Plan provides counseling and referral services for many types of personal problems, including mental health, chemical dependency and work/family issues. Services are arranged for and provided through Magellan. See page 8. Administrative and ERISA Information This Plan is subject to rules of the federal government, including the Employee Retirement Income Security Act (ERISA), not state insurance laws. You and your family members who lose eligibility may continue EHAP coverage for a limited time in certain circumstances. See page 15. 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 page 22.

6 About the Employee Health Advisory Program Eligibility and Enrollment Eligibility and Enrollment - Eligible Family Members - When Coverage Begins - When Coverage Ends How the Plan Works Continuation Coverage Administrative and ERISA Information Key Terms Q. What are the Plan s eligibility requirements? A. Most U.S. dollar-paid employees of Exxon Mobil Corporation and participating affiliates are eligible for EHAP. See eligible employees on page 21 of the Key Terms section. Your eligible family members may also participate. Coverage is automatic; you do not enroll. Generally, you are eligible if: You are a regular employee. You are an extended part-time employee. You are characterized as a trainee as described in the Key Terms section. You are an expatriate employee inbound to the United States (including service-oriented employees employed by non-u.s., non-participating employers who are temporarily working in the United States). Eligible Family Members Your eligible family members include: Your spouse. Your child(ren) under age 26. Coverage ends at the end of the month in which they reach age 26. If your situation involves a family member other than your biological or legally adopted child, call Benefits Administration. Your totally and continuously disabled child(ren) who is incapable of selfsustaining employment by reason of mental or physical disability, that occurred prior to otherwise losing eligibility and meets the Internal Revenue Service's definition of a dependent. A person who otherwise is not a spouse but who as a dependent of a former Mobil employee who participated in or received benefits under a Mobil-sponsored plan or program prior to March 1, 2000, is considered an eligible dependent as long as that person's eligibility for coverage as a dependent under a Mobil-sponsored plan would have continued. Refer to Key Terms for definitions of eligible family members, child, spouse and Qualified Medical Child Support Order.

7 When Coverage Begins 6 Generally, your coverage begins on your first day of employment. Family members are covered on the later of the date you begin employment or the date your family member meets the eligibility requirements. When Coverage Ends Coverage for you and/or your family members ends on the earliest of the following dates: The last day of the month in which: You terminate employment or are no longer classified as a regular employee of a participating employer. Your employment is deemed to continue for purposes of this Plan until the end of the period during which you are: Absent due to a leave of absence approved by your employer or Receiving short-term disability benefits under a disability income plan sponsored by the company. The date your family member ceases to be eligible. The date: You (as a covered employee or family member) are no longer eligible for benefits under this Plan. Your employer discontinues participation in the Plan. Your family member begins active duty in the armed forces of any country, state or international organization, or becomes a member of any civilian force auxiliary to any military force. The Plan is terminated. A Qualified Medical Child Support Order is no longer in effect for a covered family member. A family member under a Qualified Medical Child Support Order becomes eligible for benefits under another plan providing benefits similar to this Plan. Extended Benefits at Termination You are entitled to extended coverage for as much as a year if you are terminated due to disability with fewer than 15 years of service. This coverage is provided at no cost to you. This is considered a portion of the COBRA continuation period. In order to assure coverage beyond this extension period, you must elect COBRA upon termination of employment. Several conditions must be met: The disability must exist when your employment terminates. The extension lasts only as long as the disability continues, but no longer than 12 months. This extension applies only to the employee who is terminated because of a disability. Continuation coverage for eligible family members may be available through COBRA.

8 About the Employee Health Advisory Program Eligibility and Enrollment How the Plan Works - Private and Confidential - Professional Counselors - No Charge for EHAP Services - After-Care Counseling Continuation Coverage Administrative and ERISA Information Key Terms How the Plan Works Q. What are the benefits of the Plan? A. The Plan provides counseling visits and referral services as described in this section. Up to eight counseling visits may be provided at no cost to you, as clinically appropriate. All counseling services are arranged by and provided through Magellan, the Care Manager for this Plan. Private and Confidential EHAP professional counselors are located away from your workplace location, and Magellan does not reveal to the company the names of or reasons for individuals seeking EHAP assistance. Unless your supervisor identifies and discusses with you a situation where EHAP benefits would be beneficial, you tell others, or the law requires disclosure, no one at the company will know that you are using the program. In situations involving real or potential harm to individuals (for example, child abuse cases or direct threats of violence against a person), laws require that certain notifications be made. EHAP counselors will comply with these laws and disclose required information. Professional Counselors Magellan makes available the counseling and referral services offered by EHAP through a network of contracted EHAP counselors. Counselors include trained psychologists, family and marriage counselors, social workers and therapists who specialize in resolving personal problems.

9 8 No Charge for EHAP Services Many problems can be resolved in just a few visits with an experienced counselor. EHAP may provide you or your eligible family members with up to eight visits in a calendar year for each problem. If you need more counseling visits than are provided under EHAP - or if you need services that are not provided by EHAP - the EHAP counselor will refer you to outside services which may be a covered service under your medical plan. If the EHAP counselor determines that more intense services are needed, you may be immediately referred to an appropriate mental health provider. The cost of the additional or outside services is not covered under EHAP but may be partly covered by your medical plan; refer to the summary of benefits and coverage (SBC) for your medical plan or contact Benefits Administration (see Information Sources at the front of this SPD) for information. After-Care Counseling Services The Plan also provides chemical dependency support, counseling and monitoring services for eligible employees who are actively at work following primary treatment for chemical dependency. Magellan determines the extent to which after-care counseling services are available to employees under this Plan.

10 About the Employee Health Advisory Program Eligibility and Enrollment How the Plan Works Continuation Coverage - Continuation Coverage Rights under COBRA - What is COBRA Coverage? Administrative and ERISA Information Key Terms Continuation Coverage Q. Can coverage be continued after eligibility in this Plan ends? A. Yes. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) entitles you and your covered family members to extend EHAP benefits beyond the date your coverage would normally end. Continuation Coverage Rights under COBRA This section contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan under certain circumstances when coverage would otherwise end. This section generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. The right to COBRA coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to your spouse and children, if they are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review this SPD or contact Benefits Administration at the telephone numbers or address listed under Information Sources at the front of this SPD. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally doesn't accept late enrollees. What is COBRA Coverage? COBRA coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later in this section. If a specific qualifying event occurs and any required notice of that event is properly provided to Benefits Administration, COBRA coverage must be offered to each person losing coverage who is a "qualified beneficiary." You, your spouse, and your children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Certain newborns, newly adopted children, and alternate recipients under QMCSOs may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below. Under the Plan, qualified beneficiaries who elect COBRA coverage may be required to pay the entire cost for COBRA coverage.

11 10 Who is entitled to elect COBRA? If you are an employee, you will be entitled to elect COBRA, if you lose your coverage under the Plan because either one of the following qualifying events happen: Your hours of employment are reduced; or Your employment ends for any reason other than your gross misconduct. If you are the spouse of an employee, you will be entitled to elect COBRA if you lose coverage under the Plan because any of the following qualifying events happen: Your spouse dies; Your spouse's hours of employment are reduced; Your spouse's employment ends for any reason other than his or her gross misconduct; You become divorced from your spouse. Also, if your spouse (the employee) reduces or eliminates your group health coverage in anticipation of a divorce, and a divorce later occurs, then the divorce may be considered a qualifying event for you even though your coverage was reduced or eliminated before the divorce. A person enrolled as the employee's child will be entitled to elect COBRA if he or she loses coverage under the Plan because any of the following qualifying events happen: The parent-employee or parent-retiree dies; The parent-employee's hours of employment are reduced; The parent-employee's employment ends for any reason other than his or her gross misconduct; The child stops being eligible for coverage under the Plan as a child. When is COBRA Coverage Available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after Benefits Administration has been notified that a qualifying event has occurred. Employer Gives Notice of Some Qualifying Events When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, the employer must notify Benefits Administration of the qualifying event. You Must Give Notice of Some Qualifying Events For the other qualifying events (divorce or a child losing eligibility), a COBRA election will be available to you only if you notify and provide the appropriate forms to Benefits Administration within 60 days after the later of (1) the date of the qualifying event or (2) the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the qualifying event. In providing this notice, you must notify the correct Benefits Administration entity based on your status and follow the procedures outlined in the next section. If these procedures are not followed or if the wrong entity is notified during the 60-day notice period, THEN ALL QUALIFIED BENEFICIARIES WILL LOSE THEIR RIGHT TO ELECT COBRA. Notice Procedures for Qualifying Events Notices of qualifying events from current employees must be made by logging onto Employee Direct Access (EDA) located on the ExxonMobil Me HR Intranet site. Forms are also available from ExxonMobil Benefits Administration/ Health Plan Services for those individuals who do not have access to EDA. Notices of these qualifying events from retirees and survivors must be made via the ExxonMobil Benefits Web or by calling the ExxonMobil Benefits Service Center. Notice is not effective until either EDA or the ExxonMobil Benefits Web change is made or the properly completed form is received.

12 11 Election of COBRA Each qualified beneficiary will have an independent right to elect COBRA. Covered employees and spouses (if the spouse is a qualified beneficiary) may elect COBRA on behalf of all qualified beneficiaries, and parents may elect COBRA on behalf of their children. Any qualified beneficiary for whom COBRA is not elected within the 60- day election period specified in the Plan s COBRA election notice WILL LOSE HIS OR HER RIGHT TO ELECT COBRA. How long does COBRA coverage last? COBRA coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the covered employee s divorce or a child's losing eligibility as a child, COBRA coverage under the Health Advisory Program can last for up to a total of 36 months. When the qualifying event is the end of employment or the reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA coverage under the Health Advisory Program for qualified beneficiaries (other than the employee) who lose coverage as a result of the qualifying event can last until up to 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA coverage for his spouse and children who lost coverage as a result of his termination can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). This COBRA coverage period is available only if the covered employee becomes entitled to Medicare within 18 months BEFORE termination or reduction of hours. Otherwise, when the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA coverage under the Health Advisory Program generally can last for only up to a total of 18 months. The COBRA coverage periods described above are maximum coverage periods. COBRA coverage can end before the end of the maximum coverage periods described in this notice for several reasons. There are two ways (described in the following paragraphs) in which the period of COBRA coverage resulting from a termination of employment or reduction of hours can be extended. Disability Extension of COBRA Coverage If a qualified beneficiary is determined by the Social Security Administration to be disabled and you notify the correct Benefits Administration entity, in a timely fashion, all of your qualified beneficiaries in your family may be entitled to receive up to an additional 11 months of COBRA coverage, for a total maximum of 29 months. This extension is available only for qualified beneficiaries who are receiving COBRA coverage because of a qualifying event that was the covered employee s termination of employment or reduction of hours. The disability must have started at some time before the 61st day after the covered employee s termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above). The disability extension is only available if you notify Benefits Administration in writing of the Social Security Administration s determination of disability within 60 days after the latest of: The date of the Social Security Administration s disability determination The date of the covered employee s termination or reduction of hours; and The date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee s termination of employment or reduction of hours.

13 12 You must also provide this notice within 18 months after the covered employee s termination of employment or reduction of hours in order to be entitled to a disability extension, and you must notify the correct Benefits Administration entity at least 30 days before the end of the 18-month period. See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60-day notice period and within 18 months after the covered employee s termination of employment or reduction of hours, THEN THERE WILL BE NO DISABILITY EXTENSION OF COBRA COVERAGE. Second qualifying event extension of COBRA coverage If your family experiences another qualifying event while receiving COBRA coverage as a result of the covered employee s termination of employment or reduction of hours (including COBRA coverage during a disability extension as described above), the covered spouse and children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the correct Benefits Administration entity. This extension may be available to the spouse and any children receiving COBRA coverage if the employee or former employee dies, gets divorced, or if the child stops being eligible under the Plan. This extension is not available under the Plan when a covered employee becomes entitled to Medicare after his or her termination of employment or reduction of hours. This extension due to a second qualifying event is available only if you notify the correct Benefits Administration entity within 60 days of the date of the second qualifying event. See the last page of this notice for the listing of Benefits Administration entities. If these procedures are not followed or if the notice to the correct Benefits Administration entity is not provided during the 60 day notice period and within 18 months after the covered employee s termination of employment or reduction of hours, THEN THERE WILL BE NO EXTENSION OF COBRA COVERAGE. Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse s plan) through what is called a special enrollment period. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at More Information About Individuals Who May Be Qualified Beneficiaries Children born to or placed for adoption with the covered employee during COBRA coverage period A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is considered to be a qualified beneficiary provided that, if the covered employee is a qualified beneficiary, the covered employee has elected COBRA coverage for himself or herself. The child's COBRA coverage begins when the child is enrolled in the Plan, whether through special enrollment or open enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the Plan, the child must satisfy the otherwiseapplicable Plan eligibility requirements (for example, regarding age). Alternate recipients under QMCSOs A child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order (QMCSO) received by Exxon Mobil Corporation during the covered employee's period of employment with Exxon Mobil Corporation is entitled to the same rights to elect COBRA as an eligible child of the covered employee. Cost of COBRA Coverage A person who elects continuation coverage may be required to pay the group rate premium for continuation coverage plus a 2% administration fee, if applicable, or 102% of cost to the plan to maintain the coverage, unless the person is entitled to extended coverage due to disability. If the person becomes entitled to such extended coverage, the person may be required to contribute up to 150% of contributions after the initial 18-month's coverage until coverage ends. A person who elects continuation coverage must pay the required contributions within 45 days from the date coverage is elected retroactively to the date benefits terminated under the Plan.

14 13 If You Have Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administration (EBSA) in your area or visit (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) For more information about the Marketplace, visit Keep Your Plan Informed of Address Changes In order to protect your family's rights; you should keep Benefits Administration informed of any changes in your addresses as well as the addresses of family members. You should also keep a copy, for your records, of any notices you send to Benefits Administration. Determination of Benefits Administration Entity to Contact: IMPORTANT - "Benefits Administration" references throughout this notice change depending on your status. Unless specifically stated otherwise, you should refer to the correct Benefits Administration entity using the list below. If your status is not listed, call ExxonMobil Benefits Administration/Health Plan Services for assistance. Current ExxonMobil and XTO Employees or their covered family members should use EDA or contact ExxonMobil Benefits Administration/ Health Plan Services; Exxon, ExxonMobil, Mobil, XTO or Superior Oil Retirees, or their Survivors, or their covered family members contact ExxonMobil Benefits Service Center; and Former Exxon, Exxon Mobil or XTO Employees and Exxon and ExxonMobil Retirees (who retired before October 1, 2005) and their Survivors or covered family members, who have elected and are participating through COBRA, contact ExxonMobil COBRA Administration. The following sets out the contact numbers based on your status under the ExxonMobil Medical Plan. Failure to notify the correct entity could result in your loss of COBRA rights. If your status is not listed, call ExxonMobil Benefits Administration/Health Plan Services for assistance.

15 14 Plan Contact Information Phone Numbers: Employees and their covered family members: ExxonMobil Benefits Administration/Health Plan Services Monday - Friday except certain holidays 8:00 a.m. to 3:00 p.m. (U.S. Central Time) (toll free outside Houston) Retirees, their survivors and covered family members: ExxonMobil Benefits Service Center Monday Friday except certain holidays 8:00 a.m. to 6:00 p.m. (U.S. Eastern Time) (toll free) 800-TDD-TDD4 ( ) for the hearing impaired Address: ExxonMobil Benefits Administration ATTN: Health Plan Services ExxonMobil BA BSC USBA 4300 Dacoma BH-1 Houston, TX ExxonMobil Benefits Service Center P.O. Box 1014 Totowa, NJ Former employees and retirees (who retired before October 1, 2005), their survivors and family members who have elected and are participating through COBRA: ExxonMobil COBRA Administration Monday - Friday except certain holidays 8:00 a.m. to 7:00 p.m. (U.S. Central Time) Benefits Continuation Services, Dept. 166 ADP National Accounts Services ExxonMobil (800) (toll free) COBRA Administration P O Box 2968 Alpharetta, GA Fax: (770)

16 About the Employee Health Advisory Program Eligibility and Enrollment How the Plan Works Continuation Coverage Administrative and ERISA Information - Basic Plan Information - Benefit Claims - Denied Claims - Filing a Mandatory Appeal - Legal Actions - No Implied Promises - Future of the ExxonMobil Employee Health Advisory Program - Your Rights Under ERISA Key Terms Administrative and ERISA Information Q. What other information do I need to know about the Plan? A. This section contains technical information about the Plan and identifies its administrator. It also contains a summary of your rights with respect to the Plan and instructions about how you can submit an appeal if your claim for benefits is denied. The formal name of the Plan is the ExxonMobil Employee Health Advisory Program. Plan Sponsor and Participating Affiliates The ExxonMobil Employee Health Advisory Program is sponsored by: Exxon Mobil Corporation 5959 Las Colinas Boulevard Irving, Texas All of Exxon Mobil Corporation's divisions and most of the major U.S. affiliates participate in the ExxonMobil Health Advisory Program. A complete list of participating affiliates is available from the Administrator-Benefits upon written request. Certain employees covered by collective bargaining agreements do not participate in the Plan. Basic Plan Information Plan Administrator The Plan Administrator for the ExxonMobil Health Advisory Program is the Administrator-Benefits. The Administrator-Benefits is the Manager-Global Benefits Design, Exxon Mobil Corporation. You may contact the Administrator-Benefits at the following address. Legal process may be served upon the Administrator-Benefits c/o Exxon Mobil Corporation by serving the Corporation's Registered Agent for Service of Process, Corporation Service Company (CSC). Administrator-Benefits ExxonMobil Medical Plan P.O. Box 2283 Houston, Texas For service of legal process: Corporation Service Co. 211 East 7 th Street, Suite 620 Austin, Texas

17 16 Authority of Administrator-Benefits The Administrator-Benefits (and those to whom the Administrator-Benefits has delegated authority) has the full and final discretionary authority to determine eligibility for benefits, to construe and interpret the terms of the Employee Health Advisory Program in its application to any participant or beneficiary, and to decide any and all claim appeals. Claims Fiduciary and Appeals The Claims Fiduciary is the person to whom all appeals are filed. For the ExxonMobil Employee Health Advisory Program, the Claims Fiduciary is the Care Manager, Magellan Behavioral Health. The Care Manager will decide all appeals for denied benefits. File any appeals with: Magellan Behavioral Health P.O. Box 2128 Maryland Heights MO Type of Plan The ExxonMobil Employee Health Advisory Program is a welfare plan under ERISA providing professional counseling for personal problems requiring limited intervention and referral services for more complicated problems. Plan Numbers The ExxonMobil Employee Health Advisory Program is identified with government agencies under two numbers: the Employer Identification Number and the Plan Number 609. Plan Year The Plan year is the calendar year, January 1 through December 31. Plan Funding Benefits are funded through employer contributions. Benefit Claims Magellan will generally make a determination on your request for EHAP services and inform you of its determination in your initial telephone call to request services. If Magellan cannot decide while on the initial call, Magellan will decide within five (5) calendar days of your request for services or of notice to Magellan of a circumstance that affects the availability of further EHAP services. Magellan will inform you by telephone of its determination within one (1) business day after it decides. If you consent to written notice, Magellan will send you written notice of its determination within one business day of the telephonic notice. If you are receiving an ongoing course of EHAP counseling, Magellan will notify you in advance if it intends to terminate or reduce the number of EHAP sessions that can be provided so that you will have an opportunity to appeal the decision before the termination or reduction takes effect. If Magellan determines that you need Urgent Care, Magellan will provide telephonic crisis counseling and make an appropriate referral to your benefit plan and/or emergency resources in the community.

18 17 Because Magellan pays all EHAP providers directly, you should not make any payment to a provider for EHAP services. In the event that you mistakenly pay a provider for EHAP services, Magellan will make a determination on your request for reimbursement within 15 days after receipt of the Claim (if EHAP services have not yet been received) or with 30 days after receipt of the Claim (if the EHAP services have already been received). Magellan will notify you of its determination telephonically, and, if you consent to written notice, in writing, within the 15 day or 30 day period, as applicable. To use EHAP, call Magellan toll free. You do not pay for or file claim forms for your EHAP counseling sessions. If you require additional services beyond that provided by EHAP, those services may be provided under your medical plan. If you have a problem with a plan benefit, contact Magellan. The Care Manager is responsible for determining and informing you of your entitlement to a benefit. The following categories of claims for benefits apply to the ExxonMobil Employee Health Advisory Program, and according to the type of claim submitted, Magellan will review your claim and respond within a designated response time. If Magellan needs additional time (an extension) to decide on your claim because of special circumstances, you will be notified within the claim response period. Urgent care means care needed to avoid serious jeopardy to your life or health or to regain maximum function (or required to avoid severe pain), as determined by Magellan or your treating physician. Magellan does not make Claim determinations relating to Urgent Care. Pre-Service claims are any claims for benefits where the Plan provisions require approval before care is obtained. Post-service claims are claims made after care is received and apply to claims under the ExxonMobil Employee Health Advisory Program. Type of Claim Urgent claims Pre-service claims Post-service claims Response time Not applicable Extension 15 days An additional 15 days. However, if an extension is necessary due to incomplete information, you must provide the additional information within 45 days from the date of receipt of the extension notice. 30 days An additional 15 days. However, if an extension is necessary due to incomplete information, you must provide the additional information within 45 days from the date of receipt of the extension notice.

19 18 Denied Claims If your claim for benefits is denied completely or partially, and you authorize written communication to you, Magellan will provide written notice to you, your beneficiary, or designated representative. The notice will describe: The specific reason(s) for the denial for the denial decision, Identify Plan provisions on which the decision is based; Describe any additional material or information necessary for an appeal review and an explanation of why it is necessary; Explain the review procedure, including time limits for appealing the decision and to sue in federal court; Identify your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol or similar criterion relied on in making the decision; Identify your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EHAP services are not clinically appropriate). If you do not authorize written notice, Magellan will furnish this information to you or your Authorized Representative by telephone. Filing a Mandatory Appeal If you believe your Claim for EHAP benefits was denied in error, you may appeal the decision. Your appeal must be submitted in writing to Magellan within 180 days following your receipt of a denial notice. Your appeal should state the reasons why you feel your Claim for EHAP benefits is valid and include any additional documentation that you feel supports your Claim for EHAP benefits. You can also include any additional questions or comments. You may submit written comments, documents, records and other information relating to your appeal, whether or not the comments, documents, records or information were submitted in connection with the initial Claim for EHAP benefits. On your request, Magellan will make relevant documents available to you. The review of the initial decision will consider all new information, whether or not it was presented or available for the initial decision. The person who conducts the appeal review will be different from the person(s) who originally denied your Claim for EHAP benefits and will not report directly to the original decision maker or prior reviewer. You or your Authorized Representative will be notified of the appeal decision within the following time frames: If the case involves an adverse determination on a request for EHAP services or a pre-service adverse determination relating to reimbursement, within thirty (30) days of Magellan's receipt of the request for appeal; If the case involves a post-service adverse determination relating to reimbursement, within sixty (60) days of Magellan's receipt of the request for appeal.

20 19 If Magellan needs additional time to decide on your claim because of special circumstances, you will be notified within the claim response period. However, an extension may be requested, but the law stipulates that no additional time will be allowed. If you authorize written communication, Magellan will give you or your Authorized Representative the decision on the appeal in writing. If the denial is upheld on appeal, the notice will set forth: The specific reason(s) for the denial and the Plan provisions upon which the denial is based. A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to the claim. Notice of your right to receive, free of charge, upon your request, any internal rule, guidelines, protocol or similar criterion relied on in making the decision. Notice of your right to receive, free of charge, upon your request, an explanation of the clinical judgment on which the decision is based (if the denial is based on exclusion of experimental treatment services or because EHAP services are not clinically appropriate). A statement of your right to bring an action under section 502(a) of the Employee Retirement Income Security Act (ERISA). If you do not authorize written notification, Magellan will furnish this information to you or your Authorized Representative by telephone. If you do not agree with the final decision of Magellan, you may bring a lawsuit in federal district court within one year of the final decision. You cannot bring legal action unless your Claim has been reviewed and denied by Magellan. Legal Actions No action at law or in equity to recover benefits under the Plan shall be brought unless the mandatory appeal process has been completed. In any event, no such action shall be brought after the expiration of one year from the time an appeal is decided by Magellan. No Implied Promises Nothing in the ExxonMobil Employee Health Advisory Program gives you a right to remain in employment or affects ExxonMobil s right to terminate your employment at any time and for any reason (which is hereby reserved).