About the Employee Medical Plan
This summary plan description (SPD) summarizes the ExxonMobil Medical Plan (the Plan) Point of Service POS II A and B options. It does not contain all Plan details. In determining your specific benefits, the full provisions of the formal plan documents, as they exist now or as they may exist in the future, always govern. You may obtain copies of these documents by making a written request to the Administrator-Benefits. ExxonMobil reserves the right to change benefits in any way or terminate the Plan at any time. These options are governed by federal laws, not by state insurance laws.
Both POS II options are self-funded. There is no insurance company to collect premiums or underwrite coverage. Instead, contributions from you and ExxonMobil pay all benefits. Prior claims experience and forecasted expenses are used to determine the amount of money needed to pay future benefits.
Applicability to represented employees is governed by collective bargaining agreements and any local bargaining requirements.
Tips for new plan participants
- Keep this guide where you can easily refer to it.
- Keep your ID card(s) in your wallet.
- Emergencies are covered anytime, anywhere, 24 hours a day. See In case of medical emergency for emergency care guidelines.
When you need information, you may contact one or more of the following sources. Please read carefully:
For claims administration:
Contact Aetna for medical/surgical and behavioral health and substance abuse claims forms, claims payment, and other claims inquiries.
Contact Express Scripts for pharmacy claims forms, claims payment, and other claims inquiries.
For benefits information:
Contact Aetna for medical/surgical benefits information, including clinical guidelines, benefits predeterminations, and providers participating in the Aetna Choice POS II network. Aetna also provides hospital precertification review for inpatient medical services as well as for certain other medical services, tests, and equipment. Ask to speak to a health advocate nurse for ongoing consultation and referral services.
Contact Magellan for behavioral health and substance abuse benefits information, including clinical guidelines, benefits predeterminations, and providers participating in the Magellan Health Preferred Provider (MHPPO) network. Magellan also provides hospital precertification review for inpatient behavioral health and substance abuse services as well as for certain other behavioral health and substance abuse services, tests, and equipment. Ask to speak to a behavioral health advocate for ongoing consultation and referral services.
Contact Express Scripts for pharmacy benefits information, including clinical guidelines, benefits predeterminations, and providers participating in the Express Scripts pharmacy network. Express Scripts also provides precertification review for certain pharmacy services, medications, and equipment. Ask to speak to a Therapeutic Resource Center (TRC) pharmacist for ongoing consultation and referral services.
For benefits administration:
References to Benefits Administration throughout this SPD pertain to the ExxonMobil Benefits Service Center. Contact the Benefits Administration for benefits administration information, including enrollment and eligibility inquiries.Phone numbers and addresses:
Aetna Member Services
210-366-2416 (if international, call collect)
Monday – Friday 8:00 a.m. to 6:00 p.m.
(U.S. Central Time), except certain holidays
Automated Voice Response - 24 hours a day, 7 days a week
P. O. Box 981106
El Paso, TX 79998-1106
To visit Aetna’s website: www.aetna.com
314-387-4700 (international, call collect)
24 hours a day, 7 days a week
14100 Magellan Plaza Drive
Maryland Heights, MO 63043
To visit Magellan’s website: https://magellanascend.com/ (enter 800-442-4123)
800-497-4641 (international, use appropriate country access code depending on country from which you are calling)
Express Scripts Home Delivery
P.O. Box 66577
St. Louis, MO 63166-65777
Direct Reimbursement Claim Form:
ATTN: Commercial Claims
P.O. Box 14711
Lexington, KY 40512-4711
Direct Reimbursement Claim Forms may also be faxed to: 608 741-5475
ExxonMobil Benefits Administration / Health and Welfare Services
ExxonMobil Benefits Administration
P.O. Box 64111
Spring, TX 77387-4111
ExxonMobil sponsored sites - Access to plan-related information including claim forms for employees, retirees, survivors, and their family members.
- Employee Connect, the Human Resources Intranet Site — Can be accessed at work by employees
- ExxonMobil Family, the Human Resources Internet Site — Can be accessed by everyone at www.exxonmobilfamily.com
The ExxonMobil Medical Plan is made up of POS II options and other options. This SPD is a summary of your benefits under the POS II options only. It does not contain all the details about the POS II options nor does it contain any information about the other options. If you enroll in any option other than the POS II options, you may access an SPD for that option.
The POS II is a network of physicians, hospitals, and other health care providers whose credentials have been reviewed by the network manager and who have agreed to provide their services at negotiated rates. The POS II A and B are different plan designs utilizing the same network.
The network for medical care covered under the POS II options – referred to as the Medical POS II in this SPD – is offered by Aetna. Aetna Life Insurance Company (Aetna) is the network manager and claims administrator for the Medical POS II.
Aetna does not render medical services or treatments. Neither the Plan nor Aetna is responsible for the health care that is delivered by providers participating or non-participating in the Medical POS II (Aetna Choice® POS II), and those providers are solely responsible for the health care they deliver. Providers are not the agents or employees of the Plan or Aetna.
The PPO for mental health and substance abuse care covered under the POS II options – referred to as the Mental Health PPO (MHPPO) in this SPD – is managed by Magellan.
The POS II options offer you the ability to use physicians and other health care providers that are part of a network. You can generally reduce your out-of-pocket expenses by using network providers.
If you elect the POS II A or B option and you live outside one of the network areas, you are provided benefits on an out-of-network area basis. However, if you live within the network area and choose to use a non-network provider, specific limitations apply to the benefits you are provided. These tools can help you find specific information quickly and easily.
- Plan at a glance, a user's guide highlighting plan basics.
- Charts and tables throughout this SPD provide information, examples and highlights of plan provisions, including Benefit Summary charts.
- References to places where you can get more information.
- A list of Key terms containing definitions of some words and terms used in this SPD. Terms are underlined and linked for easy identification.
A careful reading of this SPD will help you understand how the POS II options work so you can make the best use of the Plan provisions. You may obtain additional information through the sources shown in the ‘About the Medical Plan’ section.
Plan at a glance
You may enroll yourself and your eligible family members within 60 days of hire or within 60 days of a subsequent change-in-status or at annual enrollment. See the Eligibility and enrollment section.
Basic Plan features
The Plan covers medically necessary and preventive treatment, care and services, that are not otherwise excluded. You can save money and time if you use a provider who participates in the POS II network. When you receive care through the POS II network, the provider files claims and obtains necessary precertifications and the negotiated rates generally lower your out-of-pocket costs. See the Basic Plan features section.
The prescription drug program
The Plan offers you three cost-saving ways to buy prescription drugs – at a local participating network pharmacy for short-term prescriptions, through Express Scripts home delivery for long-term prescriptions, and through Accredo home delivery for specialty prescriptions. See the Prescription drug program section.
Mental health and substance abuse care
The Plan provides for mental health and substance abuse care through Magellan's nationwide Mental Health PPO network. All inpatient and intensive outpatient care must be precertified. If an in-patient stay is not precertified, a $500 penalty will apply and the stay may not be covered. See the Mental health and substance abuse care section.
Covered and excluded expenses
You and the Plan share costs for covered treatment and services. You pay a fixed copayment for covered items such as a POS II network doctor's office visit and most related lab work. For other types of care, you must first satisfy a deductible before the Plan begins paying. If you meet your annual out-of-pocket limit, the Plan pays 100% of most covered costs for the rest of that calendar year. See the Payments section.
POS II network providers file claims for you. You are responsible for ensuring that claims for non-network care are filed. The Plan treats the assignment of benefits to non-network providers as a direction to pay rather than as an assignment of benefits. See the Claims section.
Culture of Health and Health Management Programs
Culture of Health is a set of programs and resources to support the overall health of our workforce both at work and at home, including online tools and resources for individual goal setting, a personal health survey, and an annual biometric screening. These tools and resources are available to all eligible employees and family members (age 18 and older) eligible to enroll in the Plan.
Additional integrated Health Management programs are available to participants in the POS II options, to help you manage your health and to assist you in obtaining good health care when care is needed. These programs reflect a commitment by you and the company to good health and quality care. The Health Management tools and resources available to POS II participants include a 24 Hour Nurse Line, Medical and Behavioral Health Advocates, Condition Management Programs, Cancer Care Program, Online Diabetes Prevention Program, Fertility Services Counselling, Expert Medical Opinion Services, and Centers of Excellence.
Health management tools and resources are available to you at no additional cost. However, health care claims (e.g., doctor's fees or facilities charges) are processed according to the Plan’s provisions. See the Health Management Programs section.
Consolidated Omnibus Budget Reconciliation Act 1985 (COBRA)
You and your family members who lose eligibility may continue medical coverage for a limited time under certain circumstances. See Continuation coverage section.
Administrative and ERISA information
This Plan is subject to rules of the federal government, including the Employee Retirement Income Security Act of 1974, as amended (ERISA), not state insurance laws. See Administrative and ERISA information section.
This is an alphabetized list of words and phrases, with their definitions, used in this SPD. These words are underlined and linked throughout the SPD for easy identification. See Key terms section.
Brief summaries of benefits for the POS II A and B options. See Benefit summary.