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ExxonMobil Medical Plan: POS II “B”Summary of Benefits and Coverage: What this Plan Covers & What it CostsCoverage Period: 01/01/2017 – 12/31/2017Coverage for: All Coverage Levels Plan Type: POSThis is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plandocument at -and-b or by calling 1-800-262-2363.Important QuestionsAnswersWhy this Matters:What is the overalldeductible? 300/person and 600/family for in-networkand out-of-network area. For non-network 400/person and 800/family.Doesn’t apply to preventive services.You must pay all the costs up to the deductible amount before this plan beginsto pay for covered services you use. Check your policy or plan document to seewhen the deductible starts over (usually, but not always, January 1st). See thechart starting on page 2 for how much you pay for covered services after youmeet the deductible.Are there otherdeductibles for specificservices?You must pay all of the costs for these services up to the specific deductibleYes. 150 for in-network and out-of-networkamount before this plan begins to pay for these services.inpatient hospital services, mental health, andchemical dependency and 300 for non-network.There are no other specific deductibles.Is there an out–of–pocketlimit on my expenses?Yes. For in-network and out-of-network areaproviders 3,000/person and 6,000 /family.For non-network providers 12,000/person and 24,000/family. For prescription drugs, 2,500/individual and 5,000/family.The out-of-pocket limit is the most you could pay during a coverage period(usually one year) for your share of the cost of covered services. This limit helpsyou plan for health care expenses.What is not included inthe out–of–pocket limit?Premiums, balance-billed charges, and health carethis plan doesn’t cover.Even though you pay these expenses, they don’t count toward the out-ofpocket limit.No.Is there an overall annuallimit on what the plan pays?The chart starting on page 2 describes any limits on what the plan will pay forspecific covered services, such as office visits.Does this plan use anetwork of providers?Yes. See www.aetna.com/docfind or call 1800-255-2386 for a list of in-network providers.Select Aetna Choice POS II when selecting aplan in DocFind If you use an in-network doctor or other health care provider, this plan will paysome or all of the costs of covered services. Be aware, your in-network doctor orhospital may use an out-of-network provider for some services. Plans use theterm in-network, preferred, or participating for providers in their network. Seethe chart starting on page 2 for how this plan pays different kinds of providers.Do I need a referral to seea specialist?No. You don’t need a referral to see a specialist.You can see the specialist you choose without permission from this plan.Are there services this plan Yes.doesn’t cover?Some of the services this plan doesn’t cover are listed on page 5. See your policyor plan document for additional information about excluded services.Questions: Call 1-800-255-2386 or visit us at www.aetna.com.If you aren t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossary 2012/uniform-glossary-final.pdf or call 1-800-262-2363 to request a copy.1 of 8

Copayments are fixed dollar amounts (for example, 15) you pay for covered health care, usually when you receive the service. Coinsurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the plan’sallowed amount for an overnight hospital stay is 1,000, your coinsurance payment of 20% would be 200. This may change if you haven’t met yourdeductible. The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount,you may have to pay the difference. For example, if an out-of-network hospital charges 1,500 for an overnight stay and the allowed amount is 1,000,you may have to pay the 500 difference. (This is called balance billing.) This plan may encourage you to use in-network providers by charging you lower deductibles, copayments and coinsurance amounts.CommonServices You MayMedical Event NeedIf you visit ahealth careprovider’s officeor clinicIf you have atestIf you needdrugs to treatyour illness orconditionYour Cost IfYou Use anIn-NetworkProvider 25 co-pay/visitPrimary care visit totreat an injury or illnessSpecialist visit 35 co-pay/visitOther practitioner 35 co-pay/visitoffice visitfor chiropractorand acupunctureprovided byphysicianPreventive care/No chargescreening/immunizationDiagnostic test (x-ray, No chargeblood work)Imaging (CT/PET20% co-insurancescans, MRIs)Prescription generic30% co-pay (retail)drugs25% co-pay (mail)Your Cost If YouUse aNon-NetworkProvider40% co-insurance40% co-insurance40%/visit forchiropractor andacupunctureprovided byphysicianNo chargeYour Cost IfLimitations & ExceptionsYou Use anOut-of-NetworkArea Provider20% co-insurance Not subject to annual deductible for in-network.Reasonable and customary limits apply to non20% co-insurance network and out-of-network area providers.20%/visit forCoverage is limited to 1,000 annually for chiropracticchiropractor and care. Reasonable and customary limits apply to nonacupuncturenetwork and out-of-network area providers.provided byphysicianNo ––––––––40% co-insurance20% co-insurance40% co-insurance20% co-insuranceIf using a nonnetwork pharmacy,you pay 100% of thePrescription formulary 30% co-pay (retail) difference betweenbrand drugs25% co-pay (mail) the actual cost andthe discountedPrescription non50% co-pay (retail) network cost plusformulary brand drugs 45% co-pay (mail) retail co- pays.No ChangeNo ChangeNo ChangeReasonable and customary limits apply to nonnetwork and out-of-network area providers.Prior authorization over Enhanced Clinical Review(ECR) might be required.Max/prescription: 50 (retail), 100 (mail)3rd retail refill: 55% co-pay. Claims must besubmitted for non-network pharmacies.Max/prescription: 115 (retail), 200 (mail)3rd retail refill: 55% co-pay. Claims must besubmitted for non-network pharmacies.Max/prescription: 170 (retail), 300 (mail)3rd retail refill: 75% co-pay. Claims must besubmitted for non-network pharmacies.2 of 8

Your Cost IfYou Use anIn-NetworkProviderSame as any otherprescription drug(see above).Your Cost If YouUse aNon-NetworkProviderFacility fee (e.g.,ambulatory surgerycenter)Physician/surgeonfeesEmergency roomservicesEmergency medicaltransportationUrgent careFacility fee (e.g.,hospital room)20% co-insurance40% co-insurance20% co-insuranceReasonable and customary limits apply to nonnetwork and out-of-network area providers.20% co-insurance40% co-insurance20% co-insurance 100 co-pay/visit20% co-insurance20% co-insurance 100 co-pay/visit20% co-insurance20% co-insurance 100 co-pay/visit20% co-insurance20% co-insurance 35 co-pay20% co-insurance40% co-insurance40% co-insurance20% co-insurance20% co-insurancePhysician/surgeon fee20% co-insurance40% co-insurance20% co-insuranceMental/Behavioralhealth outpatientservicesMental/Behavioralhealth inpatientservices 25 or 35 co-pay40% co-insurance20% co-insurance20% co-insurance40% co-insurance20% co-insuranceReasonable and customary limits apply to nonnetwork and out-of-network area providers.Co-pay waived if admitted. Inpatient co-paymentsapply upon admission.Patient is responsible for any non-coveredsupplies/services during –––––––––– 150 inpatient deductible for in-network andout-of-network area. 300 inpatient deductible fornon-network. 500 penalty if you fail to pre-certifyinpatient care for non-network and out-of-networkarea providers. Reasonable and customary limitsapply to non-network and out-of-network areaproviders.Reasonable and customary limits apply to nonnetwork and out-of-network area providers.Not subject to annual deductible for in-network.Reasonable and customary limits apply to nonnetwork and out-of-network area providers. 150 deductible for in-network and out-of-networkarea. 300 deductible for non-network. 500 penaltyif you fail to pre-certify inpatient care for non-networkand out-of-network area providers. Deductible andreasonable and customary limits apply to non-networkand out-of-network area providers.CommonServices You MayMedical Event NeedMore informationaboutprescriptiondrug coverage isavailable atwww.expressscripts.com/If you haveoutpatientsurgeryIf you needimmediatemedicalattentionIf you have ahospital stayIf you havemental health,behavioralhealth, orsubstanceabuse needsPrescription specialtydrugsYour Cost IfLimitations & ExceptionsYou Use anOut-of-NetworkArea ProviderNo ChangeCertain specialty drugs must be pre-certified byExpress Scripts (formerly Medco).Max/prescription and 3rd retail refill limitations areidentical to any other prescription drug (see above).3 of 8

Your Cost IfYou Use anIn-NetworkProviderSubstance use disorder 25 or 35 co-payoutpatient servicesYour Cost If YouUse aNon-NetworkProvider40% co-insuranceSubstance use disorder 20% co-insuranceinpatient services40% co-insurancePrenatal and postnatalcareDelivery and allinpatient services20% co-insurance40% co-insurance20% co-insurance40% co-insuranceIf you needHome health carehelp recoveringor have otherspecial healthInpatientneedsrehabilitation servicesInpatient habilitationservicesSkilled nursing care20% co-insurance40% co-insurance20% co-insurance40% co-insurance20% co-insurance40% co-insurance20% co-insurance40% co-insuranceDurable medicalequipment20% co-insurance40% co-insuranceHospice service20% co-insurance40% co-insuranceEye examGlassesDental check-upNot coveredNot coveredNot coveredNot coveredNot coveredNot coveredCommonServices You MayMedical Event NeedIf you arepregnantIf your childneeds dental oreye careYour Cost IfLimitations & ExceptionsYou Use anOut-of-NetworkArea Provider20% co-insurance Not subject to annual deductible for in-network.Reasonable and customary limits apply to nonnetwork and out-of-network area providers.20% co-insurance 150 deductible for in-network and out-of-networkarea. 300 deductible for non-network. 500 penalty ifyou fail to pre-certify inpatient care for non-networkor out-of-network providers. Deductible andreasonable and customary limits apply to non-networkand out-of-network area providers.20% co-insurance Reasonable and customary limits apply to nonnetwork and out-of-network area providers.20% co-insurance 150 deductible for in-network and out-of-networkarea. 300 deductible for non-network. Inpatientdeductible does not apply for nursery charges. 500penalty if you fail to pre-certify inpatient care for nonnetwork and out-of-network area providers.20% co-insurance Pre-certification required. Reasonable and customarylimits apply to non-network and out-of-network areaproviders.20% co-insurance 500 penalty if you fail to pre-certify inpatient care fornon-network and out-of-network area providers.20% co-insurance Deductible and reasonable and customary limits applyto non-network and out-of-network area providers.20% co-insurance Pre-certification required. Deductible and reasonableand customary limits apply to non-network and outof-network area providers.20% co-insurance Pre-certification required. Deductible and reasonableand customary limits apply to non-network and outof-network area providers.20% co-insurance Deductible and reasonable and customary limits applyto non-network and out-of-network area providers. 500 penalty if you fail to pre-certify inpatient care fornon-network and out-of-network area providers.Not coveredLimited benefits available when needed because ofinjury or disease.Not coveredNot coveredRefer to SPD for details on covered dental services.4 of 8

Excluded Services & Other Covered Services:Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.) Cosmetic surgery Long-term care Routine eye care (Adult and child) Dental care (Adult and child) Private-duty nursing (if custodial) Routine foot careOther Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.) Acupuncture (if performed by a physician) Chiropractic care Bariatric surgery Hearing aids Infertility treatment Non-emergency care when traveling outside theU.S. Weight loss programs (only morbid obesitytreatments including physician services and labcosts)5 of 8

Your Rights to Continue Coverage:If you lose coverage under the plan, then, depending upon the circumstances, Federal and State laws may provide protections that allowyou to keep health coverage. Any such rights may be limited in duration and will require you to pay a premium, which may besignificantly higher than the premium you pay while covered under the plan. Other limitations on your rights to continue coverage mayalso apply. For more information on your rights to continue coverage, contact the plan at 1-800-262-2363. You may also contact your stateinsurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa,or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov.Your Grievance and Appeals Rights:If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal or file a grievance. Forquestions about your rights, this notice, or assistance, you can contact the plan at 1-800-255-2386. You may also contact the Department of Labor s,Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa, or the U.S. Department of Health and Human Services at 1-877-2672323 x61565 or www.cciio.cms.gov.Nondiscrimination Notice:The ExxonMobil Medical Plan and its administrators comply with applicable federal civil rights laws and do not discriminate on the basis of race, nationalorigin, age, disability or sex. To see the full notice of nondiscrimination for the ExxonMobil Medical Plan and for each administrator go to:http://www.exxonmobilfamily.comDoes this Coverage Provide Minimum Essential Coverage?The Affordable Care Act requires most people to have health care coverage that qualifies as “minimum essential coverage.” This plan or policy doesprovide minimum essential coverage.Does this Coverage Meet the Minimum Value Standard?The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). Thishealth coverage does meet the minimum value standard for the benefits it provides.Language Access Services:[Spanish (Español): Para obtener asistencia en Español, llame al 1-800-262-2363][Chinese (中文): 1-800-262-2363][Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-262-2363]Disclaimer: The health plan and benefits summarized herein are governed under law by formal Plan documents. If there is any discrepancy between theinformation provided in this Summary of Benefits and Coverage (SBC) and the formal Plan documents, the Plan documents –––––––To see examples of how this plan might cover costs for a sample medical situation, see the next –––––––6 of 8

ExxonMobil Medical Plan: POS II “B”Coverage Period: 01/01/2017 – 12/31/2017Coverage for: All Coverage Levels Plan Type: POSCoverage examplesAbout these CoverageExamples:These examples show how this plan might covermedical care in given situations. Use theseexamples to see, in general, how much financialprotection a sample patient might get if they arecovered under different plans.This isnot a costestimator.Don’t use these examples toestimate your actual costsunder this plan. The actualcare you receive will bedifferent from theseexamples, and the cost ofthat care will also bedifferent.See the next page forimportant information aboutthese examples.Having a babyManaging type 2 diabetes(normal delivery) Amount owed to providers: 7,540 Plan pays: 5,524 Patient pays: 2,016Sample care costs:Hospital charges (mother)Routine obstetric careHospital charges (baby)AnesthesiaLaboratory testsPrescriptionsRadiologyVaccines, other preventiveTotal 2,700 2,100 900 900 500 200 200 40 7,540Patient pays:DeductiblesCo-paysCo-insuranceLimits or exclusionsTotal 450 35 1,381 150 2,016(routine maintenance ofa well-controlled condition) Amount owed to providers: 5,400 Plan pays: 3,700 Patient pays: 1,700Sample care costs:PrescriptionsMedical Equipment and SuppliesOffice Visits and ProceduresEducationLaboratory testsVaccines, other preventiveTotal 2,900 1,300 700 300 100 100 5,400Patient pays:DeductiblesCo-paysCo-insuranceLimits or exclusionsTotal 300 250 1070 80 1,7007 of 8

ExxonMobil Medical Plan: POS II “B”Coverage examplesCoverage Period: 01/01/2017 – 12/31/2017Coverage for: All Coverage Levels Plan Type: POSQuestions and answers about the Coverage Examples:What are some of theassumptions behind theCoverage Examples? Costs don’t include premiums.Sample care costs are based on nationalaverages supplied by the U.S.Department of Health and HumanServices, and aren’t specific to aparticular geographic area or health plan.The patient’s condition was not anexcluded or preexisting condition.All services and treatments started andended in the same coverage period.There are no other medical expenses forany member covered under this plan.Out-of-pocket expenses are based onlyon treating the condition in the example.The patient received all care from innetwork providers. If the patient hadreceived care from out-of-networkproviders, costs would have been higher.What does a Coverage Exampleshow?Can I use Coverage Examplesto compare plans?For each treatment situation, the CoverageExample helps you see how deductibles, copayments, and co-insurance can add up. Italso helps you see what expenses might be leftup to you to pay because the service ortreatment isn’t covered or payment is limited. Yes. When you look at the Summary ofDoes the Coverage Examplepredict my own care needs? No. Treatments shown are just examples.The care you would receive for thiscondition could be different based on yourdoctor’s advice, your age, how serious yourcondition is, and many other factors.Does the Coverage Examplepredict my future expenses? No. Coverage Examples are not costestimators. You can’t use the examples toestimate costs for an actual condition. Theyare for comparative purposes only. Yourown costs will be different depending onthe care you receive, the prices yourproviders charge, and the reimbursementyour health plan allows.Benefits and Coverage for other plans,you’ll find the same Coverage Examples.When you compare plans, check the“Patient Pays” box in each example. Thesmaller that number, the more coveragethe plan provides.Are there other costs I shouldconsider when comparingplans? Yes. An important cost is the premiumyou pay. Generally, the lower yourpremium, the more you’ll pay in out-ofpocket costs, such as co-payments,deductibles, and co-insurance. Youshould also consider contributions toaccounts such as health savings accounts(HSAs), flexible spending arrangements(FSAs) or health reimbursement accounts(HRAs) that help you pay out-of-pocketexpenses.Questions: Call 1-800-255-2386 or visit us at www.aetna.com.If you aren t clear about any of the underlined terms used in this form, see the Glossary. You can view the Glossaryat http://www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf or call 1-800-262-2363 to request a copy.8 of 8