16 FAM 201.1 OFFICE OF MEDICAL CLEARANCES AND THE MEDICAL CLEARANCE PROCESS

UNCLASSIFIED (U)

16 FAM 200 PROCEDURES FOR MEDICAL EXAMINATION AND CLEARANCE

16 FAM 201 PROCEDURES FOR MEDICAL EXAMINATION AND CLEARANCE

OFFICE OF MEDICAL CLEARANCES AND THE MEDICAL CLEARANCE process

(CT:MED-1; 08-21-2025)
(Office of Origin: MED)

(CT:MED-1; 08-21-2025)
(Uniform State/USAID/U.S. and Foreign Commercial Service/Foreign Agricultural Service/Animal and Plant Health Inspection Service/USAGM)
(Applies to all U.S. Government Employees and Eligible Family Members Participating in the Department of State Medical Program)

a. This chapter outlines the Bureau of Medical Services’ Medical Clearance program, the role of medical clearances in the post review process, and employee responsibility related to medical examinations.

b. This chapter also serves the purpose of introducing the new clearance classification system (16 FAM 201.1-3) which will eventually replace the legacy system detailed below in 16 FAM 201.1-4.

16 FAM 201.1-2 Authorities

(CT:MED-1; 08-21-2025)
(Uniform State/USAID/U.S. and Foreign Commercial Service/Foreign Agricultural Service/Animal and Plant Health Inspection Service/USAGM)(Applies to all U.S. Government Employees and Eligible Family Members Participating in the Department of State Medical Program)

Medical Clearances acts in accordance with:

(1) Section 904 of the Foreign Service Act of 1980, as amended, and codified at 22 U.S.C. 4084 (Health Care Program);

(2) Section 901 of the Foreign Service Act of 1980, as amended, 22 U.S.C. 4081 (Travel);

(3) 29 U.S.C. 7011 Rehabilitation Act of 1973

(4) 5 U.S.C. 552a Privacy Act of 1974

16 FAM 201.1-3 MEDICAL CLEARANCE classifications

(CT:MED-1; 08-21-2025)

16 FAM 201.1-3(A) Medical Clearances Background

All employees and eligible family member(s) (as defined by 16 FAM 122.2 Family Member Status) who are posted abroad or who are on TDY travel for 30 or more days require a medical clearance to receive benefits under the Department of State’s Medical Program (MED). Benefits include, but are not limited to, post Health Unit access, medical evacuation travel, and secondary payer coverage for hospitalizations.

16 FAM 201.1-3(B) Clearance Classifications

a. In 2023, the Bureau of Medical Services revised the medical clearance classification system to incorporate a new program, MED Care Management (MCM). In addition, an alphabetic classification system will ultimately replace the legacy numeric classification system. Individuals who currently have a numeric classification will be gradually phased to an alphabetic classification.

b. MCM offers employees and EFMs individual consultations with MED’s Office of Medical Clearances regarding the medical, healthcare, and educational resources that are available at overseas posts. With this information, employees can make an informed decision on how to meet the medical and education needs for them and their family members as they review their bidding and assignment options. Although some individuals will be automatically enrolled in MCM, the program remains available to all those who wish to participate. MCM incorporates a patient-centered approach supporting individuals’ autonomy to accept greater responsibility for their care needs.

c. Classifications for pre-employment candidates:

(1) Y: Meets the applicable Minimum Medical Qualification Standard.

(2) YZ: Meets the applicable Minimum Medical Qualification Standard and enrolled in MED Care Management (MCM); issued to individuals with a medical condition that could pose a significant risk of substantial harm to the health or safety of the individual or others, or to individuals for whom specialty medical resources are recommended more often than annually. Individuals with this clearance classification must seek post approval with Medical Clearances prior to assignment per 16 FAM 206.

(3) N: Does not meet the applicable Minimum Medical Qualification Standard.

(4) R: Under review.

d. Classifications for employees and EFMs:

(1) O (Overseas Eligible): Issued to individuals with no identified medical resource needs or with specialty medical resource needs that are recommended less frequently than annually.

(2) OZ (Overseas Eligible and automatically enrolled in MED Care Management (MCM)): Issued to individuals for whom specialty medical resources are recommended more frequently than annually, or to individuals with a medical condition that could pose a significant risk of substantial harm to the health or safety of the individual or others. Individuals with this clearance classification must participate in the post review process with MED Clearances prior to assignment, per 16 FAM 206.

(3) D (Domestic Only): Issued to individuals who have a medical condition which is incapacitating, or likely to pose a significant risk of substantial harm if overseas. Employees or EFMs with this medical clearance classification may not be assigned outside the United States or be on a TDY for 30 days or more outside the United States.

(4) M (Medevac status): Issued to individuals who have been evacuated from their post of assignment for medical care. M is not valid for return travel to their current overseas duty station.

(5) R (Under review): Issued to individuals awaiting completion of the evaluation of a medical condition and receipt of relevant records by Medical Clearances. R is not valid for travel to an assignment outside the United States or to be on a TDY for 30 days or more outside the United States. If the examination/evaluation is not completed or the requested records are not received within 90 days, the individual will be issued a C: Cancelled medical clearance and will not be eligible for the Medical Program abroad unless an extension is granted by Medical Clearances.

(6) C (Cancelled): Issued to an individual whose medical evaluation is incomplete, and the application has been inactive for more than 90 days.

(7) E (Deceased): Issued for individuals at notification of death.

(8) S (Separation from service): Issued to employees and EFMs following notification of separation from employment with their agency after which they no longer have Health Unit access. This also includes EFMs who have reached age 21, children on education travel orders, and persons no longer considered EFMs through legal separation or divorce.

(9) T (Temporary travel): Issued only to an EFM child who is not medically cleared to reside at the employee’s assigned post but is authorized to visit that post for a period of time not to exceed 120 days per calendar year.

16 FAM 201.1-4 REVISED Legacy medical Clearance Classifications

a. Worldwide available (Class 1): Issued to individuals with no identified medical resource needs or with specialty medical resource needs that are recommended less frequently than annually.

b. Post-specific (Class 2): Issued to individuals for whom specialty medical resources are recommended more frequently than annually, or to individuals with a medical condition that could pose a significant risk of substantial harm to the health or safety of the individual or others. Individuals with this clearance classification must participate in the post review process with MED Clearances prior to assignment, per 16 FAM 206

c. Domestic only (Class 5): Issued to individuals who have a medical condition which is incapacitating, or likely to pose a significant risk of substantial harm if overseas. Employees or EFMs with this medical clearance classification may not be assigned outside the United States or be on TDY for 30 days or more outside the United States.

d. Temporary travel (Class 6): Issued only to an EFM child who is not medically cleared to reside at the employee’s assigned post but is authorized to visit that post for a period of time not to exceed 120 days per calendar year.

e. Pending (Class 7): Issued to individuals awaiting completion of the evaluation of a medical condition within 90 days. Class 7 is not valid for travel to an assignment abroad. If the examination/evaluation is not completed within 90 days, the individual will be issued a Class 8 clearance and will not be eligible for the Medical Program abroad.

f. Incomplete/cancellation (Class 8): Issued to an individual whose medical evaluation is incomplete, or has been inactive for more than 90 days. Class 8 clearances will also be issued to an employee or eligible family member who is in pending status (Class 7) and who has not completed the evaluation within the allotted 90 days.

g. Separation (Class 9): Issued to employees and EFMs following separation from employment with their agency after which they no longer have Health Unit access. This also includes EFMs who have reached age 21, children on education travel orders, and persons no longer considered EFMs through legal separation or divorce.

h. Deceased (Class 10): Issued to employees or EFMs at notification of death.

16 FAM 201.1-5 pre-employment medical Clearance

a. Candidates whose hiring agency or authority requires a medical clearance from the Department of State as a condition for employment must undergo a pre-employment medical examination using form DS-1843 and have the results of the examination forwarded to Medical Clearances. Once received, the applicant has 90 days to submit any further requested supporting documents, otherwise their file will be closed.

b. The purpose of the pre-employment medical examination is to determine if a candidate meets the Minimum Medical Qualification Standard (MMQS) for employment set forth by their hiring agency or authority. There are no medical conditions that automatically precludes applicants from meeting the MMQS as each applicant undergoes an individualized assessment. The responses provided on the DS-1843 and the supporting documentation submitted, including assessments and recommendations by treating providers, inform the medical clearance determination.

c. Department of State Foreign Service generalist and specialist candidates, except for medical specialist candidates, will meet the pre-employment MMQS if they are determined to be medically qualified to serve at all MEDEVAC posts (currently Bangkok, London, Pretoria, and Singapore).

d. Medical Specialist candidates will meet the MMQS if they are determined to be medically qualified to serve at all MEDEVAC posts, along with a select number of additional posts.

e. Consular Fellows candidates will meet the MMQS if they meet the medical qualification standard for the position as determined by CA and PERT.

f. For other hiring agencies or authorities, Medical Clearances will apply the MMQS as established by such hiring agencies or authorities.

g. Medical Clearances will notify the candidate if they meet the MMQS. If an applicant does not meet the MMQS, they will be informed of the basis for the determination. In that case, the clearance determination will be automatically submitted to the Chief Medical Officer via the Medical Review Panel (MRP), and the applicant will have up to 30 days to submit supplemental documentation in support of their request for a medical clearance (ref 16 FAM 207). Following the review by the MRP, MED will report its final medical clearance determination to the applicant and applicant’s hiring officials. No medical information will be shared with anyone other than the candidate except as authorized by law.

h. Referrals to Disability and Reasonable Accommodation Division (DRAD): If, following MRP review, a Department of State applicant fails to meet the MMQS, the applicant will be referred to the Bureau of Personnel and Training , Office of Accessibility and Accommodations, Disability and Reasonable Accommodation Division (GTM/OAA/DRAD) should the candidate wish to engage in an interactive process in order to assess whether the applicant can meet the MMQS with a reasonable accommodation (see 3 FAM 3670). Applicants for other agencies can contact their hiring authority for reasonable accommodation options.

i. Administrative Waiver of Medical Standards for Candidates:

(1) A Department of State Foreign Service candidate who did not meet the MMQS after an MRP appeal and who is unable to meet the MMQS with a reasonable accommodation, may request an administrative waiver of the medical standards from the Director General of the Foreign Service (DG). Decisions of the DG or his or her designee are final and are not subject to further appeal by the candidate.

(2) Candidates from other foreign affairs agencies [USAID, Foreign Commercial Service, Foreign Agricultural Service, APHIS and the U.S. Agency for Global Media (USAGM)] who similarly have not met their MMQS may request an administrative waiver of medical standards from the director of human resources of their respective agency.

(3) If an administrative waiver is granted by the DG for State or by the director of human resources for other foreign affairs agencies, the candidate is issued a post-specific (Class 2 or OZ) medical clearance.

j. The candidate must notify Medical Clearances if there is any significant change in their medical condition at any time. Such changes include but are not limited to:

(1) a hospitalization or urgent outpatient treatment;

(2) a change of or initiation of regularly taken medications;

(3) worsening of a current condition; or

(4) the need for new regular specialty care.

k. A completed pre-employment medical clearance is valid for 5 years from the date of issuance. If the candidate is not employed within 5 years of the date of issuance, the candidate must submit Form DS-3057, Medical Clearance Update to initiate a review to determine if they still meet the MMQS.

16 FAM 201.1-6 First-time MEDICAL CLEARANCE FOR EMPLOYEES AND Eligible Family Members

a. Employees and eligible family members (EFMs) who will accompany an employee assigned abroad must undergo a medical examination prior to proceeding abroad for the first time using form DS-1843, Medical History and Examination for Foreign Service (for Individuals Age 12 and Older), or Form DS-1622, Medical History and Examination for Foreign Service (for Children 11 Years and Under). Exceptions are for Foreign Service Officers who have completed a pre-employment medical clearance. Their clearance is valid for overseas travel for up to 2 years from its date of issue after which they must update their medical clearance by submitting form DS-3057 medical clearance update.

b. Each agency that pays into the MED program through ICASS must verify an employee’s and EFM’s medical clearance status before issuing travel orders. An employee or EFM with a Class 2 or OZ medical clearance must complete a post review with MED. MED will communicate approved posts to assignments officials at the employing agency. Failure to obtain a post approval before traveling abroad may result in the individual being denied participation in the Medical Program, including access to Health Units abroad.

16 FAM 201.1-7 MEDICAL CLEARANCE Renewal FOR Employees and Eligible Family Members

a. A medical clearance is valid for the length of an overseas tour and any extensions to that tour unless there is a significant change in the individual’s medical condition that leads to a change in medical clearance. A medical clearance is renewed or updated by submitting Form DS-3057, Medical Clearance Update.

b. If additional evaluations are needed to make the clearance decision, MED may issue Form DS-616, Authorization for Medical Tests/Consultations that authorizes reimbursement for these evaluations deemed necessary by Medical Clearances.

c. An employee or EFM with a Class 2, YZ, or OZ medical clearance must complete a post review and approval with MED prior to being assigned by their agency and onward travel to post. Employees and EFMs with these clearances must receive post approval before traveling. If an employee or EFM arrives at post without a valid medical clearance, they must update their clearance immediately to avoid becoming ineligible for the Medical Program including Health Unit access and medical travel benefits. (REF 16 FAM 120 and 16 FAM 300)

d. Employees and EFMs should renew their medical clearance prior to bidding on their next assignment abroad or prior to entry into long-term language training in preparation for assignment abroad.

e. All employee TDY travel abroad for 30 consecutive days or more requires a valid medical clearance. A medical clearance for domestic assigned employees on TDY travel is valid for 2 years unless there is a significant change in the individual’s medical condition that leads to a change in medical clearance. A medical clearance is renewed or updated by submitting Form DS-3057, Medical Clearance Update. An individual with a Class 2,YZ, or OZ medical clearance must complete a post review and approval with MED prior to each TDY assignment of 30 days or more or as otherwise determined by Medical Clearances.

16 FAM 201.1-8 Post Review process

a. For individuals with a medical clearance requiring post approval, MED assesses whether the proposed post or posts can meet their medical needs. MED reviews the required medical resources, identifies suitable posts, and informs the individual of its findings.. : :

b. During the post review process, MED will discuss with the employee the available medical resources and care options at potential posts of assignment. Medical resource availability is determined by MED.

c. During the post review process, MED will perform an individualized assessment to determine whether the individual is medically qualified for a specific post of assignment or, for EFMs, to accompany an employee to a specific post of assignment. Post approvals may be denied for the following reasons, as determined by MED:

(1) The individual has a medical condition that poses a significant risk of substantial harm to the individual or others at the proposed post of assignment.

(2) The individual’s acute or long-term care needs are not yet known due to a new or chronic condition that is unstable and/or actively being evaluated.

(3) The individual asks to not approve a post where they cannot access specialty medical care recommended more frequently than annually.

d. Post denials for reasons i and ii above should state: (1) the health condition(s) that is indicative of instability or poses a significant risk of substantial harm; (2) the nature of the risk (e.g., duration, likelihood, severity, imminence); and (3) which resources are unavailable at post. MED determines the availability of acceptable medical resources at post. Post denials will include instructions on how to request an appeal with the Medical Review Panel (MRP).

e. MED will share medical information only with the individual seeking post approval, except as authorized by law. MED will share whether an individual was approved for a specific post, as appropriate, for assignment purposes.

f. For any State Department employee’s post denial that is upheld by the Chief Medical Officer after an MRP review, employees have the option to seek a reasonable accommodation, through the Bureau of Personnel and Training , Office of Accessibility and Accommodations, Disability and Reasonable Accommodation Division (GTM/OAA/DRAD). Employees of other agencies will be directed to contact their hiring authority for accommodation options.

g. Individuals who choose to serve in locations/assignments where their medical needs cannot be met are financially responsible for all the travel and logistics needed to obtain their specialized care consistent with 16 FAM 315.4 (c) (travel limitations).

16 FAM 201.1-9 APPEAL OF MEDICAL Clearance DECISION

a. An applicant, employee, or eligible family member (EFM) may submit a written appeal of a clearance decision to the Chief Medical Officer or their designee. Requests are sent to the Medical Review Panel (MRP) Chair. The appeal request may include any additional medical documentation or other information in support of their appeal.

b. The Chief Medical Officer or designee will convene a three-clinician panel to review the request. For mental health cases, the panel will consist of two Regional Medical Officer Psychiatrists and one clinician (Regional Medical Officer or Medical Provider). For other medical cases, the panel will consist of at least two Regional Medical Officers and one Medical Provider. The panel’s recommendation will be presented to the Chief Medical Officer for a decision. The Chief Medical Officer’s final decision will address any contentions or additional information the individual submitted to the MRP and will be sent to the individual by the MRP Chair. by the MRP Chair.

c. The MRP decides if the panel agrees or disagrees with the medical clearance decision factoring in any additional information provided by the individual seeking the MRP review. The MRP will forward their determination and recommendation(s) to the Chief Medical Officer for final determination.

d. If the Chief Medical Officer upholds the medical clearance decision, Department of State employees have the option to seek a reasonable accommodation that would allow them to meet the medical qualification for a specific post of assignment, with GTM/OAA/DRAD. Employees of other agencies can contact their hiring authority or human resources division for reasonable accommodation options.

16 fam 201.1-10 MEDICAL CLEARANCE PROCESS FOR NEW FAMILY MEMBERS ACQUIRED THROUGH MARRIAGE, domestic partner affidavit, BIRTH, LEGAL ADOPTION, OR GUARDIANSHIP

a. A new eligible family member (EFM) may receive overseas medical program benefits for up to 90 days while obtaining a medical clearance decision. The employee is responsible for initiating the medical clearance process (REF 16 FAM 122.4).

b. Otherwise, EFM(s) who are abroad without a medical clearance (and post approval, if required) are not authorized medical program benefits.

16 fam 201.1-11 MEDICAL CLEARANCE REVIEW for Medical Evacuees or Individuals with NEW or significant change in medical Condition when assigned overseas

(CT:MED-1; 08-21-2025)
(Uniform/State/USAID/Commerce/Foreign Service Corps-USDA/USAGM)
(Applies to Civil Service and Foreign Service Employees)
(Participating ICASS Agencies)

a. Individuals who are medically evacuated (medevac) from post will be advised prior to travel that their current medical clearance will be suspended while on Medevac status (M) until resolution of the medevac.

b. Upon the conclusion of a medevac, MED will re-adjudicate the individual’s medical clearance. An individualized assessment of the individual’s health needs will be conducted and will consist of a review of the individual’s condition, the treatment received, and any other medical conditions identified that may impact the individual’s ability to meet their medical care needs at their current post. Any employee or EFM who receives a Class 2, OZ, 5 or D medical clearance determination that precludes their return to post must promptly notify the Office of Career Development and Assignments (GTM/CDA) (for State Department Foreign Service employees) or human resources point of contact (for all others). Employees of all other agencies will need to inform their agency human resources and their assignment officer.

c. A medical clearance review and when appropriate a post review will be initiated (per 16 FAM 205 and 16 FAM 206) when an employee with a medical clearance experiences a significant change in his or her medical condition.

16 fam 201.1-12 EMPLOYEE Responsibilities

a. Employees and their eligible family members (EFMs) should renew their medical clearances prior to bidding on their next assignment. They may begin the medical clearance process up to 12 months before departure from their current assignment, and up to 18 months before departure for any child with special needs.

b. If the employee or an EFM has a Class 2 or OZ medical clearance, they must go through the post review process and should take a proactive stance engaging with MED to review resource availability at potential posts of assignment. .

c. The employee must ensure that they and all accompanying EFMs have received a Class 1 or O medical clearance or a Class 2 or OZ medical clearance with the employee’s post of assignment approved by MED before traveling to post.

d. The employee must notify MED of any significant change in the employee’s or EFM’s medical condition at any time as referenced in 16 FAM 210.

e. It is the responsibility of the employee to ensure timely transmission of all requested medical records to MED.

UNCLASSIFIED (U)