16 FAM 120
APPLICABILITY AND ELIGIBILITY
(CT:MED-41; 03-07-2019)
(Office of Origin: MED)
16 FAM 121 applicability
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
Section 904 of the Foreign Service Act, 22 U.S.C. 4084, is the authorizing legislation for the Department of State to operate a medical services program abroad. The law defines basic eligibility as follows:
"The Secretary of State shall establish a health care program to promote and maintain the physical and mental health of members of the Service, and (when incident to service abroad) other designated eligible Government employees, and members of the families of such members and employees."
16 FAM 122 eligibility
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
An individual must meet the applicable criteria (employment, family member, ICASS, medical clearance status) to be eligible for participation in the Medical Program (MED). In addition, an individual whose sponsoring agency does not fund medical evacuations must provide documentation that he or she has personal medical evacuation insurance.
16 FAM 122.1 Employment Status
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
Eligibility based upon employment status includes:
(1) A full-time direct-hire U.S. Government employee who is assigned, by official travel/transfer orders, to a position abroad established under chief-of-mission authority;
(2) Part-time direct-hire U.S. Government employees, including both Foreign Service and Civil Service employees who are assigned abroad on official temporary duty (TDY) travel order including employees on “when actually employed (WAE)” appointments; and
(3) Contractors, fellows, scholars, summer interns hired in the United States, and other categories of employees whose sponsoring agency subscribes to ICASS on their behalf.
16 FAM 122.2 Family Member Status
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
a. Eligibility based upon family member status includes:
(1) A spouse, domestic partner as defined in 3 FAM 1610, or unmarried dependent child under 21 years of age who is included on official travel orders and domiciled at post of assignment;
(2) An unmarried child under 23 years of age who travels to post on educational travel orders; or
(3) An unmarried, dependent child who has a medically documented disability that occurred prior to the child’s 21st birthday and that renders him or her incapable of self-sustaining employment (16 FAM 530).
b. Members of household, as defined in 3 FAM 4180, are not eligible for participation in the Medical Program.
16 FAM 122.3 ICASS Status
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
Eligibility based upon ICASS status includes:
(1) The sponsoring agency must subscribe to the Interagency Cooperative Administrative Support Services (ICASS) health service cost center program at the Washington-level;
(2) The sponsoring agency must subscribe at post for ICASS health services and must contribute its share of the costs of the overall Medical Program through that subscription for health services. When authorized by MED, the employing agency must also fund medical travel and hospitalization directly for individual employees or family members; and
(3) The embassy management officer will provide to the post health unit a list of individuals eligible for health services based upon their sponsoring agencies’ subscription to ICASS.
16 FAM 122.4 Medical Clearance Status
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
a. Eligibility based upon medical clearance status includes:
(1) A person who holds a valid medical clearance as defined in 16 FAM 211.2 for the post of assignment;
(2) Foreign Service, Civil Service, and employees serving in “when actually employed” (WAE) appointments who:
(a) Travel abroad for 30 consecutive days or more in a calendar year on temporary duty (TDY) travel orders, and
(b) Hold a valid medical clearance as defined in 16 FAM 211.2; and
(3) New family member acquired through birth, adoption, marriage, domestic partner affidavit as defined in 3 FAM 1610, or legal guardianship, for the 90-day period after being included on the employee’s Form OF-126, Foreign Service Residence and Dependency Report, and after which time, the new family member must have the required medical clearance for continued eligibility for benefits within the Medical Program.
b. Spouses, domestic partners as defined in 3 FAM 1610, or other family members of TDY employees who are not included in travel authorizations are not eligible for the Medical Program. These family members who elect to accompany an employee on TDY travel orders are advised to obtain comprehensive medical travel insurance that includes both hospitalization abroad and air ambulance evacuation benefits.
16 FAM 122.5 Nonfunded Medical Evacuation
(CT:MED-41; 03-07-2019)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Civil Service and Foreign Service Employees)
An individual whose sponsoring agency does not fund medical evacuations must provide documentation that he or she has personal medical evacuation insurance.
16 FAM 123 through 129 unassigned