It is DoD policy that family members who meet the following criteria will be enrolled in the EFMP:
- Potentially life threatening conditions and/or chronic medical/physical conditions requiring intensive follow-up support (such as high risk newborns; patients with a diagnosis of cancer within the last 5 years; sickle cell disease; insulin dependent diabetes) or sub-specialty care.
- Chronic mental health diagnosis (such as bi-polar, conduct, major affective, thought or personality disorders), inpatient mental health service within the last 5 years, mental health services required at the present time, including patients under the care of their primary care manager (PCM).
- A diagnosis of asthma or other respiratory related diagnosis with wheezing which meets one of the following criteria:
- Routine use of inhaled anti-inflammatory agents and/or bronchodilators.
- History of emergency room use or clinic visits for acute asthma exacerbations.
- History of one or more hospitalizations within the past 5 years.
- History of one or more intensive care unit admissions.
- A diagnosis of attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) that meet one of the following criteria:
- A co-morbid psychological diagnosis.
- Requires multiple medications, psycho-pharmaceuticals (other than stimulants) or does not respond to normal doses of medication.
- Requires management and treatment by a mental health provider(s) (e.g. Psychiatrist, Psychologist, Social Worker).
- Require subspecialty consultants other than family practice more than twice a year on a chronic basis.
- Requires modifications of the educational curriculum or the use of behavioral management staff.
- Requires adaptive equipment.
- Requires Assistive technology devices or services.
- Requires wheelchair accessible/housing modifications.
- Has or requires an Individualized Education Program (IEP).
- Has or requires an Individualized Family Service Plan (IFSP).
For more information Click Here to review Diagnosis Quick Guide.
To enroll or update in the EFMP you must do the following:
- Complete part one of the Medical Summary DD Form 2792 (see forms below).
- Have the Medical Summary completed by your primary care physician.
- Have the Education Summary DD Form 2792-1 (see forms below) completed by the school (applicable if your child is age 3 or above)
- Have the Education Summary DD Form 2792-1 (see forms below) completed by the Child Care Provided if you child has attended formalized Child Care.
- Attach a copy of the IEP/IFSP to the completed application. (if applicable).
- Make an appointment with the EFMP Case Worker to complete the application process.
Note: This application may be completed by the spouse without the need for a power of attorney.
Disenrollment Process
If at some point the medical or special educational services are no longer required you would do the following:
- Complete part one of the Medical Summary DD Form 2792 (see forms below).
- Have the Medical Summary completed by your primary care physician indicating that services are no longer required.
- Have the Education Summary DD Form 2792-1 (see forms below) completed by the school (applicable if your child is between the age of 3 and 21) indicating that services are no longer required
- Make an appointment with the EFMP Case Worker to complete the application process.
Waiver for Services
By signing this form you allow the EFM Program access to the information in the Exceptional Family Member Medical Summary. This allows the EFMP office to better serve the enrolled member, because we can identify beneficial resources and/or benefits. We inform families of educational workshops, town halls, assist in advocating for the EFM, or contact the family to offer further assistance.
Declination of Services
By signing this form the EFMP staff will not contact the EFM family. The Exceptional Family Member Program Staff will not be able to access information in the Exceptional Family Member Medical Summary.
The signing of either form is not permanent and can be withdrawn in writing or by contacting the EFMP Office. The service member cannot sign a waiver for the spouse or an adult dependent, 18 years or older. The adult EFM must complete their waiver. A minor's waiver has to be signed by a parent or guardian.
Once the form has been signed please bring it to the EFMP office for submission to HQMC. We must have one of the two waivers on file before the case can proceed.
Forms
Complete the following forms:
Spouse/Other Adult Family Member over the age of 21:
Children (Birth - 2 years old):
Children (3 years - 21 years old):
All forms need to be submitted concurrently.
Please call the EFMP office at MCAS 228-6903 or MCRDPI/ERR 228-3843 to schedule an appointment to submit the completed paperwork.
Process
Once the completed application is returned to the EFMP Caseworker, a copy will be provided to you. The original is sent to EFMP Headquarters for screening. The screening committee sends a recommendation for a category to Headquarters Marine Corps. Headquarter Marine Corps will send a verification letter directly to the sponsor 6-8 weeks from receiving the category recommendation.
Permanent Dependent: Instructions for Designating a Disabled Child (Over the Age of 21) as a Permanent Dependent.
MARINE (Active & Retired)
INCAPACITATED MILITARY ID
(Instructions for designating a disabled child (over 21) as a permanent dependent) |
When to process this request: 3 months prior to 21st birthday.
1. DD Form 1172, Sep 2005: Application for Uniformed Services ID Card – DEERS Enrollment.
2. DD Form 137-5, Oct 2004: Dependency Statement – Incapacitated Child Over Age
Link for forms: http://www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm. Once it opens, look on the left side for DD Forms and click on the numerical number of those forms.
Send/Fax:
3. Current medical statement within the last 3 – 4 months, preferably from the child’s PCM, explaining in narrative format:
- The onset of the disability.
- The child’s current physical and cognitive status.
- Functional level (what the child cannot do or needs assistance doing is better that what the child can do).
- Current treatments.
- Prognosis for recovery.
- Prognosis for self supporting.
4. Copy of the child’s birth certificate.
5. Verification of Medicare A & B (or disapproval letter from Social Security)
6. Photo ID.
7. Updated information (eye color, hair color, height & weight)
8. Copy of Social Security Card
9. Recent proof of support if the child does “NOT” live with the member.
10. Recent proof of child’s income.
The entire packet gets mailed to the appropriate address below:
Active Duty Marines:
Headquarters Marine Corps Phone 1-703-784-9529 - Fax: 1-703-784-9827
Manpower Reserve Affairs (MRP-1)
3280 Russell Road
Quantico, VA 22134
Retired Marines:
Headquarters Marine Corps Phone: 1-703-784-9311 - Fax: 1-703-784-9834
Manpower Reserve Affairs (MMSR-6)
3280 Russell Road
Quantico, VA 22134
First Stage, package is reviewed by BUMED board. This is the medical board that will review the documents that you will submit to see if the child is Permanently INCAP, Temporarily INCAP, or if the packet is insufficient and/or needs more information.
Second Stage, MRP (Dependency Determination Section) will assess the financial side. They will determine if the member is providing 50% or more of their child’s support and to see if the child’s income does not exceed their expenses. Current TRICARE prescriptions cost goes under “the value of the USIP card.” |
