Enrollment & Forms
Eligible family members are those with a diagnosed medical (physical, emotional and/or intellectual) or education condition who require specialty care or special education. To qualify for EFMP family members must legally reside with the active duty sponsor, be enrolled in the Defense Eligibility Enrollment Reporting System (DEERS) and the Marine Corps Total Forces System (MCTFS). Requirements for enrollment in the EFMP include, but are not limited to:
- Potentially life threatening conditions and/or chronic medical/physical conditions requiring follow up support more than once a year and/or specialty/sub-specialty care.
- Current and chronic (duration of six months or longer) diagnosed mental health conditions or inpatient or intensive outpatient mental health services within the last two years. Intensive outpatient is defined as monthly, or more frequent, mental health services.
- A diagnosis of asthma or other respiratory-related diagnosis with scheduled use of inhaled anti-inflammatory agents or bronchodilators, a history of acute asthma exacerbations or history of hospitalizations.
- A mental health diagnosis (including Attention Deficit Disorder) that requires prescribed psychotropic medications and/or treatment by a mental health provider (e.g., psychiatrist, psychologist, licensed clinical social worker, etc.).
- Special Education eligibility under the Individuals with Disabilities Education Act (IDEA) (e.g. an Individualized Family Service Plan (IFSP) or Individual Education Program (IEP)).
- The required use of adaptive equipment, assistive technology devices/services or wheelchair accessible/housing modifications.
Enrollment Procedure: Birth to 21
Enrollment is required by MCO 1754.4B. Forms must be updated every three years or as your family status changes. To enroll or update in the EFMP, please do the following:
- Complete pages 1-3 of the Medical Summary DD Form 2792 (see forms below) and submit the entire document to a qualified medical professional who will complete pages 4-11.
- Complete the Education Summary DD Form 2792-1 (see forms below) with the school or early intervention staff.
- If applicable, attach a copy of the IEP/IFSP to the Education Summary DD Form 2792-1.
- Complete the Authorization to Release and Consent to Exchange Information Form (see forms below) to allow the EFMP access to the information in the Medical Summary DD Form 2792.
- Meet with your EFMP Case Worker to complete the enrollment process and submit the completed forms.
All forms need to be submitted at one time and may be completed by the spouse without the need for a power of attorney. An EFMP Case Worker will provide you with a copy of the completed forms and the originals will be sent to EFMP Headquarters Marine Corps (HQMC) for review.
Enrollment Procedure: Permanent Dependent
To designate a dependent with disabilities as a permanent dependent, complete the following at least 6 months prior to the dependent’s 21st birthday:
- Complete Application for Identification Card/DEERS Enrollment Form DD 1172-2 (see forms below).
- Complete Dependency Statement - Incapacitated Child Over Age 21 Form DD 137-5 (see forms below).
- Attach recent proof of dependent’s income to Dependency Statement - Incapacitated Child Over Age 21 Form DD137-5.
- Supply a current medical statement (within the last 4 months) from a qualified medical professional explaining in narrative form:
- The onset of the disability and current treatments.
- The dependent’s current physical and cognitive status and functional level.
- Prognosis for recovery and self-support.
An EFMP Case Worker can assist you in sending the packet to the appropriate review board. The packet will be reviewed by Bureau of Medicine and Surgery (BUMED) board to determine if the dependent has Permanent Incapacity for Self-Support (INCAP), Temporary INCAP or if the packet is insufficient and/or requires additional information. A financial review will also be conducted to determine if the sponsor is providing 50% or more of the dependent’s support and if the dependent’s income does not exceed their expenses.
The Marine Corps believes that families should not bear the cost of completing Medical Summary DD Form 2792 to comply with a DOD-mandated program. In order to get reimbursed for having Form 2792 completed by a medical professional your TRICARE authorized provider must give you a receipt that includes the following information:
- Physician’s name
- Form completion listed as a separate expense
- Amount charged
- Marked “PAID” or showing zero balance
For more information about reimbursement, CLICK HERE
Family members may dis-enroll from EFMP when medical or special educational services are no longer required or when the Exceptional Family Member (EFM) is no longer the sponsor’s dependent. To dis-enroll:
- Complete the Medical Summary DD Form 2792 (see forms below) with a qualified medical professional and include supporting documentation from the physician or mental health provider stating the diagnosis no longer exist or services are no longer required.
- Complete the Education Summary DD Form 2792-1 (see forms below) with the school or early intervention staff indicating that services are no longer required.
- Submit the completed forms to your EFMP Case Worker to complete the disenrollment process.
All forms need to be submitted at one time and may be completed by the spouse without the need for a power of attorney.
Declination of Services
Families can refuse services by completing and submitting the Family Support Services Declination Form (see forms below). Declination of family support does not prevent required assignment screening and services. Sponsors will only be contacted for EFMP updates and during assignment relocation.
Medical Summary DD Form 2792
Education Summary DD Form 2792-1
Authorization to Release and Consent to Exchange Information Form
Family Support Services Declination Form