6/8 Waivers

Waivers of the Six-Year and Eight-Year Limits on Continuous Domestic Service

Individuals with a Domestic Only (Class 5) clearance have a medical condition which is incapacitating or for which specialized medical care is best obtained in the United States. Employees or eligible family members with a Class 5 medical clearance may not be assigned outside the United States. Certain conditions may require that the employee stay in the United States for longer than 6 years. The Foreign Service Act of 1980, as amended, 22 U.S.C. § 3901 et seq., requires all Foreign Service employees to serve a substantial portion of their careers overseas, and limits the number of years Foreign Service employees can spend in continuous domestic service.

Employees subject to the six- or eight-year rule must work with their CDOs to make a request for a waiver by completing the attached 6/8 waiver request form. Such requests should be submitted no earlier than May prior to the new bidding cycle and no later than 30 days prior to the bid due date. The waiver request should be sent to the CDO, who will forward it to the Five/Eight Committee.

Requests for a 6/8 waiver where neither the employee nor a family member has any special physical or mental health condition that would require the Bureau of Medical Services’ (MED’s) expertise may be considered by the Committee without MED input. Examples include, but are not limited to, the need to spend time with otherwise healthy children; to assist their readjustment to new living circumstances; to complete an adoption; or to assist in the career or personal needs of a non-tandem spouse.

Where a particular physical or mental health condition, or extraordinary stress, or similar circumstances are presented as the justification for a 6/8 waiver, MED or an outside medical professional must confirm the basis for the request. The Committee reserves the right to seek MED’s opinion when it deems such opinion is necessary for proper adjudication of the request, consistent with the Health Insurance Portability and Accountability Act (HIPAA) and implementing regulations at 45 C.F.R. Parts 160 and 164. The point of contact in MED is the Chief of Domestic Programs (MEDDP@state.gov), who will relay the request to the appropriate office or person in MED and return a formal recommendation to the CDO or Committee, as appropriate.


Clearance Classifications (AKA: What Does My Clearance Classification Mean?)

16 FAM 211.2: Clearance Classifications

(CT:MED-41; 03-07-2019)
(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. Worldwide Available (Class 1): Issued to applicants, employees and eligible family members who have no identifiable medical conditions that would limit assignment abroad.

b. Post-Specific (Class 2): Issued to an individual with a medical condition that would pose a significant risk to the health or safety of the individual or others if the individual were assigned to work at one or more posts abroad. The Office of Medical Services (MED) determines approval for assignment to a specific post based on the criteria above.

c. Domestic Only (Class 5): Issued to all who have a medical condition which is incapacitating or for which specialized medical care is best obtained in the United States. Employees or eligible family members with a Class 5 medical clearance may not be assigned outside the United States.

d. Temporary Travel (Class 6): Issued only to an eligible family member 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 pre-employment medical evaluation is incomplete and the application 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 eligible family members following separation from State’s Medical Program. This includes eligible family members who have reached age 21, or persons leaving the program through legal separation, divorce, or death. Although qualified students who travel on educational travel orders are eligible for care abroad under the Medical Program up to their 23rd birthday (16 FAM122.2, subparagraph a(2)), their separation examination must be completed within 90 days of their 21st birthday (16 FAM 122.2, subparagraph a(1)).


ESCAPE Posts

Medical Clearance Guidance for Deploying to ESCAPE Posts

The Department of State has identified certain posts as Employee Self-Certification and Ability to Perform in Emergencies (ESCAPE) posts. ESCAPE posts comprise a subset of High-Threat, High Risk (HTHR) posts. All employees including Locally Employed Staff, contractors and Eligible Family Members who will be posted to a designated ESCAPE posts for 30 or more consecutive days are required to obtain a medical clearance. ESCAPE posts have limited medical capabilities and personal security risks. All individuals going to these posts must meet strict medical standards.

Current ESCAPE Posts Include:

  • Iraq (Must meet Department of State’s medical clearance requirements only)
  • Afghanistan, Libya, Peshawar, Somalia, Syria, and Yemen (All individuals going to these post must meet both the Department of State’s (DOS) and the Department of Defense’s (DOD) strict medical standards.)

DOS Medical Guidelines and DOD Medical Deployment Requirements.

The military provides emergency medical support for the Department of State in Afghanistan, Libya, Peshawar, Somalia, Syria, and Yemen. DOD deployment requirements are generally stricter than DOS medical clearance guidelines. While an individual may have Worldwide Availability under DOS guidelines, that same individual may not be approved for an ESCAPE post under DOD deployment requirements. Examples of chronic conditions that must meet stricter DOD requirements to be deployed to an ESCAPE include but are not limited to; tighter control of seizures, asthma, headaches and mental health issues; injectable or refrigerated medications; cardiovascular risk factors and excessive weight (BMI >35). Waivers of these DOD requirements may be granted in select cases.

Medical Clearance Requirements for ESCAPE Posts

Employees and their EFMs of one of the 5 Foreign Service Agencies must complete a:

Employees, LE Staff, Contractors, and EFMs who are Non-Foreign Service Personnel must complete a:

Persons holding a current valid ESCAPE medical clearance and are extending their tour at an ESCAPE post must complete the below documents annually.

Persons who are CONUS based doing frequent TDYs to ESCAPE post/s must complete the below documents every two years.

Persons who are not an ESCAPE post at the time of their medical clearance renewal must complete the below documents:

Employees and their EFMs of one of the 5 Foreign Service Agencies:

Employees, LE Staff, Contractors, and EFMs who are non-Foreign Service Personnel:

How to Submit Documents

Submit all medical documentation to Medical Records

Via email in PDF format to MEDMR@state.gov (preferred)
Or fax to 202-647-0292 (less preferred)
Include the Medical Records coversheet.

Instructions for Employee on Completing the Forms

  • Make sure the agency (DOS/DOD/USAID etc.) is entered. Under Status of Employee check or write in the appropriate designation (Employee, contractor, EFM, TDY, etc). If you are an institutional contractor, write the name of the specific contracting company or NGO.
  • ESCAPE Post(s) of Assignment is REQUIRED. If you are going on TDY, indicate if you are CONUS-based, any possible ESCAPE posts you may travel to, and estimated duration of your TDY.
  • All blanks need to be filled in. Please be sure that the name, DOB, and email address are all printed clearly. The name of the examinee (employee, contractor, LES or EFM) and DOB must appear at the top of each page 2, 3, & 4.
  • The employee, contractor, LE Staff, or EFM must provide a full explanation of all answers checked “Yes” on page 2. Provide explanations in section IIA on page 2 or on a separate sheet of paper.
  • On the DS-6570: Pre-Deployment Physical Exam Acknowledgement Form, the Employee, Contractor, LE Staff, or EFM must sign and date the bottom of page 2. Unsigned forms will not be accepted by Medical Records.
  • Contract employees should refer to their contracting managers in order to determine if they are participants in ICASS for medical care. Once employee obtains verification of ICASS medical program participation, submit the signed 3308 (for DOD) or 3308.5 (for Contractors) ICASS Verification Form along with the DS-6561 Medical Clearance form and DS-6570 ESCAPE Pre-Deployment physical exam acknowledgement form.

Instructions for Medical Providers on completing the forms:

  • The healthcare provider should review all yes answers on page 2 and provide relevant comments.
  • The healthcare provider must also review all current medications, dosages and frequency of use. Allergies must also be reviewed.
  • All items listed in the physical exam section on page 3 must be completed by the medical provider (examiner).
  • All chronic medical conditions must be listed on page 4 in assessment or problem list section. Each diagnosis must have a statement clarifying prognosis, stability, follow-up plan, and if that follow-up must be done by a specialist. An additional sheet of paper may be used if more space is needed. Providers are also encouraged to submit supporting medical reports, labs, and consults for each chronic condition. All foreign reports must be in English or translated into English.
  • The healthcare provider must print or stamp their name, as well as sign and date page 4. Unsigned forms will not be accepted by Medical Records.
  • All required tests on page 4 of the DS-6561 or DS-1843 should be performed within the last 12 months. In addition to the labs on DS-6561, a Hepatitis C Antibody Screen, and a Hepatitis B Surface Antigen Screen, plus a lipid profile for those 35 or older must be added to the DS-6561 or DS-1843. These are DOD medical standards. While not required for Iraq, these are advised for possible travel to other ESCAPE posts.
  • All optional tests are optional, unless clinically indicated, and not required for an ESCAPE post clearance.
  • On the DS-6570: Pre-Deployment Physical Exam Self-Acknowledgement Form, the medical provider (examiner) should sign page 1. Health care providers should not approve anyone they feel is not able to perform the functions outlined. Assure that the designated ESCAPE post/s are identified on page 1.

In-Service

In-Service Medical Clearance Update Guidance

Reason to Update a Medical Clearance While In-Service

All personnel must update their medical clearance prior to departure for a new overseas assignment.

The medical clearance process is designed to identify medical, mental health, or educational issues before departing for an overseas assignment. All persons posted overseas or on TDY travel for 30 or more consecutive days must have a valid medical clearance before they can access a post’s health unit and other Medical Program benefits abroad including coordination of a medical evacuation or hospitalization. While a medical clearance is not required for TDY travel of less than 30 days, persons with health concerns should avoid to travel to localities where medical care is inadequate to meet their needs.

The majority of people who have no significant health concerns and can be posted anywhere in the world. However, for some individuals with on-going medical, mental health or educational issues adequate medical resources may not be available in all countries. Medical Clearances matches an individual medical needs with posts capable of providing adequate medical or education services. Medical Clearances will not “clear” an individual to go to a post that does not have adequate resources for that person.

The in-service clearance process is simplified by the use of a DS-3057: Medical Clearance Update (MCU) form.

When to Update a Medical Clearance

An employee, contractor or Eligible Family Member (EFM) may start up-dating their medical clearance process up to one year prior to departing for their next overseas assignment or training.

Who May Do a Medical Clearance Update?

The following in-service employees, contractors and EFMs are required to update their medical clearance:

  • From one overseas assignment to another overseas assignment
  • From a domestic assignment to a new overseas assignment
  • On TDY overseas for more than 30 consecutive days
  • Extension of WAE status
  • Language or extended CONUS training for the assigned post after language training
  • Linked assignment for both current and linked assignment

Persons assigned to the United States and not traveling overseas do not require a medical clearance. Everyone is “cleared” to be in the United States. They are reminded that they must update their clearance before their next overseas assignment.

For How Long is a Medical Clearance Valid?

A medical clearance is valid until your scheduled home leave or end-of-tour whichever is sooner.

A TDY medical clearance is valid for 2 years from the date it was issued.

Individuals assigned to an ESCAPE post has a medical clearance valid for one year.

The Medical Clearance Form (MCU)

A DS-3057: Medical Clearance Update (MCU) is the preferred method of renewing a medical clearance. This brief, two page document requires does not require a physical exam.

The following employees, contractors and EFMs should not use a MCU: New employees (including newly hired EFMs), those switching agencies, any person not currently assigned to or has a valid TDY clearance for an ESCAPE post, separating from the Foreign Service, and new REA/WAEs.

The Medical Clearance Process

  1. Complete an MCU for each member of the family.For adults or children with a Post-Specific (Class 2) clearance or who have a new on-going medical, mental health or educational concerns should submit an MCU early. Ideally months in advance of bidding. Medical Clearances will ask for additional documentation regarding these individual’s current health or educational status shortly after receiving the MCU. ESCAPE Posts: Individuals who are currently assigned to an ESCAPE post or have a valid TDY Medical Clearance for ESCAPE Posts can complete an MCU but only at the Health Unit at their ESCAPE post or in the DOS Exam Clinic in Washington, DC. Current ESCAPE posts are Iraq, Afghanistan, Yemen, Somalia, Libya, Peshawar, and Syria. In depth information can be found at Medical Clearance Guidance for Deploying to ESCAPE Posts.
  2.  

  3. Send your completed forms and medical reports:

     
    Via email in a PDF format to MEDMR@state.gov (preferred)
    Or fax to 202-647-0292 (less preferred)
    Include the Medical Records coversheet.

  4.  

  5. The employee, contractor or EFM will be notified within 30 days of their clearance status. The process may take significantly longer than 30 days if additional information is needed to make a medical clearance decision. Those individuals will remain in a “pending” status.

Tips for Your In-Service Medical Clearance Update

  1. Take charge! Ask questions! Get involved! It is your clearance. Failure to have all family members’ medical clearances completed will delay the issuing of travel orders for individuals departing Washington DC.
  2. You may start one year prior to departing for your next overseas assignment.
  3. Clearly print the person’s name on each page submitted to Medical Records.
  4. Provide a current phone number and valid mailing address. Medical Clearance Notices will be sent to your via the e-mail address you place on your form. Please print your email legibly.
  5. List your prescription medications, hospitalizations, and medical conditions since your last clearance.
  6. Please check the signature area. A missing signature will delay the medical clearance review process.
  7. Do not travel to your next overseas assignment without a valid medical.

Pre-Employment/Pre-Assignment

Pre-Employment or Pre-Assignment Medical Clearance

The medical clearance process is designed to identify on-going medical, mental health, or special educational issues for which adequate resources may not be available at a specific post.

Foreign Service Officers and Limited Non-Career Appointees from any of the 5 Foreign Services Agencies must be able to serve at any post in the world for their first tour based on their pre-employment medical exam. Employees of other Government agencies, contractors, fellows and Eligible Family Members (EFMs) and do not need to meet this worldwide availability requirement on their first overseas assignment.

The following information will help explain the pre-employment/pre-assignment process.

Required Physical Exam Forms

Foreign Service Officer Candidates and EFMs of one of the 5 Foreign Affairs Agencies1

Limited Non-Career Appointees, Contractors, Civil Service, Locally Employed Staff, Personnel from Non-Foreign Service Government Agencies, and EFMs

Other Medical Information

Medical reports do not need to be submitted with your initial medical clearance forms, be aware that Medical Clearances may require reports from providers, medical facilities or schools for anyone with significant past medical, mental health, or special educational needs.

ESCAPE Posts: Afghanistan, Iraq, Yemen, Somalia, Libya, Peshawar, or Syria

Individuals assigned to any of these ESCAPE posts, including TDY travel of 30 or more consecutive days, must meet more rigid standards and undergo further medical vetting than addressed in this document. Please read and follow the instructions in Medical Clearance Guidance for Deploying to ESCAPE Posts.

Where to Perform a Medical Clearance Exam

  • The medical clearance exam may be completed for you and your family members by a licensed medical provider of your choice.If done overseas insure that the all sections, labs and reports are in English. The individual, parent or guardian should complete the first two pages of each form. Page 2 must be signed and dated. The examiner/provider should complete the physical exam and lab portion of the exam. In addition to the hand written lab section, MED requires copies of the lab and radiology reports and the EKG tracing, if indicated.
  • The clearance exam may also be done at the Department of State Exam Clinic in Washington DC for those over 6 years of age. For information on how to schedule an appointment with the Exam Clinic, contact MEDASEC@state.gov or 202-663-1779.

Payment

Medical Clearance related medical expenses not covered by your medical insurance may be reimbursed by receiving a DS-3069 payment authorization form from your human resources and submitting your invoices and “Explanation of Benefits” to Medical Claims at MEDClaims@state.gov.

Contractors and DOD Civilians should contact their sponsor’s human resources.

Tips for Submitting Your Medical Clearance Application

  1. Failure to have all family members’ medical clearance in order may delay your travel orders.
  2. Ideally type the form.
  3. Insure the patient’s name and date of birth is at the top of each page of the exam form.
  4. Provide a personal, legible e-mail address good for the next 90 days.
  5. EFMs, age 18 and over, must provide their own email address for privacy reasons
  6. Send your completed forms and medical reports:

     
    Via email in a PDF format to MEDMR@state.gov (preferred)
    Or fax to 202-647-0292 (less preferred)
    Include the Medical Records coversheet.

  7.  

  8. After a Medical Clearance is issued, any required follow-up care for any medical condition is the patient’s responsibility. Patients can arrange appointments on personal travel, during R&R, home leave or other government funded travel when services are not available at the post of assignment.

Post Specific (Class 2)

Guidance for Post Specific (Class 2) Employees, Contractors, and Eligible Family Members (EFMs)

There are several extra steps involved in bidding on overseas jobs if you or one of your Eligible Family Members (EFM) has a Post Specific (Class 2) Medical Clearance. The following information is designed to assist as you navigate the MED Post Approval process for those with a Post Specific clearance.

A Post Specific (Class 2) Medical Clearance means you (or your EFM) have (or has) an on-going medical, mental health, or educational issue where the medical capabilities needed may not be available at every post in the world. For example, if an individual needs an English speaking speech therapist, there are many posts he or she can go to, but many others that would not have that resource. Other conditions are less restrictive and others are more restrictive in terms of the number of posts with resource.

  1. If you or your EFM has a Post Specific clearance, we recommend you ACT EARLY! Getting reports from specialists, hospitals, therapist and schools is time consuming. You can begin up to one year prior to departure from your current post. Any documentation should be submitted well in advance of bidding season.
  2.  

  3. Complete a DS-3057: Medical Clearance Update (MCU) form.If available include reports from your specialists regarding the current status of your health issues. These should include summary reports of what follow-up you may need (specialist visits, radiology, labs, therapy visits, treatment regiments, etc.) and how often.If your child has educational needs or receives SNEA, reach out to the school and other specialists working with your child for recent documentation – ideally, before school staff departs for the summer break.
  4.  

  5. Send your completed forms and medical reports:

     
    Via email in a PDF format to MEDMR@state.gov (preferred)
    Or Fax to 202-647-0292 (less preferred)
    Include the Medical Records coversheet.

  6.  

  7. An MCU can be submitted to your health unit (preferred) or directly submitted to MEDMR@state.gov if you are in the USA or at a post without a health unit.
  8.  

  9. Early in the bidding season submit your bid list or post choices to your State Department CDO or agency human resources. Do NOT submit to Medical Clearances. State Department employees should start with a bid list of no more than 15 countries in alphabetical order. Additional countries can be submitted after the first 15 have been reviewed. Do NOT include any personal medical information in this communication.
  10.  

  11. Your CDO or agency HR will send your list to MED Clearances. Do NOT submit your bids to MED Clearances.
  12.  

  13. A MED Clearances Nurse Consultant assigned to you will follow this process:
  • Review the list of posts submitted by the CDO or agency HR.
  • Submit internal consults or reach out to you for additional data, as needed.
  • Consult the Medical Capabilities database and alternatively consult with post directly.
  • Document rationale for Post Approvals and/or Disapprovals.
  • Inform your CDO or Agency HR of approval determinations.
  • Your CDO or Agency HR will notify you of posts you have been medically cleared for your next assignment.

Employees and Contractors have the right to appeal any Post-Approval decision. If an employee wishes to contest a decision they may contact the Medical Review Panel (MRP) at MEDMRP@state.gov and a review will be convened by a three-physician panel. For further questions or information, please contact MEDClearances@state.gov.

For further questions or information, please contact MEDClearances@state.gov. Please send inquiries only to this email address. Send all medical forms and reports to MEDMR@state.gov. Sending forms and reports to the wrong email address results in confusion.


Separation/REA/WAE

Separation or Retirement Examination

The separation (or retirement) physical examination is for employees and eligible family members (EFMs) leaving the Foreign Service. This includes those retiring/separating from the Foreign Service, moving to the private sector, Civil Service or another agency, divorcing from a Foreign Service Spouse and Eligible Family Members turning 21 years of age. This exam is recommended but not mandatory.

The following information will help explain the process of completing a Separation Exam.

Reasons for a Separation or Retirement Exam

The medical examination performed at the time of separation from the Medical Program serves to identify medical conditions that may have developed during service abroad. In addition, MED encourages you to have your exam at your future medical provider’s office so that you can establish a medical relationship with your new provider.

Forms

Complete a DS-1843: Medical History and Examination for Foreign Service or Individuals Age 12 and Older form.

Complete a DS-1622: Medical History and Examination for Foreign Service for Children Age 11 and Younger form

Submit your completed forms and other medical reports to Medical Records:

Send via email to MEDMR@state.gov (preferred)
Or fax to 202-647-0292 (less preferred)
Include the Medical Records coversheet.

Those who send documents to MEDMR@state.gov will receive a confirmation e-mail indicating that the documents have been received. Keep original documents for your permanent files.

Medical Clearances reviews the submitted documentation and retains a copy in your permanent medical file.

Where to Perform a Separation Exam

  1. CONUS Option: The employee and EFMs are encouraged to have the separation medical exam completed by their private medical provider in the US. This is an opportunity to establish or re-establish a professional relationship with your primary care provider.
  2.  

  3. Exam Clinic Option: Appointments for separation or retirement examinations are available at Department of State Exam Clinic. For information on how to schedule an appointment with the Exam Clinic, contact MEDASEC@state.gov or 202-663-1779.
  4.  

  5. Post Health Unit Option: If you would like the examination at post, please contact your Foreign Service Medical Provider (RMO or MP) for guidance.

When to Do a Separation Exam

The employee and/or EFM should complete the separation exam within 90 days of retiring or separating from the Foreign Service. Travel orders are not required to start the process.

Possible Reemployed Annuitant/While Actually Employed (REA/WAE) Employee

If you are retiring and plan to work as a REA/WAE, please check the form under both separation and pre-assignment with REA/WAE handwritten next to pre-assignment.

Payment

Medical Clearance related medical expenses not covered by your medical insurance may be reimbursed by receiving a DS-3069 payment authorization form from your human resources and submitting your invoices and “Explanation of Benefits” to Medical Claims at MEDClaims@state.gov.

Tips for Your Separation Medical Examination

Clearly print the person’s name and date of birth on each page submitted to Medical Records.

Provide a valid phone number and e-mail address good for 90 days when you submit the paperwork.

The examinee, parent or guardian must sign and date page 2 of the DS-1843. The examiner must sign and date page 4 of the DS-1843. This is a medical-legal requirement.

U.S. Department of State

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