DEFENSE SECURITY COOPERATION AGENCY  2800 DEFENSE PENTAGON  WASHINGTON, D.C. 20301-2800	11/21/2002

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SUBJECT :

MEDICAL POLICY FOR INTERNATIONAL TRAINING PROGRAM UPDATE MESSAGE - IMET AND FMS TRAINING. (DSCA POLICY MEMO 02-42)

1. THE PURPOSE OF THIS MESSAGE IS TO PROVIDE COMPREHENSIVE MEDICAL POLICY INFORMATION, INCLUDING CURRENT POLICY, RECENT CHANGES AND FUTURE INITIATIVES.
2. A LIST OF ACRONYMS USED IN THIS MESSAGE FOLLOWS:
   • AFIT - AIR FORCE INSTITUTE OF TECHNOLOGY
   • CONUS - CONTINENTAL UNITED STATES
   • DOD - DEPARTMENT OF DEFENSE
   • FMS - FOREIGN MILITARY SALES (FMS)
   • FY - FISCAL YEAR
   • IMET - INTERNATIONAL MILITARY EDUCATION AND TRAINING (PROGRAM)
   • IMS - INTERNATIONAL MILITARY STUDENT (MEANING STUDENT ATTENDING
   • TRAINING UNDER THE IMET OR FMS TRAINING PROGRAM)
   • ITO - INVITATIONAL TRAVEL ORDERS
   • MILDEPS - MILITARY DEPARTMENT INTERNATIONAL PROGRAM OFFICES
   • MTF - MEDICAL TREATMENT FACILITY
   • NATO - NORTH ATLANTIC TREATY ORGANIZATION
   • NPS - NAVY POSTGRADUATE SCHOOL
   • OSD/HA - OFFICE OF SECRETARY OF DEFENSE FOR HEALTH AFFAIRS
   • PFP - PARTNERSHIP FOR PEACE
   • SAO - SECURITY ASSISTANCE ORGANIZATION OR SECURITY ASSISTANCE OFFICER
   • STATE/PM - DEPARTMENT OF STATE/POLITICAL-MILITARY BUREAU
   • SOFA - STATUS OF FORCES AGREEMENT
   • TPMR - TRAINING PROGRAM MANAGEMENT REVIEW
   • USG - UNITED STATES GOVERNMENT
   • USMC - UNITED STATES MARINE CORPS
   • WHINSEC - WESTERN HEMISPHERE INSTITUTE OF SECURITY COOPERATION
3. CURRENT POLICY:
   1. PREDEPARTURE MEDICAL EXAMINATIONS FOR IMS AND AUTHORIZED ACCOMPANYING FAMILY MEMBERS (PRIOR TO ISSUANCE OF ITO) (PARAGRAPH 10-46A, JSAT AND CHAPTER 2 SECURITY ASSISTANCE HEALTH AFFAIRS HANDBOOK).
      1. FOR IMS:
         • COMPLETE PHYSICAL EXAMINATION TO INCLUDE CHEST X-RAY AND SEROLOGICAL TEST FOR HIV
         • MEDICAL CERTIFICATION (SIGNED BY COMPETENT MEDICAL AUTHORITY (PHYSICIAN) THAT THE NAMED INDIVIDUAL IS:
           • FREE OF COMMUNICABLE DISEASES
           • COMPLIED WITH REQUIRED IMMUNIZATIONS (CHAPTER 2 SECURITY ASSISTANCE HEALTH AFFAIRS HANDBOOK)
           • COMPLETE DENTAL EXAMINATION INCLUDING DENTAL CERTIFICATION (SIGNED BY COMPETENT DENTAL AUTHORITY (DENTIST)) THAT NO CARE IS REQUIRED FOR:
             • CARIES
             • INFECTION
             • ORAL DISEASE
      2. FOR EACH AUTHORIZED FAMILY MEMBER:
         • COMPLETE PHYSICAL EXAMINATION TO INCLUDE CHEST X-RAY AND SEROLOGICAL TEST FOR HIV
         • MEDICAL CERTIFICATION (SIGNED BY COMPETENT MEDICAL AUTHORITY (PHYSICIAN) THAT THE NAMED INDIVIDUAL IS:
           • FREE OF COMMUNICABLE DISEASES
           • COMPLIED WITH REQUIRED IMMUNIZATIONS (CHAPTER 2 SECURITY ASSISTANCE HEALTH AFFAIRS HANDBOOK)
         • NOTE: IF THE AUTHORIZED FAMILY MEMBER IS UNDER AGE 15, THE FOLLOWING TESTS ARE NOT REQUIRED:
           • SEROLOGICAL TEST FOR HIV
           • CHEST X-RAY
   2. MEDICAL FINANCIAL RESPONSIBILITY REQUIREMENT ON THE ITO FOR IMS AND AUTHORIZED FAMILY MEMBERS.
      1. FOR IMS:
         • SAO WILL CHECK THE APPROPRIATE BLOCK ON THE ITO TO INDICATE HOW MEDICAL CHARGES WILL BE PAID. FOR FMS STUDENTS, INDICATE WHETHER FMS CASE, IMS OR FOREIGN COUNTRY WILL PAY.
      2. FOR AUTHORIZED ACCOMPANYING FAMILY MEMBERS:
         • SAO WILL CHECK THE APPROPRIATE BLOCK ON THE ITO TO INDICATE HOW MEDICAL CHARGES WILL BE PAID. INDICATE WHETHER IMS OR FOREIGN COUNTRY WILL PAY. 'IF' FAMILY MEMBER MEDICAL CHARGES ARE NOT COVERED BY A FMS CASE OR BY THEIR HOME GOVERNMENT, SAO MUST INCLUDE STATEMENT TO THE EFFECT IN THE REMARKS SECTION OF THE SPONSOR'S ITO. IT IS ABSOLUTELY IMPERATIVE THAT FINANCIAL RESPONSIBILITY FOR MEDICAL CHARGES INCURRED FOR AUTHORIZED FAMILY MEMBERS IS CLEARLY AND CORRECTLY SHOWN ON THE SPONSOR'S ITO.
4. NEW POLICY:
   1. PROOF OF COVERAGE FOR COST OF HEALTH CARE FOR IMS AND AUTHORIZED FAMILY MEMBERS. HEALTH CARE IN THE UNITED STATES IS COSTLY. THE USE OF CIVILIAN HEALTH CARE PROVIDERS/TREATMENT FACILITIES MORE OFTEN THAN NOT REQUIRE THE PATIENT TO SHOW HOW THE BILLS TO BE INCURRED WILL BE PAID. YEARS OF EXPERIENCE IN THE INTERNATIONAL TRAINING BUSINESS MAKES A CONVINCING ARGUMENT TO ENSURE THAT BOTH THE IMS AND AUTHORIZED ACCOMPANYING FAMILY MEMBERS ARE COVERED FOR HEALTH CARE EXPENSES INCURRED DURING THE TIME THEY ARE IN THE UNITED STATES. HEALTH CARE EXPENSES OF THE CATASTROPHIC VARIETY CAN BE DEVASTATING, THUS THE RATIONALE THAT NECESSITATES THIS NEW POLICY REQUIREMENT PROMULGATED BY DSCA.
   2. WHAT IS THE MINIMUM REQUIRED 'QUALIFYING' MEDICAL INSURANCE COVERAGE?
      1. MEDICAL BENEFITS OF AT LEAST $50,000 PER ACCIDENT OR ILLNESS (SICKNESS).
      2. A DEDUCTIBLE NOT TO EXCEED $500 PER ACCIDENT OR ILLNESS.
      3. REPATRIATION OF REMAINS IN THE AMOUNT OF $7,500, SHOULD A DEATH OCCUR IN THE U.S.
         NOTE: THIS WOULD PROVIDE FOR THE PREPARATION AND TRANSPORTATION OF REMAINS TO HOME COUNTRY.
      4. MEDICAL EVACUATION IN THE AMOUNT OF $10,000 IN THE EVENT INSUREE MUST BE RETURNED TO HIS/HER HOME COUNTRY DUE TO A SERIOUS MEDICAL CONDITION.
      5. INSURANCE MUST PAY BENEFITS TO A DEPARTMENT OF DEFENSE MEDICAL FACILITY IF APPROPRIATE.
         NOTE: MEDICAL INSURANCE CAN BE PURCHASED ON LINE. INFORMATION ON MEDICAL INSURANCE CAN BE FOUND AT HTTP://DISAM.OSD.MIL/INTL_TRAINING/INTL_TNG_MGT FUNCTIONAL-HEALTH AFFAIRS.
   3. HEALTH COVERAGE REQUIREMENTS OUTLINED
      1. FOR IMS: EACH FMS IMS REPORTING TO CONUS TRAINING IS REQUIRED TO HAVE HEALTH CARE COVERAGE FOR HEALTH CARE CHARGES INCURRED CLEARLY AND CORRECTLY SHOWN ON THE ITO. ONE OF THE FOLLOWING STATEMENTS WILL APPEAR IN THE REMARKS SECTION.
         1. "THE IMS WILL BE REIMBURSED BY HIS HOME COUNTRY FOR HEALTH CARE CHARGES INCURRED. IMS IS REQUIRED TO FIRST PAY THE CHARGES AND OBTAIN REIMBURSEMENT FROM HIS COUNTRY."
         2. "MEDICAL BILLS SHOULD BE SENT TO THE FOLLOWING ADDRESS FOR PAYMENT."
         3. "IMS HAS ACQUIRED QUALIFYING MEDICAL INSURANCE COVERING THE ENTIRE PERIOD HE/SHE WILL BE PRESENT IN THE U.S. DURING THE SCHEDULED TRAINING."
         4. NOTE: THERE ARE SOME SPONSOR COUNTRIES THAT COME UNDER DIFFERENT MEDICAL COVERAGE. FOLLOWING IS A SHORT SUMMARIZATION OF COVERAGE BY INTERNATIONAL AGREEMENTS. IF A SAO IS NOT SURE HOW THE PAYMENT OF MEDICAL BILLS SHOULD BE ANNOTATED ON ITOS THEY PREPARE, THEY MUST CONTACT SONJA RUMSEY BY E-MAIL AT SRUMSEY@WORLD-NET FOR CLARIFICATION PRIOR TO PREPARING THE ITO.
            1. FOR AN IMS FROM A COUNTRY WITH A NATO/PPP SOFA:
               • HEALTH CARE AT A DOD MEDICAL TREATMENT FACILITY IS AS FOLLOWS:
                 - FREE OUTPATIENT CARE (MEDICAL AND DENTAL)
                 - INPATIENT CARE ON A REIMBURSABLE BASIS
               • HEALTH CARE AT A CIVILIAN MTF IS AS FOLLOWS: - FREE OUTPATIENT CARE (MEDICAL AND DENTAL) (REFERRING FACILITY PAYS)
                 - OUTPATIENT CARE ON A REIMBURSABLE BASIS WHEN NO DOD MTF IS AVAILABLE
                 - INPATIENT CARE ON A REIMBURSABLE BASIS
               • POLICY REQUIREMENT: WHEN IMS HAS FINANCIAL RESPONSIBILITY FOR PAYMENT OF HEALTH CARE COST, IN MOST CASES PROOF OF INSURANCE FOR INPATIENT CARE ONLY WILL BE REQUIRED.
            2. FOR IMS FROM COUNTRIES WITH A RECIPROCAL HEALTH CARE AGREEMENT. THE SPECIFICS WILL VARY FROM AGREEMENT TO AGREEMENT; HOWEVER, THESE AGREEMENTS DO 'NOT' COVER CIVILIAN IMS, PARAMILITARY AND IN SOME INSTANCES IMET/FMS IMS.
               • POLICY REQUIREMENT: FMS IMS MUST SHOW PROOF OF INSURANCE FOR CIVILIAN HEALTH CARE.
      2. FOR AUTHORIZED ACCOMPANYING FAMILY MEMBERS: EFFECTIVE WITH CY 2003, EACH AUTHORIZED FAMILY MEMBER OF AN IMS ATTENDING CONUS TRAINING IS REQUIRED TO HAVE COVERAGE FOR HEALTH CARE CHARGES INCURRED CLEARLY AND CORRECTLY STATED ON THE ITO. THIS REQUIREMENT APPLIES TO IMS SPONSORS WHO BRING FAMILY MEMBERS WITH THEM FOR PART OR ALL OF CONUS TRAINING. WHEN AN IMS IS RESPONSIBLE FOR HEALTH CARE COST FOR AUTHORIZED FAMILY MEMBERS PROOF OF MEDICAL INSURANCE MUST BE DEMONSTRATED TO THE IN COUNTRY ITO ISSUING AUTHORITY PRIOR TO FAMILY MEMBERS BEING 'AUTHORIZED' AND ADDED TO THE SPONSOR'S ITO.
         1. FAMILY MEMBERS ARE ENCOURAGED TO ACCOMPANY THE IMS ATTENDING THE FOLLOWING COURSES:
            • NATIONAL DEFENSE UNIVERSITY
            • ARMY WAR COLLEGE
            • COMMAND AND STAFF COLLEGE (ARMY)
            • SGT MAJOR ACADEMY (ARMY)
            • COMMAND AND STAFF COLLEGE (WHINSEC)(ARMY)
            • COMMAND COLLEGE (NAVY)
            • STAFF COLLEGE (NAVY)
            • COMMAND AND STAFF COLLEGE (USMC)
            • AMPHIBIOUS WARFARE SCHOOL (USMC)
            • JOINT SERVICES STAFF COLLEGE (FORMERLY ENTITLED ARMED FORCES STAFF COLLEGE)
            • AIR WAR COLLEGE (AIR FORCE)
            • COMMAND AND STAFF COLLEGE (AIR FORCE)
            • SQUADRON OFFICER SCHOOL (AIR FORCE)
            • NAVAL POSTGRADUATE SCHOOL (NPS - NAVY)
            • GRADUATE PROGRAMS AT AIR FORCE INSTITUTE OF TECHNOLOGY (AFIT)
         2. FAMILY MEMBERS ARE DISCOURAGED FROM ACCOMPANYING THE IMS AT MOST OTHER COURSES. HOWEVER, IF FAMILY MEMBERS DO ACCOMPANY THE IMS AND THE IMS IS FINANCIALLY RESPONSIBLE FOR THE HEALTH CARE OF THE ACCOMPANYING FAMILY MEMBERS, THE IMS MUST HAVE PROOF OF HEALTH INSURANCE.
         3. WHEN ACCOMPANYING FAMILY MEMBERS ARE AUTHORIZED, THE IMS'S ITO WILL INCLUDE ONE OF THE FOLLOWING MANDATORY STATEMENTS (AS APPLICABLE) IN THE REMARKS SECTION.
            1. "THE IMS HAS BEEN FULLY BRIEFED ON THE REQUIREMENT TO SHOW PROOF OF MEDICAL INSURANCE FOR AUTHORIZED FAMILY MEMBERS UPON ARRIVAL AT THE FIRST CONUS TRAINING LOCATION."
            2. "AT THE TIME THE IMS'S ITO WAS ANNOTATED TO AUTHORIZE ACCOMPANYING FAMILY MEMBERS, SAID IMS PROVIDED PROOF OF QUALIFYING MEDICAL INSURANCE TO THE SAO TRAINING OFFICE."
            3. "THE IMS HAS BEEN MADE FULLY AWARE THAT A 'LACK' OF MEDICAL INSURANCE COVERAGE FOR ACCOMPANYING FAMILY MEMBERS, REVEALED AT ANY TIME DURING CONUS TRAINING COULD RESULT IN THE IMS'S REMOVAL FROM SCHEDULED CONUS TRAINING AND RETURN TO COUNTRY."
            4. OTHER POSSIBLE STATEMENTS (AS APPLICABLE):
            5. "THE STUDENT WILL BE REIMBURSED BY HIS HOME COUNTRY FOR MEDICAL CHARGES INCURRED BY HIS FAMILY MEMBERS. STUDENT IS REQUIRED TO FIRST PAY FOR MEDICAL CHARGES INCURRED BY FAMILY MEMBERS."
            6. "MEDICAL BILLS FOR FAMILY MEMBERS SHOULD BE SENT TO THE FOLLOWING ADDRESS FOR PAYMENT."

         4. NOTE: THERE ARE SOME SPONSOR COUNTRIES THAT COME UNDER DIFFERENT MEDICAL COVERAGE. FOLLOWING IS A SHORT SUMMARIZATION OF FAMILY MEMBER COVERAGE. BOTTOM LINE: IF AN SAO IS NOT SURE HOW THE PAYMENT OF MEDICAL BILLS FOR FAMILY MEMBERS SHOULD BE ANNOTATED ON ITOS THEY PREPARE, THEY MUST CONTACT SONJA RUMSEY BY E-MAIL AT SRUMSEY@WORLD-NET FOR CLARIFICATION PRIOR TO PREPARING THE ITO.

            1. FOR IMS FROM A COUNTRY WITH A NATO OR PFP SOFA:
               • MEDICAL CARE AT A DOD MEDICAL FACILITY FOR FAMILY MEMBERS IS AS FOLLOWS:
                 - FOR AUTHORIZED FAMILY MEMBERS
                 - FREE OUTPATIENT CARE (MEDICAL AND DENTAL EMERGENCIES)
                 - INPATIENT CARE ON A REIMBURSABLE BASIS
               • HEALTH CARE AT A CIVILIAN MTF IS AS FOLLOWS:
                 - FOR AUTHORIZED FAMILY MEMBERS
                 - OUTPATIENT CARE - TRICARE STANDARD (OLD CHAMPUS PROGRAM) PATIENT PAYS PATIENT PORTION
                 - INPATIENT CARE ON A REIMBURSABLE BASIS
               • POLICY REQUIREMENTS: WHEN IMS HAS FINANCIAL RESPONSIBILITY FOR PAYMENT OF HEALTH CARE COST FOR ACCOMPANYING FAMILY MEMBERS IN MOST CASES PROOF OF INSURANCE FOR INPATIENT CARE ONLY WILL BE REQUIRED.
            2. FOR IMS FROM A COUNTRY WITH A RECIPROCAL HEALTH CARE AGREEMENT (RHCA)
               • THERE ARE CERTAIN COUNTRIES WITH A RECIPROCAL HEALTH CARE AGREEMENT BETWEEN THE U.S. AND THAT COUNTRY. THE SPECIFICS VARY FROM AGREEMENT TO AGREEMENT; HOWEVER, RECIPROCAL AGREEMENTS DO 'NOT' PROVIDE FOR MEDICAL CARE FOR CIVILIAN IMS; FOR PARAMILITARY IMS; AND SOME DO NOT COVER FAMILY MEMBERS OF AN IMS.
               • POLICY REQUIREMENT:
                 - WHEN FAMILY MEMBERS ARE COVERED BY THE RHCA: SHOW PROOF OF MEDICAL INSURANCE FOR CIVILIAN HEALTH CARE.
                 - WHEN FAMILY MEMBERS ARE NOT COVERED BY THE RHCA: SHOW PROOF OF MEDICAL INSURANCE FOR ALL HEALTH CARE.

             

         5. COPIES OF IMMUNIZATION RECORD AND PHYSICAL EXAMINATION, TO INCLUDE COPY OF MEDICAL CERTIFICATION, HIV TEST AND RADIOLOGY REPORT OF CHEST X-RAY MUST ACCOMPANY IMS AND AUTHORIZED ACCOMPANYING FAMILY MEMBERS.
         6. REQUIREMENT, EFFECTIVE IMMEDIATELY, TO INCLUDE FOLLOWING STATEMENT IN THE ITO REMARKS SECTION: 'MEDICAL EXAMINATION, TO INCLUDE HIV TEST, WAS COMPLETED ON MM/DD/YYYY. PROGRAM REQUIREMENTS HAVE BEEN COMPLIED WITH.' NOTE: DSCA WILL WORK TO UPDATE APPLICABLE REGULATIONS TO REFLECT THIS CHANGE.
         7. CHEST X-RAY REQUIREMENT: IF AN INDIVIDUAL NEEDS TO TRAVEL TO THE U.S. FOR TRAINING MORE THAN ONCE IN A 12 MONTH PERIOD AND THE CHEST X-RAY PRIOR TO THE INITIAL TRAINING PERIOD IS DOCUMENTED TO HAVE BEEN NEGATIVE FOR ACTIVE DISEASE, A REPEAT CHEST X-RAY(S) IS NOT REQUIRED UNLESS THE INDIVIDUAL HAS SYMPTOMS OR A CLINICAL EXAMINATION WHICH IS SUSPICIOUS FOR A PULMONARY (LUNG) PROBLEM. NOTE: DSCA WILL WORK TO UPDATE APPLICABLE REGULATIONS TO REFLECT THIS CHANGE.
5. FUTURE IMS MEDICAL POLICY INITIATIVES: CURRENTLY IN-WORK.
   1. STANDARD DOD APPROVED MEDICAL HISTORY AND PHYSICAL EXAMINATION FORMS. DSCA WILL CONDUCT TEST, IN SELECTED COUNTRIES, THE USE OF DD FORM 2807 MEDICAL HISTORY AND DD FORM 2808 PHYSICAL EXAMINATION. COMPLETED FORMS WILL ACCOMPANY IMS TO THEIR CONUS TRAINING INSTALLATION FOR A ONE YEAR PERIOD AND THEN IMPLEMENT WORLDWIDE IF SUCCESSFUL.
   2. FINAL REVIEW, STAFFING AND PROMULGATION OF THE MEDICAL POLICY HANDBOOK FOR THE SECURITY ASSISTANCE COMMUNITY.
6. THIS POLICY MESSAGE WAS COORDINATED WITH STATE/PM, OSD/HA, SERVICE SURGEON GENERAL OFFICES, UNIFIED COMMANDS AND MILDEPS.
7. POCS FOR THIS POLICY MESSAGE ARE BRION MIDLAND/DSCA/P3-P2 (UNCLAS) E-MAIL: BRION.MIDLAND@OSD.PENTAGON.MIL (ALL LOWER CASE) AND SONJA RUMSEY, INTERNATIONAL HEALTH CARE CONSULTANT, DEFENSE INSTITUTE OF MEDICAL OPERATIONS (DIMO), (UNCLAS) E-MAIL: SRUMSEY@WORLD-NET (ALL LOWER CASE). BT #8100

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