Not everyone working for the federal government is eligible for treatment at a medical treatment facility (MTF).
Eligibility is verified by showing a valid ID card and using the Defense Enrollment Eligibility Reporting System (DEERS).
What is the Defense Enrollment Eligibility Reporting System (DEERS)?
DEERS is a computer system. It was developed to help with the military healthcare services and included systems to measure cost and catch fraudulent claims.
You can read all about Navy Medicine’s eligibility for care instruction in NAVMEDCOMINST 6320.3 series. This instruction helps with determining who was eligible to get medical and dental care at Navy facilities.
Family member enrollment is approved for all 7 uniformed services
- Air Force
- Marine Corps
- Coast Guard
- Public Health Service
- National Oceanic & Atmospheric Administration
How do family members become eligible for medical and dental care at Navy facilities?
In order for family members to take this opportunity, they had to complete the Uniformed Services Identification and Privilege Card application, DD 1172. Family members with cards are updated in the service member’s DEERS. If a problem so happens to occur regarding the active duty or family, it must be traced back to the sponsor’s personnel support detachment (PSD). Any other beneficiaries are to report to their nearest PSD as well.
How do HMs check beneficiaries for eligibility?
HMs will examine both DEERS and ID cards of the beneficiary. They will check for the date of expiration on the ID. Next, they will also be required to check DEERS using Composite Health Care System (CHCS), a system that allows clinicians to electronically perform patient appointment processes and scheduling, order laboratory tests, authorize radiology procedures and prescribe medications.
This DEERS verification process is detailed in OPNAVIST 1750.2 series, Defense Enrollment Eligibility Reporting System.
What happens when a patient is eligible but forgets his or her ID?
If the patient is found in DEERS but they don’t have their ID with them, they are required to first sign a statement that they are eligible for care and a reason why they don’t have their ID with them.
A valid ID must be provided within 30 calendar days or the patient will be billed as a Civilian Humanitarian Non-indigent (IAW) according to the Resources Management Handbook, NAVMED P-5020.
If this patient doesn’t have their ID and also can’t be found in DEERS, then non-emergency care will be denied.
What are some reasons why someone might no longer be eligible for Navy medicine care?
If a patient is not in DEERS and not eligible for care, non-emergency healthcare will be denied. There could also be many reasons for this, some of which include:
- Sponsor not enrolled in DEERS
- Family member not enrolled in DEERS
- Ineligible due to passed terminal eligibility date like a child who ages out at 18 years old
- Sponsor has separated from active duty
- Spouse is devoiced from the sponsor and not entitled to benefits as a former spouse
- Family member child is married
- Secretary of the Navy Designee
Who can deny requested care after a clerk performs an eligibility check?
Only command supervisory personnel can deny care.