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Eligibility

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Although DEERS and the ID card system are related, there are instances when the beneficiary is in possession of a valid ID card and the DEERS system shows the patient as ineligible or not in the database. In these instances, eligibility verification using the ID card shall not override DEERS without some other type of collateral documentation. (See sections on DEERS overrides and exceptions later in this chapter.) It must be stressed that military treatment facilities (MTFs) are to verify eligibility. Establishment of eligibility is under the cognizance of the respective service personnel offices. Eligibility Patients who present for non-emergency treatment without a valid ID card but who are in the DEERS database will not be provided medical care without first signing a statement that they are eligible and giving the reason why a valid ID card is not in their possession. If a valid ID card is not provided within 30 calendar days, the patient is referred for billing as a Civilian Humanitarian Non-indigent, in accordance with the R e s o u rc e s M a n a g e m e n t H a n d b o o k, NAVMED P-5020. Such billing may be delayed if the commanding officer of the facility is convinced proof is delayed for reasons beyond the control of the patient or sponsor. In all cases where a patient presents without an ID card and does not appear in the DEERS database, non-emergency care will be denied. REASONS FOR INELIGIBILITY.—When a DEERS check is performed and the patient is found ineligible for any of the following reasons, routine non-emergency healthcare will be denied (except as noted later in this section).  Sponsor not enrolled in DEERS  Dependent not enrolled in DEERS  Ineligible due to passed terminal (end) eligibility date  Sponsor has separated from active duty  Spouse is divorced from sponsor and is not entitled to benefits as a former spouse  Dependent child is married UNDER NO CIRCUMSTANCES WILL THE CLERK PERFORMING THE ELIGIBILITY CHECK DENY THE REQUESTED CARE. Only command-designated supervisory personnel can perform this function. DEERS ELIGIBILITY OVERRIDES.—The nine “DEERS eligibility overrides” are listed below. Unless otherwise stated, all overrides must be supported by a valid ID card. 1. DD 1172—The patient presents an original or copy of the DD 1172 used for DEERS enrollment. There are specific items required for verification, and current service directives must be checked. 2. All Other Dependents Recently Becoming Eligible for Benefits—Patients who become eligible for benefits in the previous 120 days may be treated upon presentation of a valid ID card. For children under 10 years of age, a valid ID card of a parent or guardian is acceptable. Upon application for care beyond 120 days, follow the procedure in item 1, above. 3. New Identification Card—Patients presenting with a new valid ID card, issued within the previous 120 days, will not be denied care. 4. Ineligible Due to ID Card Expiration—When the database shows a patient as ineligible because of ID card expiration, care may be rendered as long as the patient has a new ID card issued within the previous 120 days. After 120 days, follow the procedure in item 1, above. 5. Sponsors Entering Active Duty Status for a Period of Greater than 30 Days—A copy of orders ordering a reservist or guardsman to an active duty period of greater than 30 days may be accepted for the first 120 days of the active duty period. After that, follow the procedure in step 1. 6. Newborns—Newborns will not be denied care for a period of 1 year following birth. The patient’s birth certificate suffices when presented with a parent’s valid ID card. 7. Emergency Care—This is a medical decision and shall be determined by criteria established within the command. 8. Sponsor’s Duty Station is Outside the 50 United States or has an APO/FPO Address—Dependents whose sponsors are assigned outside the 50 United States or to a duty station with an APO/FPO address will not be denied care as long as the sponsor is enrolled and eligible in DEERS. 9. Survivors—When an eligibility check indicates that a deceased sponsor is not enrolled 15-2



   


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