Exceptional Family Member Program

Understanding the EFMP

By: Sue Hoppin, MOAA, Deputy Director for Spouse Outreach, Benefits Information Department

Question from Milspouse.com:

We are an active duty family of five and our son qualifies for the Exceptional Family Member Program (EFMP).  Are we better served by going to TRICARE Standard and choosing the physicians and specialists who would best serve the needs of our son?

Answer:

Only you understand your family’s needs and individual situations enough to make this decision.  There are some general guidelines that I will outline below, but remember that you will need to do a cost/benefit analysis to determine your TRICARE selection. 

If your son qualifies for the EFMP and you choose to participate in the program, first enroll with your sponsor’s military service branch, then register with the regional TRICARE office.  Once you’re enrolled in EFMP, you may be qualified for additional programs and services through the Extended Care Health Option (ECHO).  For information on EFMP, ECHO and additional resources, consult militaryhomefront.dod.mil/efmp.  Once there, type in “Special Needs Parent Toolkit” in the search engine to pull up an invaluable resource that will walk you through all your options, cost comparisons and point you to additional resources.  This information will help you make the decision that’s best for you and your family.

Remember that a family’s TRICARE selection can be split.  Outside of the service member who is automatically covered under TRICARE Prime, the election can be different among the other eligible family members.  Evaluate what type of care you’re currently getting in Prime.  If your son is able to receive the care he needs through your Military Treatment Facility (MTF) and the TRICARE referral system, Prime may be your best option and is the most cost effective. 

The greatest benefit of TRICARE Standard is the ability to manage your health care through your choice of providers.  While there are some costs associated with TRICARE Standard, for active duty families, the catastrophic cap for TRICARE covered benefits is $1000 per family per fiscal year. 

Regardless of what selection you make, remember that you are your son’s best advocate.  Outside of the military and TRICARE programs available for you, I hope that you will look into support groups both on and off the installation.  There’s a lot of comfort to be found in talking to other people who might be going through a similar situation.  In addition to providing moral support, they may be able to share some additional insights and resources with you.