efmp

.:Exceptional Family Member Program:.

Bldg. 1551
Phone: 760-830-7740
Fax: 760-830-8997

Hours of Operation:
Mon - Fri: 7:30am - 4:30pm
Sat, Sun & Holidays: Closed
 

.:Extended Care Health Option (ECHO):.

            The Extended Care Health Option (ECHO) is a supplemental program to the TRICARE Basic benefit.  ECHO provides eligible active duty family members with an additional financial resource for services and supplies designed to help reduce the disabling effects of a beneficiary’s qualifying condition.  In 2005, ECHO replaced the TRICARE Program for Persons with Disabilities (PFPWD).

ECHO has no enrollment fee, however; you must register for ECHO to receive ECHO benefits.  Registration in ECHO requires the beneficiary be enrolled in the Exceptional Family Member Program (EFMP) as provided by the sponsor’s branch of service. There is no enrollment fee for the EFMP.

ECHO Eligibility

ECHO benefits are available to the following dependents with a qualifying condition:

  • TRICARE eligible dependents of members of the uniformed services, including members of the National Guard and Reserves activated for more than 30 days;
  • Family members eligible for continued TRICARE medical benefits through the Transitional Assistance Management Program (TAMP); 
  • Children or spouses of former members of the Uniformed Service who were victims of physical or emotional abuse;
  • Family members of a deceased active duty sponsor remain eligible for ECHO benefits during the period they are in transitional survivor status.

Qualifying conditions for ECHO include:

  • Moderate or severe mental retardation;
  • A serious physical disability;
  • A physical or psychological condition that causes the beneficiary to be homebound

Children may remain eligible for ECHO benefits beyond the usual TRICARE eligibility age limit (21 or age 23 if enrolled in college full time) provided the sponsor remains on active duty, the child is incapable of self-support because of a mental or physical incapacity that occurs prior to the loss of their eligibility, and the sponsor is responsible for more than one-half the child's support.

ECHO Coverage

Benefits provided under ECHO may include any of the following:

  • Medical and rehabilitative services;
  • Training to use assistive technology devices;
  • Special education;
  • Institutional care when a residential environment is required;
  • Transportation under certain circumstances;
  • Assistive services, such as those from a qualified interpreter or translator, for beneficiaries whose visual or hearing impairment qualifies them for ECHO benefits;
  • Durable equipment, including adaptation and maintenance of beneficiary-owned equipment;
  • In-home medical services;
  • In-home respite care services
  • Beneficiaries who are homebound may qualify for the ECHO Home Health Care (EHHC) benefit in addition to other ECHO benefits. 

Coverage Limit and Government/Sponsor Liability

Prior to the National Defense Authorization Act for Fiscal Year 2009 NDAA-FY09), the Government’s limit for the cost of all ECHO benefits combined, excluding the EHHC,was $2,500 per month.  NDAA-FY09 increased that limit to $36,000 per year.  The increased limit applies to training, rehabilitation, special education, assistive technology devices, and care in institutions and facilities-and transportation to and from such institutions and facilities.  The Government limit for the cost for all other ECHO benefits combined remains at $2,500 per month and the costs also accrue to the $36,000 annual limit.

ECHO-allowable amounts are not subject to a deductible. The cost-share for every month beneficiaries use ECHO benefits is based on the sponsor’s pay grade, as shown in the following table:

ECHO Cost-Share Amounts

Sponsor Pay Grade

Sponsor Cost-Share Amount

E-1 through E-5

$25.00

E-6

$30.00

E-7 and 0-1

$35.00

E-8 and 0-2

$40.00

E-9, WO/WO-1,CWO-2, and 0-3

$45.00

CWO-3, CWO-4, and 0-4

$50.00

CWO-5, 0-5

$65.00

O-6

$75.00

O-7

$100.00

O-8

$150.00

O-9

$200.00

O-10

$250.00

Reference: TRICARE Policy Manual: Chapter 9