Medical Clearance and Healthcare FAQs

The following seeks to address questions from prospective employees of the Department of State, USAID, and other foreign affairs agencies about medical clearance processing and LGBTQIA+ healthcare domestically and abroad.

This information is grouped by topic below, was compiled by glifaa, and reflects our understanding of current State Department policy. However, this informal Q&A is not an official publication of the Department of State nor any other U.S. Government agency and has not been cleared by any U.S. government source.

Please reach out to your Health Unit, Regional Medical Officer, the Bureau of Medical Services, Management Section, Executive Office, and/or Human Resources office to confirm the accuracy of this information before taking any action based on the contents of this page.

This page was last updated in August 2022.

Medical Clearance and Healthcare Topics

Health Insurance

Q: What health insurance coverage is available for U.S. government employees?
A: Most Federal employees are eligible to elect insurance coverage under the Federal Employees Health Benefits (FEHB) Program, managed by the Office of Personnel Management. The FEHB program offers access to a wide range of health insurance plans that meet OPM’s coverage regulations and are offered by private providers. Your agency determines your eligibility for FEHB participation and some positions may be excluded by law or regulation. If you did not enroll during the 60-day period after your employment start date, you can enroll during the annual Federal Benefits Open Season (mid November through mid-December) or upon experiencing an FEHB-specific Qualifying Life Event. Visit OPM’s website at https://www.opm.gov/healthcare-insurance/ to learn more.

Q: Can my family members enroll in the FEHB insurance program?
A: Certain family members (defined as “Eligible Family Members“) are eligible for coverage under FEHB’s “Self and Family” or “Self Plus One” enrollment options. Eligible family members include your spouse and children under age 26, including children placed for adoption, recognized natural children, and stepchildren. Foster children and a child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 may be covered in some cases as well. Visit OPM’s website at https://www.opm.gov/healthcare-insurance/ to learn more.

Q: I will be a U.S. government employee working under Chief of Mission authority abroad, and my agency participates in the State Department’s medical program. Can my unmarried partner (same-sex or opposite-sex) participate in the FEHB and State Department medical programs?
A: No. Generally, in order to be eligible for FEHB health insurance coverage and to participate in the State Department’s medical program, all partners (same-sex or opposite sex) must be legally married.

Q: Does the U.S. Federal government recognize legally valid same-sex marriages for purposes of issuing health insurance coverage and other benefits available to spouses?
A: Yes, as of June 26, 2013. Prior to this date, the Defense of Marriage Act prevented the Federal government from recognizing same-sex marriages. In the U.S. v. Windsor decision issued on that date, the Supreme Court determined the Defense of Marriage Act was a violation of the Due Process Clause of the Fifth Amendment. Since this decision, the U.S. government recognizes legally valid same-sex marriages. Same-sex marriage became legal nationwide following the Supreme Court’s 2015 Obergefell v. Hodges ruling. From 2009 to 2015, while the Defense of Marriage Act was in effect and prior to the Obergefell ruling, the State Department operated a Same-Sex Domestic Partnership program that provided limited employee benefits (not including healthcare coverage) to same-sex partners. More information on the discontinued SSDP program is available from glifaa’s website archive.

Q: My partner and I were legally married abroad. Is our marriage valid in the United States for purposes of obtaining health insurance and other Federal benefits available to spouses?
A: According to 7 FAM Exhibit 1454, in general, marriages which are legally performed and valid abroad are also legally valid in the United States. Inquiries regarding the validity of a marriage abroad should be directed to the attorney general of the state in the United States where the parties to the marriage live.

Q: Do all FEHB plans offer the same coverage for LGBTQIA+ and gender-affirming healthcare?
A: No. While all providers are required to meet basic OPM standards for FEHB coverage, each plan has its own policies and rules regarding the extent to which specific healthcare procedures are covered. Researching and understanding what your plan will cover is extremely important for those seeking LGBTQIA+ care, especially gender-affirming healthcare, as not all FEHB plans offer the same benefits.

Medical Care in the United States

Q: How do I seek care under FEHB health insurance while in the United States?
A: In the United States, FEHB operates like any other employer-provided, private health insurance plan. During Open Season (generally mid-November to mid-December), you can select a health insurance plan offered by private insurance providers who participate in the FEHB program. All providers are required to meet basic OPM standards for FEHB coverage, but each plan has its own policies and rules regarding the specific healthcare procedures covered. Researching and understanding the specifics of what your plan will cover is extremely important for those seeking LGBTQIA+ and gender-affirming healthcare, as not all FEHB plans offer the same benefits. If you need medical care in the United States, reach out to your primary care physician, local urgent care, or the nearest hospital emergency department. For concerns over public health threats such as emerging infectious diseases, contact your local public health department.

Medical Care Abroad

Q: What medical care is available abroad to U.S. government employees and family members?
A: The State Department’s Bureau of Medical Services (MED) provides healthcare to U.S. government direct-hire (USDH) employees and their eligible family members (EFMs) while assigned to U.S. embassies and consulates worldwide. MED has over 200 clinicians working in more than 170 countries, supported by medical and administrative personnel in Washington, DC and abroad. U.S. government employees from the State Department, USAID, and other foreign affairs agencies operating under Chief of Mission authority while assigned to U.S. embassies and consulates are generally covered by the State Department’s medical program. More information is available on MED’s website at https://www.state.gov/bureaus-offices/under-secretary-for-management/bureau-of-medical-services/.

Q: I will be a U.S. government employee working under Chief of Mission authority abroad, and my agency participates in the State Department’s medical program. Do I also need to have FEHB coverage?
A: Yes, in most cases. MED usually offers primary care provider and will often provide referrals to local healthcare providers and specialists. Employees are responsible for paying the cost of this locally provided care abroad upfront and seeing reimbursement through FEHB insurance plans. In case of hospitalization, MED can operate as a secondary payer, but primary reimbursement must be obtained through the FEHB insurance provider.

Q: Do all FEHB plans provide coverage outside of the United States?
A: No. If you are working abroad, make sure to select an FEHB plan that offers international coverage. You can find international FEHB plans using the Compare Plans tool on OPM’s website at https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/. More information on international coverage is available from OPM at https://www.opm.gov/healthcare-insurance/healthcare/plan-information/important-facts-about-overseas-coverage/.

Medical Clearance Processing

Q: I will be a U.S. government employee working under Chief of Mission authority abroad, and my agency participates in the State Department’s medical program. Am I required to obtain a medical clearance?
A: Yes. Per 16 FAM 120, to be eligible for MED Medical Privileges, including Health Unit access at posts abroad and assistance with a medical evacuation, any individual working under Chief of Mission authority abroad for more than 30 consecutive days must have a valid medical clearance. Additionally, the sponsoring agency must subscribe to the medical portion of the post ICASS package on behalf of the individual, and the sponsoring agency must fund a medical evacuation or the individual must carry personal medical evacuation insurance. More information about the medical clearance process is available on MED’s website at https://www.state.gov/start-here-steps-to-a-medical-clearance/ and https://www.state.gov/popular-topics-medical-clearances/.

Q: My family members and I have been issued a Class Two (or more restrictive) medical clearance based on a diagnosed medical condition. Is there a quick way to check where I can serve?
A: The State Department’s Bureau of Medical Services (MED) maintains a Medical Clearance Preview Tool that is currently accessible only to State Department OpenNet account holders who can access OpenNet in the office, via Go Desktop, or using Go Virtual. The tool is accessible from the Medical Clearances homepage on the State Department Intranet. To find the tool, search for “Medical Clearances” on the home page or via search.state.gov.

Q: Will I be asked about my sexual orientation and/or gender identity during the medical clearance process? Will I be asked if I have sought LGBTQIA+ or gender-affirming healthcare?
A: All medical clearance applicants are asked to disclose their gender (listed as sex) on the medical clearance form. While you otherwise might not be asked directly about your sexual orientation and/or gender identity during the medical clearance process, there are circumstances in which you could be asked directly about this or in which it would be unavoidable to reveal it. During the medical evaluation, the physician may ask about your sexual activity, any medication you are taking or have taken, or any medical procedures you have undergone. You will also be asked if you have consulted a therapist or other mental health professional, and to explain the circumstances of your treatment. If the circumstances are linked to your sexual orientation and/or gender identity, it is possible that you would need to disclose your orientation and/or gender identity. In all cases, candor and honesty are essential and it is incumbent upon the applicant to be complete and forthcoming in providing relevant information for the medical clearance evaluation process. Being part of the LGBTQIA+ community is not a barrier to employment with U.S. government. U.S. law forbids discrimination on the basis of sexual orientation and gender identity when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, and any other term or condition of employment. For more information on the legal protections provided by Title VII of the Civil Rights Act following the Supreme Court’s 2020 Bostock v. Clayton County decision, visit the Equal Employment Opportunity Commission’s website at https://www.eeoc.gov/sexual-orientation-and-gender-identity-sogi-discrimination.

Q: I previously experienced Sexual Orientation Change Efforts (SOCE), aka “conversion therapy.” Will I be required to disclose this as mental health therapy to MED? Will MED contact my SOCE provider for more information about my experience?
A: Sexual Orientation Change Efforts (SOCE) are not therapy. SOCE techniques, also known as “conversion therapy,” are discredited by most psychologists and psychological organizations and have been banned for minors in 20 states and over 100 municipalities in the United States as well as a growing number of countries around the world (as of 2021). In its February 2021 resolution on SOCE, the American Psychological Association reiterated its opposition to this practice, stating, “APA opposes SOCE because such efforts put individuals at significant risk of harm, and [APA] encourages individuals, families, health professionals, and organizations to avoid SOCE,” a position “consistent with other major professional mental health associations, including the Pan-American Health Organization (2012), American Counseling Association (2017), American Academy of Child and Adolescent Psychiatry (2018), American Psychiatric Association (2000), National Association of Social Workers (2015), and World Psychiatric Association (2016).” You should not be asked to contact your SOCE provider as part of the medical clearance process. If you need further assistance regarding this matter, please email the glifaa board at board@glifaa.org to request an individual advocacy case consultation.

Individuals Living with HIV

Q: Will I be tested for HIV during the employment application process?
A: Yes. An HIV test is a standard part of the required medical exam for U.S. government employees covered by the State Department’s medical program.

Q: I am a person living with HIV. Will my HIV+ status prevent me from obtaining a State Department Class One/Worldwide Available medical clearance?
A: Employees and eligible family members living with HIV currently serve successfully around the world in the State Department and many other U.S. government foreign affairs agencies. For medical clearance assessments on the basis of HIV status alone, State MED generally considers HIV+ individuals with an undetectable viral load and without additional complications as eligible for a Class One/Worldwide Available medical clearance. Successful HIV treatment, including maintaining good compliance with daily antiretroviral therapy, is an essential step towards obtaining and keeping a Class One medical clearance. When a person living with HIV begins an antiretroviral treatment regimen, their viral load drops. For almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less. Continuing to take HIV medications as directed is imperative to stay undetectable. Please note that each medical clearance is considered individually and your specific medical circumstances may lead to a different clearance determination. In addition to any medical clearance restrictions, some countries may refuse to accredit (and/or decide to prohibit the entry of) individuals living with HIV. Additional information on country-specific entry restrictions for LGBTQIA+ travelers and people living with HIV can be found on travel.state.gov and the Global Database on HIV-Specific Travel and Residence Restrictions.

Q: I’m a person living with HIV. Who at State will know my status beyond the MED bureau?
A: The State Department’s MED staff regards its medical clearance evaluations and the existence of any condition to be medically privileged information that cannot be divulged without the consent of the individual, except when that individual is at risk for harming themselves, someone else, or U.S. national security. In addition, Department medical records are protected by the Privacy Act. Under this federal law, information from Department of State medical records may be disclosed within the Department only to those individuals who have a specific need for this information in the performance of their official duties. Lastly, all MED medical providers sign a Code of Conduct that requires the protection of personal health information.

Q: If I become HIV+ after I’m hired, will it affect my employment? Do I need to tell MED?
A: Personnel who hold medical clearances must update their medical clearances periodically and are required to inform MED of changes in health status during the medical clearance update process. By itself, a change in HIV status should not affect a person’s continued employment with the State Department. However, certain health complications – especially those associated with undiagnosed and untreated HIV – can affect medical clearance status. Regular testing (at least once per year) can help ensure you always know your status and can start treatment immediately if necessary. For medical clearance assessments on the basis of HIV status alone, State MED generally considers HIV+ individuals with an undetectable viral load and without additional complications as eligible for a Class One/Worldwide Available medical clearance. Successful HIV treatment, including maintaining good compliance with daily antiretroviral therapy, is an essential step towards obtaining and keeping a Class One medical clearance. Certain conditions associated with undiagnosed and untreated HIV can affect an employee’s ability to maintain a Class One/Worldwide Available medical clearance, but persons with limited medical clearances can and do continue to serve in the Foreign Service. Depending on an individual’s condition and the availability of appropriate medical resources, an HIV+ person who cannot maintain an undetectable viral load and/or is experiencing additional complications could be approved for more limited overseas assignments. Medical clearance and assignment decisions for all employees, including people living with HIV, are made on a case-by-case basis considering the totality of individual health circumstances.

Q: My agency requires me to maintain a Class One/Worldwide Available medical clearance in order to obtain tenure. If I become HIV+ after I’m hired, but before I obtain tenure, will it affect my ability to obtain tenure and maintain continued employment?
A: USAID and some other agencies may require Foreign Service employees to maintain a Class One/Worldwide Available medical clearance in order to be tenured (usually within three to five years of the employment start date). Initially, a new HIV diagnosis may result in a more limited medical clearance as the employee begins treatment, before viral load drops. However, for almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less, likely allowing an employee regain a Class One/Worldwide Available medical clearance. For employees whose tenure review is scheduled during this initial six-month treatment period, a waiver may be available on the basis of the temporary nature of the limited medical clearance status. Consult your agency’s human resources policy manual for more information about the waiver process. If you need further assistance regarding this matter, please email the glifaa board at board@glifaa.org to request an individual advocacy case consultation.

Q: What happens if I am HIV- and have an HIV exposure while serving abroad (i.e. needle stick, condom break, sexual assault)?
A: Contact your Health Unit as soon as possible. All State Department Health Units worldwide stock emergency Post-Exposure Prophylaxis (PEP) medication on-site and can provide it immediately if required.

PrEP (Pre-Exposure Prophylaxis) FAQs

Q: What is PrEP?
A: PrEP is a medicine that people without HIV can take in order to reduce their chances of becoming infected with HIV. Individuals at higher risk for HIV infection often choose to take PrEP on a daily basis. Studies have found that PrEP was highly effective at reducing the risk of HIV infection when taken correctly and consistently. No method, including PrEP, can eliminate all risk of HIV infection. PrEP only targets HIV; it does not prevent any other kinds of sexually transmitted infection. PrEP is different from post-exposure prophylaxis (“PEP”), an emergency treatment given to an HIV-negative person thought to have recently been exposed to HIV. It is also different from treatment as prevention, where a person already living with HIV takes medication that lowers their viral load and reduces their chances of disease progresion and passing the virus to others.

Q: How can I get a new PrEP prescription and/or refill while serving at U.S. missions abroad?
A: Employees and eligible family members (EFMs) who select the Foreign Service Health Benefit Plan (FSBP) as their FEHB health insurance provider can receive generic PrEP medication for free through the U.S. specialty mail-order pharmacy Accredo (+1-800-803-2523). There are two options for employees and EFMs on the FSBP to access this benefit at posts abroad. First, an employee can request an appointment with their Health Unit to discuss if PrEP is right for them and to have a prescription for a one-year supply (under the plan’s “vacation policy”) transmitted to Accredo and mailed to post via DPO/Pouch. Depending on local conditions, health units may or may not be able to support the quarterly lab testing that is recommended for those taking PrEP. Second, if employees and EFMs prefer to consult with a personal physician, any U.S.-based health care provider can transmit a prescription for a one-year supply (under the plan’s “vacation policy”) to Accredo. However, some U.S. physicians may be unwilling to do this, as the quarterly lab work cannot be completed under their supervision. Your Health Unit may or may not be able to coordinate the use of a local laboratory for the lab work, and results can be shared with your U.S. physician when they are received. If your personal U.S. physician is willing to prescribe PrEP while you are posted overseas, you should ensure your physician sends a one-year prescription of the generic form of the medicine to Accredo (+1-800-803-2523). After the prescription is transmitted, you should contact Accredo (+1-800-803-2523) to confirm the full one-year supply will be filled using the generic drug in one shipment. This is part of the FSBP pre-authorization process. The full one-year supply will ensure you have enough medication to stay on PrEP without interruption. Accredo’s default will be to only fill a three-month supply, even though the prescription was transmitted for one year. When you call Accredo, you should ask the Accredo representative to ensure the full one-year supply is delivered in one shipment and in generic form. You can note this is a special benefit under the FSBP (known as the “vacation policy”) for Foreign Service employees and EFMs serving abroad. (Please note: if Accredo fills the prescription under the brand name – i.e. Truvada – instead of the generic, you may incur a significant cost.)

Q: Can MED ensure that I will receive quarterly lab testing as recommended for PrEP users?
A: Foreign Service employees and family members serve across the world and have varying access to medical care depending on the post of assignment. While lab testing on a quarterly basis may not be available at all posts, MED has committed to ensuring personnel can access PrEP medications at all posts worldwide. Please consult with your Health Unit for more information.

Q: I am on PrEP and the costs of my medication are covered by insurance, but my FEHB provider keeps billing me incorrectly for the quarterly lab work. What should I do?
A: Contact your insurance provider’s customer service team to learn why you are being charged. In many of these cases, the prescribing physician and/or laboratory service provider may be billing follow-up lab testing for PrEP monitoring using incorrect ICD codes. You can ask your insurance provider for their preferred ICD codes. Recommendations on proper ICD coding for PrEP are available from the New York State Department of Health at https://www.health.ny.gov/diseases/aids/general/prep/docs/icd_codes.pdf.

Trans, Non-Binary, and Gender Affirming Care

Please visit our Trans, Non-Binary, and Gender Affirming Care page for more information on these topics.