Reprinted from the AOPA website on 2016-07-15

December 9, 2015
By Elizabeth A Tennyson

Editor's note: The frequently asked questions were updated July 13, 2016, to reflect the latest status of third class medical reform.

Third class medical reform is closer than ever before, but it’s a complex issue and we know you have questions. Here are our answers to the most common questions we’re being asked about third class medical reform.

Are we there yet?
Just about. The only remaining step is for the president to sign the “FAA Extension, Safety, and Security Act of 2016,” which we expect to happen before the FAA’s current authorization expires on July 15.

What is the current state of play?
On July 13, the Senate passed H.R. 636 to keep the FAA operating through the end of the next fiscal year. H.R. 636, known as the “FAA Extension, Safety, and Security Act of 2016,” includes the same third class medical reform language the Senate passed three times previously. The House passed identical legislation on July 11. The legislation now goes to President Barack Obama to be signed into law before the current FAA extension expires on July 15

Once the reforms are signed into law, the FAA will have up to one year to promulgate rules under the provisions of the law. It is in that rulemaking process that many details will be worked out. You can count on AOPA to be there to represent the needs and interests of general aviation pilots at every step along the way.

Who will benefit from this reform?
Hundreds of thousands of pilots can potentially benefit from these reforms, which create an exemption from medical certification requirements. To qualify, you need to hold a current U.S. driver’s license and have held a valid FAA medical certificate, regular or special issuance, within the past 10 years from the date the legislation becomes law.
If you’ve never held a medical certificate (student pilots for example), you will need to get an FAA medical certificate from an AME one time only. If your regular or special issuance medical certificate lapsed more than 10 years before the legislation is enacted, you will need to get a medical certificate from an AME one time only. And if you develop certain cardiac, neurological, or mental health conditions, you will need a one-time-only special issuance for each condition.
Pilots whose most recent medical certificate has been revoked, suspended, withdrawn, or denied will need to obtain a new medical certificate before they can operate under the new reforms.

What will I have to do in order to take advantage of the new reforms?
Once you meet the basic qualifications, you’ll have to take a few steps to fly under the new reforms.
At least once every four years, you’ll need to visit a state-licensed physician. At the visit, you’ll need to provide your physician with an FAA-generated checklist, and your physician will need to certify that he or she has performed an examination and discussed all the items on the checklist, including medications, with you. Your physician will have to certify that he is unaware of any medical conditions that, as presently treated, could interfere with your ability to safely operate an aircraft. You will then need to make a note of the visit and include the completed checklist in your logbook. You do not need to report the outcome of the visit to the FAA unless you are specifically requested to do so.

Every two years, you’ll also need to take online training in aeromedical factors and keep the certificate of completion in your logbook. At that time you’ll need to provide the FAA with some of the same information you do today, including authorization for the National Driver Register to provide your driving record to the FAA and a signed statement certifying that you understand that you can’t operate an aircraft during a medical deficiency and that you don’t know of, or have reason to know of, any medical condition that would prevent you from flying safely.

What operating limitations will apply to pilots flying under the new reforms?
Pilots flying under the new rules will be allowed to operate “covered aircraft” that weigh up to 6,000 pounds and have up to five passenger seats plus the pilot in command, at altitudes below 18,000 feet msl and at speeds of up to 250 knots. Pilots, if appropriately rated, can fly VFR or IFR in “covered aircraft.” Pilots flying under the exemption cannot operate for compensation or hire.

How does this legislation compare with the petition for medical reform that AOPA and EAA filed jointly back in 2012?
The legislation greatly expands the number of pilots and aircraft who will be eligible to fly under third class medical reforms. The table below compares some of the key points.

  Original Petition New Legislative Reforms
Aircraft Specifications Up to 4 seats, 180 hp, single-engine, fixed gear Up to 6 seats, up to 6,000 lbs (no limitations on horsepower, number of engines, or gear type)
Flight Rules Day VFR Only Day and Night VFR and IFR
Passengers Up to 1 passenger Up to 5 passengers
Aeromedical Training Pilots must take a free online course every 2 years Pilots must take a free online course every 2 years
Altitude Restrictions Up to 10,000 feet or up to 2,000 feet agl Up to 18,000 feet msl

Why isn’t this a “driver’s license” medical standard?
To put it bluntly, we were faced with a choice: Make compromises that would allow medical reform to move forward and help thousands of pilots or allow medical reform to die. AOPA has been working to change or eliminate the third class medical certification process for nearly 30 years. The most significant medical reform prior to this was the creation of Sport Pilot, which allows pilots in some aircraft to fly without a medical certificate under limited circumstances. While we initially sought to expand that same standard to more pilots and aircraft, we ran into roadblocks at every turn. The FAA did not respond to our 2012 petition, and while the agency did initiate rulemaking, that process quickly stalled and it became clear that the regulatory path was blocked. In the legislative process that followed, some lawmakers made it absolutely clear that they would not support legislation that completely eliminated the third class medical or depended on a driver’s license medical standard. The compromises we arrived at represent the very best deal we could get for pilots while winning sufficient support in Congress to keep the legislation alive. We recognize that not every pilot who was hoping for relief will get it. Nevertheless, this legislation will help thousands of pilots, and that’s worth doing.

What will the checklist for the medical exam involve?
The checklist will have two parts—questions to be answered by the pilot in advance of the exam and a list of items for the doctor to include in the examination. The questions will be similar to those asked on the application for medical certification and include identifying information like name and address, date of birth, a short medical history and listing of current medications, and information about whether you’ve ever had an FAA medical certificate denied, suspended, or revoked. Just as you do now, you’ll have to affirm that your answers are true and complete and that you understand you can’t fly if you develop a medical deficiency or disqualifying condition.

The second part contains a list of items for your physician to cover during the examination. The items are similar to those covered in an FAA medical certification exam and include:

Head, face, neck, scalp Nose, sinuses, mouth, throat Ears and eardrums
Eyes Lungs and chest Heart
Vascular system Abdomen and viscera Anus
Skin G-U system Upper and lower extremities
Spine, other musculo-skeletal Body marks, scars, tattoos Lymphatics
Neurologic Psychiatric General systemic
Hearing Vision Blood pressure and pulse

Your physician will exercise his or her discretion to address any other medical conditions identified in the exam and determine if additional tests are needed. Your physician will need to certify that he or she has performed an examination and discussed all the items on the FAA checklist, including medications, with you. Your physician will also have to certify that he is unaware of any medical conditions that, as presently treated, could interfere with your ability to safely operate an aircraft.

Doesn’t the checklist mean that this is really just the same as a third class medical exam?
No. The current third class medical process requires the doctor to note whether a patient’s condition is “normal” or “abnormal” and explain any abnormal findings. Under the exemption, the doctor is directed to conduct a medical examination and “address, as medically appropriate, any medical conditions identified.” In addition, the results of the exam will no longer be sent to the FAA. Instead, the pilot will keep the completed checklist in his or her logbook and will only need to supply the information if the FAA specifically requests it, such as during an investigation or enforcement action.

Will doctors be willing to sign these forms?
Doctors are often asked to certify that a patient is medically fit for a specific job or activity. Many physicians are willing to administer such exams. To help make doctors more comfortable with the requirements, AOPA will work with medical organizations and physicians groups to provide educational materials and information about what the checklist requires and their role in providing their patients with these types of exams.

Can I go to any doctor for the general medical exam required every four years? How does the FAA know that I complied with that rule?
The legislation says that the comprehensive medical exam must be conducted by a state-licensed physician. To demonstrate compliance, just keep the completed checklist in your logbook. There’s nothing to report to the FAA unless specifically requested.

Will this reform change the rules regarding medications?
No. The rules regarding medications will remain unchanged. So pilots who take a medication that the FAA disallows will still be unable to fly while taking the disallowed medication. Please contact AOPA’s Pilot Information Center if you have questions about a medication you are taking or that your doctor has recommended.

I understand I will need to get a one-time special issuance medical if I have certain medical conditions. What are those conditions?
The conditions are described in the legislation and are limited to an established medical history of the following:
• Cardiovascular: myocardial infarction (heart attack); coronary heart disease that has required treatment; cardiac valve replacement; and heart replacement.
• Neurological: epilepsy; a transient loss of control of nervous system functions without satisfactory medical explanation of the cause; and disturbances of consciousness without satisfactory medical explanation of the cause.
• Mental Health: personality disorder that is severe enough to have repeatedly manifested itself by overt acts; psychosis defined as a case in which an individual has manifested or may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; bipolar disorder; and substance dependence within the previous two years as defined in FAR 67.307(4).

Pilots who have a clinically diagnosed mental health or neurological condition will be required to certify every two years that they are under the care of a state-licensed medical specialist for that condition. Details of how that certification process will work have not yet been determined.

Pilots with a cardiovascular condition will still need to get a one-time special issuance, but successful completion of a clinical evaluation will satisfy the process for getting an Authorization for Special Issuance of a medical certificate with no mandatory waiting period.

When will these new rules go into effect?
Once the legislation has been signed into law, the FAA will begin a rulemaking process to make the regulatory changes required by the legislation. To ensure that pilots don’t have to wait indefinitely, there is a provision in the legislation that says if the FAA has not produced a final rule within one year of the legislation becoming law, then pilots can operate within the parameters of the legislation without fear of enforcement action. In other words, once the legislation has been enacted, pilots will be able to fly under its provisions within one year—less if the rulemaking is completed more quickly.

How does this help me if I’m on special issuance?
If you have had a special issuance medical within the 10-year lookback period and your medical status is unchanged, you should be able to fly under the exemption provided you meet all the other qualifications, including being under the treatment of a physician for your medical condition. If you develop a new condition that requires a special issuance medical certificate you will have to apply for a one-time special issuance for that condition.

What if my regular or special issuance medical expires before the law takes effect?
If your regular or special issuance medical certificate expires before the new regulations take effect, you may choose to renew it in order to keep flying while the FAA completes its rulemaking process. Whether or not you choose to renew your medical certificate to cover the gap period, you will be allowed to fly as soon as the new rules take effect, provided your medical expired within the 10-year window following enactment of the legislation and you meet other requirements under the new legislation. To be clear, the 10-year lookback is based on the expiration date, not the issuance date, of your last medical certificate.

What if my medical becomes more than 10 years old before the law takes effect?
The clock on the 10-year lookback starts the day the legislation is enacted, not when its provisions take effect, which could be up to one year later. So, the date the legislation becomes law is the date that counts when it comes to determining whether or not your certificate was valid within the 10-year window. If your medical expired more than 10 years before the date of enactment, you will need to go through the medical certification process one more time in order to fly under the new legislation.

Will this affect me if I still want to fly as a sport pilot?
Not at all. You may still fly light sport aircraft with at least a sport pilot certificate and a valid driver’s license in lieu of a medical certificate.

Do the new rules include twin-engine operations?
As long as the aircraft meets the definition of a “covered aircraft,” you will be able to fly a twin-engine aircraft. So, twin-engine aircraft that weigh less than 6,000 pounds and have room for up to five passengers plus a pilot in command qualify, provided they are flown at speeds below 250 knots indicated airspeed and altitudes below 18,000 feet msl.

Will I be able to get insurance if I fly under these new rules?
Insurance companies have not yet addressed how they will handle medical reforms and are unlikely to do so until the FAA rulemaking process is under way. Our experience with the sport pilot regulations showed little or no impact on insurance availability or rates. Since each company uses slightly different language regarding medical requirements, the best thing to do is to contact your insurance broker or company and ask how they will handle anticipated reforms. History indicates that compliance with the applicable regulations is typically all that is required by insurance companies.

What if I just want to keep getting a third class medical certificate every two or five years?
You can do that. Just keep doing what you’re doing, including making regular visits to the AME and renewing your medical certificate as required.

What if I want to fly an aircraft with more than five passengers or that weighs more than 6,000 pounds, fly faster than 250 knots, or fly at altitudes above 18,000 feet msl?
If you want to exercise privileges outside of those established under the proposed medical exemption, you’ll need to keep going through the third class medical process. That means visiting an AME for your medical exam and renewing your medical certificate as needed.

What if I want to fly outside the United States?
You can fly under the medical reform provisions outside of the United States only if authorized to do so by the country in which the flight is conducted. It’s a good idea to check with AOPA or the aviation authority for the country in which you intend to fly to determine what conditions you will need to meet to fly internationally.

Will I still need to get a flight review?
Yes. The reforms will not affect the rules for flight reviews.

I’ve still got questions, now what?
We’ve tried to answer the most common questions our members are asking. Unfortunately, there are some questions we won’t be able to answer until the legislation becomes law and the FAA completes its rulemaking process. We’ll be actively engaged in every step of the process and we’ll keep our members informed as the situation develops and new information becomes available. Let us know if you have a question we have not addressed.