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The right help at the right time!
SERVING AIRLINE CREW MEMBERS
Many practitioners know that CIGNA delivers services to several prominent airlines, including Air Tran, FedEx and Qantas. But did you know that the airline industry is among the most regulated in the country? The Federal Aviation Authority (FAA) regulates both the airline industry and the men and women who fly and maintain aircraft. Medical and psychological conditions are evaluated continually to ensure fitness and competency. The extent and the implications of FAA regulations are important areas for our practitioners to be aware of when working with members of the airline industry.
Airline pilots, flight crew members, aircraft maintenance personnel, and air traffic controllers face unique job challenges. They are responsible, in part, for passenger safety, the integrity of the airline industry and the public trust. Consider some of the basic characteristics and requirements of the job:
• Pilots must be self-confident, independent, technically proficient, able to make decisions in compressed time frames, manage emergencies and have the discipline to be routine- and detail-oriented.
• Flight crews work schedules that may require extensive time away from home and family. They must have the ability to adapt to weather and condition changes, unplanned schedule changes and they must have superior customer service skills.
• Aircraft maintenance personnel practice their trade with virtually no margin for error and the enormous societal and economic responsibility of keeping the public confidence in the nation’s air transportation system.
Sounds like a demanding industry? You’re right …it is. To the public, airline personnel may seem like towers of strength … but they are just like the rest of us. They face the same challenges of everyday life we all do. Airline industry employees may encounter many familiar problems:
• Medical conditions
• Marital and family issues
• Problems with children
• Alcohol/Drug Abuse
• Depression/Anxiety
• Financial difficulties
• Providing for elder care and child care
• Stress and Sleep Disorders
The list could go on and would be familiar to the practitioners who help our members develop coping and resiliency skills in response to life’s stressors. There are some specific considerations that apply to civilian aircraft pilots, which are helpful to review.
Did You Know …
• Pilots in command are required by the FAA to receive detailed physical examinations every six to twelve months.
• These examinations cover both physical and mental health1 including:
o Eyes
o Ears, nose, throat, equilibrium
o Mental health
o Neurological system
o Cardiovascular system
o General medical condition
• Pilots are required to disclose on their application all physical and behavioral practitioners they have seen in the prior three years2. The pilot has the responsibility to report behavioral practitioner visits to the FAA ONLY if the visit was for treatment of alcohol/substance abuse or resulted in a psychiatric diagnosis3. These include visits to the following:
o Physician and Physician Assistants
o Nurse Practitioners
o Psychologists
o Clinical Social Workers
o Alcohol/Substance Abuse Treatment Practitioners
• The FAA has identified automatic disqualifying conditions that result in temporary or permanent loss of pilot flight eligibility status. These include both medical and mental health conditions. Note that the FAA may exercise discretionary authority to issue medical eligibility certifications4. Examples of medical conditions that result in automatic disqualification include, but are not limited to, the following:
o Angina pectoris
o Cardiac valve replacement
o Untreated and significant coronary heart disease
o Diabetes mellitus requiring insulin or other hypoglycemic medication
o Epilepsy
Mental health conditions identified by the FAA that result in automatic temporary or permanent loss of flight eligibility status include the following:
o Bipolar Disorder
o Personality Disorder that is severe enough to have repeatedly manifested in overt actions
o Psychosis, manifested by delusions, hallucinations, disorganized thoughts and behavior
o Alcohol or Substance Dependence
o Any other mental condition that makes the pilot incapable of safely performing his or her responsibilities.
CIGNA practitioners routinely evaluate members and refer for medication intervention when needed. It is important to know that the FAA does not issue lists of approved medications and rarely approves psychotropic medications due to concerns about side effects and the underlying condition being treated. Deciding to use a psychiatric medication is a significant decision for a pilot. Pilots are disqualified for all classes of medical certification once treatment with psychiatric medication is begun. Pilots can be re-certified after completion of the medication trial and verification that symptoms have been alleviated. The pilot must be symptom free for a minimum of 90 days but frequently longer periods of time are required by the FAA Medical Examiners. It is not hard to see the conflict a pilot would face if he or she were experiencing a clinically significant mental disorder, and had to make choices about treatment and medications. Contributing to the complexity of medication decisions is an ongoing
review by the FAA to permit future limited use of medication for depression.
How Do CIGNA Practitioners Help?
The good news is pilots and other airline employees can fully utilize the Employee Assistance Program, which is considered evaluation, and short term intervention for expected life events. Medical and behavioral professionals, together with the FAA, encourage all airline employees to seek assistance if needed. This includes use of prevention, education and wellness programs. Pilot visits to the EAP are not reportable on the FAA Medical Certification application if there is no psychiatric diagnosis, no alcohol or substance abuse treatment and no psychiatric medications.
Where Can CIGNA Practitioners Get Questions Answered?
It is critical to confidentiality and the practitioner/member relationship to provide accurate information when working with airline employees. The FAA Regulations are complex and may be confusing or misinterpreted. Fortunately, there is help available. CIGNA encourages all practitioners to contact the FAA directly with questions. The Airline Pilot’s Association (ALPA) is another source of expertise on FAA regulations and can provide additional help.
FAA Consumer Hotline: 1-866-835-5322
FAA Office of Aerospace Medicine: 202-267-3535
Airline Pilot’s Association: 703-481-4440
1CFR Title 14 Aeronautics and Space. Part 67 Medical Standards and Certification.
2FAA Airman Medical Application. Form 8500-8, Item 19.
3FAA Form 8500-8 instructions, Question 19.
4CFR Title 14 Aeronautics and Space. Part 67 Medical Standards and Certification. Authorization of Special Issuance.
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