I was in on Feb 7th of this year, the clinic I went to is enforcing the 34 body mass index rule, my understanding is that ALL clinics will have to enforce it Jan 1, 2014. I am six foot three and I weighed 291.6 lbs when I went in. The doctor said I could only weigh 272 lbs to have a bmi of 34. He gave me two choices, I could get a one year card if I went in and had the sleep test done and got tested for the sleep apnea, or he would give me a ninety day card and I would need to loose the extra 19.6 lbs in the ninety days, at which time he would either send me in for the sleep tests if I had failed to loose the weight or give me the full one year card if I did loose the weight. I took the ninety day card and he explained if I walked about a half hour a day several times a week and kept my calories down to three meals of 660 calories and two snacks of 220 calories, I should be able to loose the weight. Well I walked on a treadmill thirty to forty minutes a day at a pretty brisk pace and I watched my calories six days a week, eating a lot of little cups of fruit and lean cuisine frozen meals and those ninety calorie deserts. I lost the weight in 50 days and went in and got weighed and he gave me the one year card. I have continued to walk and watch my calories and I have now lost a few more pounds and I just got taken off my blood pressure medicine, so next year I hope to get a two year card. He also explained that starting in 2014 all CDL drivers are going to be bar coded and the bar code will be linked to your license with the DOT and they will be able to access your current medical card status from any of the DOT computers. I hope this helps, from a brother over at Holland.