Supplemental Health Care Program
TRICARE is derived from the Civilian Health and Medical Program of the Uniformed Services, which technically does not cover ADSMs (or National Guard and Reserve members on active duty). However, similar to TRICARE, the Supplemental Health Care Program (SHCP) provides coverage for ADSMs (except those enrolled in TPR) and non-active duty individuals under treatment for LOD conditions. Although the DoD funds the SHCP, it is separate from TRICARE and follows different rules. Only the following individuals are eligible for the SHCP:
- ADSMs assigned to MTFs
- ADSMs on travel status (e.g., leave, temporary assignment to duty, or permanent change of station)
- Navy and Marine Corps service members enrolled to deployable units and referred by the unit PCM (non-MTF)
- National Guard and Reserve members on active duty
- National Guard and Reserve members (LOD care only, unless member is on active federal service)
- National Oceanic and Atmospheric Administration personnel, U.S. Public Health Service personnel, cadets or midshipmen, and eligible foreign military personnel
- Non-active duty beneficiaries when they are inpatients in an MTF and are referred to civilian facilities for tests or procedures unavailable at the MTF, provided the MTF maintains continuity of care over the inpatient and the beneficiary is not discharged from the MTF prior to receiving services
- Comprehensive Clinical Evaluation Program participants
- Beneficiaries on the Temporary Disability Retirement List are eligible to obtain required periodic physical examinations
- Medically retired former members of the armed services enrolled in the Federal Recovery Coordination Program
To verify SHCP patient eligibility, call Humana Military at 1-800-444-5445.
The SHCP covers care referred or authorized by the MTF and/or the MMSO. When SHCP beneficiaries need care, the MTF (if available) or the MMSO refers ADSMs and certain other patients to civilian providers. If services are unavailable at the MTF, Referral for Civilian Medical Care (DD Form 2161) is sent to Humana Military before the patient receives specialty care ( form may vary by MTF site). Humana Military and the MTF, as appropriate, identify a civilian provider and notify the patient. For non-MTF referred care, the SPOC determines if the ADSM receives care from an MTF or civilian provider.
SHCP beneficiaries are not responsible for cost-shares, copayments, or deductibles. See the Claims Processing and Billing Information section for SHCP claims submission information. |
