SHCP provides coverage for services provided by civilian doctors. Active Duty Service Members (ADSM) whose duty assignment is within 50 miles of a military hospital or clinic may be eligible for care under SHCP.
SHCP covers any healthcare service as long as the military hospital or clinic refers the patient or the military Service Point-of-Contact (SPOC) authorizes the care. For covered services, ADSMs do not pay cost-shares, copayments or annual deductibles. The SPOC also acts as a liaison between the ADSM and all members of the healthcare process, from the civilian healthcare professional to the claims processor.
The civilian healthcare provider will submit a request to Humana Military for review. The request is then reviewed for services NOT excluded by TRICARE against TRICARE coverage guidelines and approved or denied based on those findings. If ADSMs receive a denial letter for non-covered services, a waiver from DHA may be required to proceed. Instructions for the waiver will be included in the denial letter.