TRICARE is derived from the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), which technically does not cover Active Duty Service Members (ADSM) or National Guard and Reserve members on active duty. However, similar to TRICARE, SHCP provides coverage for ADSMs (except those enrolled in TPR) and non-active duty individuals under treatment for Line-Of-Duty (LOD) conditions.
SHCP also covers healthcare services ordered by a military hospital or clinic provider for a non-ADSM military hospital or clinic patient for whom the military hospital or clinic provider maintains responsibility. In addition, SHCP-eligible service members may include members in travel status (leave, temporary duty, permanent change of station), Navy/Marine Corps Service members enrolled to deployable unit and referred by the unit Primary Care Manager, eligible National Guard and Reserve personnel, Reserved Officer Training Corps (ROTC) students, cadets/midshipmen, and eligible foreign military.
SHCP covers care referred or authorized by the military hospital or clinic and/or the DHA-GL. When SHCP beneficiaries need care, the military hospital or clinic (if available) or the DHA-GL refers ADSMs and certain other patients to civilian providers.
If services are unavailable at the military hospital or clinic, an electronic referral will be forwarded to Humana Military before the patient receives specialty care in the civilian healthcare system. Humana Military and the military hospital or clinic, as appropriate, identify a civilian provider and notify the patient. For non-military hospital or clinic-referred care, the Specified Authorization Staff (SAS) determines if the ADSM receives care from a military hospital or clinic or civilian provider.
SHCP beneficiaries are not responsible for cost-shares, copays or deductibles. See more on SHCP claims submission information