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North Region TRICARE Customer Service: (877) TRICARE
For further assistance after contacting the number above,
email or call 1-866-307-9749 (703-588-1850 direct)

Supplemental Health Care Program (SHCP)

The Supplemental Health Care Program is used primarily to pay for private sector (purchased) care for active duty uniformed service members. It may also be used for non-active duty MTF patients for whom the provider maintains responsibility (inpatient goes to private sector for treatment/service and returns to the MTF).

The SHCP operates similarly to the TRICARE benefit in that it is for clinically appropriate medical or dental care. SHCP differs from the normal TRICARE benefit as follows:

  • Medically necessary care that is part of TRICARE is normally included (see below for exclusions)
  • Care outside TRICARE benefit may be authorized (common example: cognitive therapy)
  • TRICARE Policy Manual restrictions do not apply
  • Most of the Government no-pay list exclusions do not apply
  • Care that is prohibited by regulation or policy is not authorized. Examples include:
    • Gastric by-pass (HA policy 07-006)
    • Elective termination of pregnancy (10 USC1093(a))
    • Off-label FDA device use (32 CFR 199.4(g)(15)(ii))
    • Network chiropractic services (HA 07-028)
  • Non-inherently medical/dental care is prohibited, such as:
    • Exercise equipment (including amputee adaptive equipment) (32 CFR 199.4(g)(43))
    • Gym memberships (32 CFR 199.4(g)(43))
    • Spas and hot tubs (32 CFR 199.4(g)(44))
  • The provider does not have to be TRICARE certified, but can not be sanctioned or suspended
  • The care must be proven safe and effective (no experimental care)

The referral from an MTF constitutes MTF Commander authorization to execute the care. For non-MTF directed care, the Military Medical Support Office (MMSO) authorizes care. As the MTF is solely responsible for SHCP, the MCSC does not regulate or approve SHCP.

The Director, TMA (via the Office of the Chief Medical Officer), has the authority to approve certain types of care that cannot be approved by the MTF Commander or MMSO, for example:

  • Phase II or III clinical trials outside the TRICARE benefit
  • Compassionate use devices outside the TRICARE benefit
  • Care available only outside the United States

A worksheet to assist is available here. Questions should be referred to (703) 588-1832.

References:

Documents:

TRO-N Customer Service
Disaster Information
Reserve Component Information Briefings
TRICARE Prime Travel Benefit
TPR Request Forms
CRSC Travel Benefits
MHS Staff Training and Education