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Supplemental Health Care Program

The Supplemental Health Care Program (SCHP) 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 patients getting care at military treatment facilities (MTFs) if 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 don't apply
  • Care that is prohibited by regulation or policy is not authorized. Examples include:
  • Non-inherently medical/dental care is prohibited, such as:
  • The provider does not have to be TRICARE certified, but cannot 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 Defense Health Agency, Great Lakes (DHA-Great Lakes) authorizes care. As the MTF is solely responsible for SHCP, the MCSC does not regulate or approve SHCP.

The Director, Defense Health Agency (via the Office of the Chief Medical Officer), has the authority to approve certain types of care that can't be approved by the MTF Commander or DHA-Great Lakes, 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

You also may be interested in...

Supplemental Health Care Program Worksheet

Form/Template
4/16/2010

Use this worksheet when referring a service member under the Supplemental Health Care Program.

Recommended Content:

Supplemental Health Care Program

Code of Federal Register: Supplemental Health Care Program

Policy

The purpose of this section is to implement, with respect to health care services provided under the supplemental health care program for active duty members of the uniformed services, the provision of 10 U.S.C. 1074(c).

10 U.S. Code 1074: Medical and Dental Care for Members and Certain Former Members

Policy

Defines members and former members of the uniformed services and explains how they are entitled to medical and dental care in any facility of any uniformed service.

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