SelectPlan For Women Application (Fill out then print)
SelectPlan For Women Application (Text only)
SelectPlan For Women Home Page
SHS SelectPlan Announcement
What is SelectPlan for Women?
SelectPlan for Women is program that is available to women who are Pennsylvania residents and who meet certain eligibility requirements. It covers selected family planning services and supplies, so most of the services you normally receive in our health center will be free-of-charge.
Who is eligible for SelectPlan for Women?
- Women between the ages of 18 and 44 years
- Permanent residents of Pennsylvania.
- U.S. citizens
- Women who do not have insurance that pays for family planning services
- Have a weekly income of less than $370 or 185% of poverty
What services does SelectPlan for Women cover?
- Women's health exams (GYN care)
- Birth control methods and supplies
- Tests and treatments for sexually transmitted diseases (STDs)
- Pap tests
- Emergency contraception
- HIV Testing
How is Pennsylvania residency determined?
- If you are 20 years old or younger, your parents must reside in Pennsylvania.
- If you are 21 years old or older, you must have a Pennsylvania address.
What do I need to show proof of Pennsylvania residency?
- A Pennsylvania driver’s license or other State-issued ID.
What documentation do I need to prove U.S. citizenship? (ONLY one is needed)
- Birth Certificate
- Final Adoption Papers
- Military Record
- American Indian Card or Northern Mariana Card
- Certificate of Naturalization
- Certificate of Citizenship
I have Healthcare insurance but it does not cover birth control. Am I still eligible for SelectPlan?
- Yes, you are eligible to receive birth control at no cost with SelectPlan.
Am I eligible for SelectPlan if I have insurance, but for confidentiality reasons do not want to use it for family planning services?
- Yes, you would be eligible for SelectPlan.
How is my income determined?
- In general, a woman’s income refers to her household income which includes the income of the applicant, the spouse and dependent children.
What documentation do I need to provide to show proof of income?
- Proof of income includes pay stubs, award letters or checks received by an applicant and her spouse in the household. Income refers to gross income or income before taxes and deductions.
What if I do not have a pay stub?
- Your employer can write a letter stating what your monthly income is.
How do I show proof that I do not have an income?
- No proof in necessary. The PA Department of Public Welfare will be checking tax records to verify lack of income.
Can I still be seen if I do not bring my Birth Certificate, driver’s license or State ID or a recent pay stub?
- Yes, you can still be seen and treated. SHS staff will work with you to start the application for SelectPlan and arrange for the documentation to be brought in as soon as possible. The PA Department of Public Welfare may also contact you regarding the documentation.
Does SelectPlan cover special services like colposcopy, ultrasounds or Emergency Room Visits?
No, those services are not covered with SelectPlan. Please talk to your SHS provider regarding other programs that you may qualify for these services.
Now that I completed an application, am I approved for SelectPlan?
Your enrollment into SelectPlan for Women means you are accepted into the program for a limited amount of time until your eligibility is checked. You can receive covered family planning services immediately-at no cost- while your eligibility is being checked by the Pennsylvania Department of Public Welfare (DPW).
What happens after my application is sent?
If you have not provided all of the necessary documents at the time you applied, DPW may need to contact you for additional information and verification documents related to your income, identity, or citizenship/immigration status.
You will receive a notice from DPW that states you have been determined eligible or ineligible based on the information and documentation you have provided. If you have not already submitted the verification documents needed, such as income, the form will indicate which documents need to be sent to DPW. It is very important that you send the information needed, or you will be dropped from SelectPlan.
Once DPW receives all of the information it needs to process your application, a notice will be sent to you indicating that you are eligible or ineligible (approved or not approved).
Are all services provided under SelectPlan for Women, confidential?
SelectPlan for Women has the same confidentiality protections as Medicaid, meaning there will not be a list of the services you received at the clinic mailed to your address. However, the Department of Public Welfare may need to contact you for additional information and verification documents related to your income, identity, or citizenship.
If you have indicated an alternate mailing address on your application, all written communication will be sent there.
If I am approved for SelectPlan for Women, how will my services be paid?
Within a few day of getting your approval notice, you will be mailed a yellow, plastic “ACCESS” card and information on how to use the ACCESS card to pay for your SelectPlan for Women services.
If you have received an ACCESS card at anytime in the past, DPW will not be sending you a new ACCESS card. If you need a new card, you should contact the Change Center at 877-395-8930 (Statewide) or 215-560-7226 (Philadelphia).
What if I’m not approved for SelectPlan? Will I be able to still receive services at this health center?
Yes. You will be assessed on a sliding fee scale, and may be eligible for free or discounted services. You will never be denied services because of inability to pay or if you don’t have insurance. If circumstances change that would make you eligible for SelectPlan for Women, you can reapply at any time.
Will I need to reapply for SelectPlan?
Eleven months after you are enrolled in SelectPlan for Women, you will be mailed a redetermination form, which you must return to the Department of Public Welfare within 30 days. If you do not return the form, your benefits will end and you will have to reapply.