SelectPlan for Women provides family planning services to women age 18 through 44 years old. SelectPlan will cover family planning services, tests and supplies related to birth control, pregnancy prevention and preventive services. PA Family Planning Waiver 12/29/05
An woman or a Family Planning Community Partner (FPCP) applying for a woman can submit an application for SelectPlan. The application can be submitted through the Commonwealth of Pennsylvania’s Access to Social Services (COMPASS) or a PA 600 SP can be submitted by mail or in person.
To be eligible for SelectPlan the woman must: PA Family Planning Waiver 12/29/05
Be age 18 through 44 years old.
Not be pregnant or sterilized.
Have no, or limited, health insurance for family planning services. See Section 311.131, Confidentiality and Third Party Liability.
Creditable Health Insurance:
The County Assistance Office (CAO) or Central Unit (CU) will review the SelectPlan application for creditable health insurance to see if:
The applicant checked she has health insurance covering both “family planning services” and “prescriptions, including contraceptives.” If so, she is not eligible for SelectPlan.
The applicant checked she only has “family planning services” or “prescriptions” or didn’t check any type of health insurance coverage. If so, she is potentially eligible for SelectPlan.
The applicant checked the “YES” box relating to “physical or emotional harm.” The applicant is requesting confidentiality and the applicant is eligible for SelectPlan even if there is creditable health insurance.
Have countable household income equal to or less than 185% of the Federal Poverty Income Guidelines (FPIGs).
NOTE: Countable household income includes income of the applicant, spouse, and dependent child.
Be a Pennsylvania resident.
NOTE: A college student who is under 21, attends college in Pennsylvania and whose parents reside in another state may not claim Pennsylvania residency unless she is emancipated and a resident of Pennsylvania.
Be a United States citizen or have satisfactory immigration status for Medical Assistance (MA). (See Chapter 322, Citizen/Noncitizen)
Not be receiving MA under another category that includes family planning services or not be eligible for full MA if applying for both SelectPlan and MA.
The CAO or CU will determine eligibility for SelectPlan based upon the requirements in this chapter and the following chapters:
Application – Chapter 304.
For applications submitted by a FPCP, verification of identification (ID) is done by the FPCP. If the ID is a Pennsylvania (PA) issued driver’s or non-driver’s ID and the ID number is given, a copy of the ID is not required. All other types of ID must be submitted with the application for SelectPlan.
Citizen/Alien – Chapter 322
Applicants applying for SelectPlan who do not provide proof of citizenship and identity at application will be authorized for SelectPlan if all other conditions of eligibility are met. The woman must cooperate with the CAO or CU in obtaining the necessary documentation for proof of citizenship and identity.
When the applicant does not provide her out-of-state birth certificate within 10 days of submitting her application, the CAO or CU will send a letter to the applicant on how to receive a copy of an out-of-state birth certificate (see Appendix B). The CAO or CU will follow the procedures outlined in Chapter 378, Appendix E for obtaining an out-of-state birth certificate.
Residence – Chapter 323
Reporting Changes – Chapter 370
Notices – Chapter 377
Verification – Chapter 378
Note: Refer to Section 311.81 for policy regarding verification requirements for SelectPlan renewals.
SelectPlan provides the following benefits: PA Family Planning Waiver 12/29/05
Family planning-related physical exams and outpatient office visits.
FDA approved medication and supplies to prevent pregnancy.
Testing for non-infectious conditions, such as cervical cancer.
Testing for infectious agents, including HIV.
A SelectPlan individual is covered under Health Care Benefits Package (HCBP) #15. See Chapter 338, Appendix A.
NOTE: Abortion is not considered a family planning service and is not covered by SelectPlan.
A woman authorized for SelectPlan will receive a Pennsylvania ACCESS card. The woman shall present the ACCESS card to an enrolled MA provider when a family planning service is provided. SelectPlan is a Fee-for-Service program. (See Section 309.4 MA Service Delivery).
NOTE: A woman receiving SelectPlan is not enrolled in the mandatory HealthChoices program or Managed Care Health Plans.
Confidentiality is important when processing and maintaining a SelectPlan application and case record. Confidentiality will not be put at risk if a request has been made by an individual.
The CAO or CU identifies an individual’s request for confidentiality on an application as follows:
Selected “YES,” that there is an alternate mailing address or provided an alternate mailing address or both.
NOTE: An alternate mailing address must be provided if the applicant responded “YES” to this question on the COMPASS application. On the PA 600SP a mailing address different than the home address would be listed indicating a need for confidentiality.
Checked “YES” after the “physical or emotional harm” statement under Health Insurance on the application.
Indicated the need for confidentiality in the “Additional Information” section of the application.
Once it is decided that confidentiality is required the CAO or CU must:
Open a separate case record for the SelectPlan woman if that individual is a member in another case record.
Enter an alternate mailing address for all notices and correspondence.
Narrate the need for confidentiality in the case record.
Not require the SelectPlan woman to pursue proof of income of their spouse if the individual is unable to provide proof due to reasons of confidentiality. The statement from the woman is all that is required if proof of the spouse’s income cannot be obtained. See example Section 311.8.
All SelectPlan women are reviewed for possible third party insurance coverage. If it is found that a woman has third party insurance coverage or the coverage that had been reported as not being creditable coverage was found to be creditable coverage, Third Party Libility (TPL) will notify the CAO or CU with this information. The CAO or CU will review the application that was submitted by the woman to determine if the woman had requested confidentiality when receiving family planning services.
No action is taken against the woman if the woman said on the application that her existing coverage was not accessible because she feared physical or emotional harm. The CAO or CU is to narrate in the case record that the woman has requested confidentiality.
Advance Notice is sent to discontinue eligibility if the SelectPlan recipient did not request confidentiality and has creditable coverage.
Updated February 14, 2012, Replacing September 29, 2010