Sexual Assault Forensic Exam
Please Note: The Crime Victim Compensation Program may be able to provide more assistance than the SAFE Fund. If the crime is reported to law enforcement and the victim intends to cooperate through prosecution, a victim can apply for assistance through the Crime Victim Compensation Program.
However, if a victim does not wish to report the crime to law enforcement, does not wish to cooperate with law enforcement through prosecution, or does not wish to submit the bill to his or her insurance provider or other payer source, the SAFE Fund can provide financial assistance.
- There is no application, but a Request for Payment Form (PDF) must accompany each bill.
- The Fund may be able to pay for the Sexual Assault Forensic Exam. Medications other than Plan B may be reimbursed if directly related to the assault.
- The individual wishing to receive assistance from the SAFE Fund must contact the billing department at the hospital, inform them that they wish to have the forensic exam paid by the SAFE Fund, and the hospital can then submit the itemized bills to the Fund, along with the completed request for payment form.
- At the time of service if the victim is not sure whether they will seek assistance from the SAFE Fund (and/or whether they will make a claim to his or her insurance agency, etc.) the hospital staff should ask the victim to contact the hospital with that decision so the hospital will know if bills should be sent to the SAFE Fund.
Questions can be directed to Karen Moore, Grants Specialist, at (608) 267-9340 or (800) 446-6564.
PO Box 7951
Madison, WI 53707-7951
Download a SAFE Fund poster (PDF)