Other Information

Forensic Exam Payment

Effective July 1, 2008, victims of sexual assault are no longer required to participate in the criminal justice system or cooperate with law enforcement in order to have a forensic medical examination or for that examination to be paid for. See the Virginia Acts Of Assembly - 2008 (pdf) for the full text of the legislation change. NOTE: Mandatory reporting requirements for child and elder abuse still apply.

For Victims

Certain costs associated with the gathering of forensic medical evidence shall be paid by the SAFE (Sexual Assault Forensic Exam) Payment Program of CICF. The following is a list of expenses eligible for reimbursement and done based on your need and preference:

  1. The forensic examiner’s fee including equipment and supplies necessary to conduct the exam.
  2. Fee for a physician to conduct a medical screening exam.
  3. Testing and prophylactic (preventative) medication for the prevention of sexually transmitted infections.
  4. Testing and prophylactic medication for the prevention of pregnancy.
  5. Ambulance transfer to a facility that is better able to provide a forensic examination.

The provider that conducted the exam should send the bill for services directly to the SAFE Payment Program, however if you receive a bill for any of the services listed above, please contact us. Keep in mind, though, that costs for the treatment of injuries and existing medical conditions are not eligible for payment through the SAFE Payment Program and you or your insurance are responsible for these expenses.

If you have any costs that are not covered by the SAFE Payment Program, or if you have additional out-of-pocket crime-related expenses such as loss of wages, prescriptions, mental health, etc., you may be eligible for compensation of those expenses through CICF. Please see ELIGIBILITY BENEFITS for more information and, if interested, you will need to complete a CLAIMS APPLICATION.

NOTE: Though you are not required to report the crime to the police to receive a forensic examination and have that examination paid for, to be eligible for compensation of other crime-related expenses, the crime must be reported within 120 hours, unless good cause is shown for a delay. Additionally, any amount paid for the forensic exam is not deducted from the total maximum award available through CICF.

For any questions regarding payment of the forensic exam or for additional information on CICF, please call 800.552.4007.

For Medical Providers

The SAFE (Sexual Assault Forensic Exam) Payment Program began processing payment of forensic exams conducted on victims of sexual assault on July 1, 2008. Forensic exams conducted for any other purpose should still be filed with the Supreme Court of Virginia in accordance with their payment policy.

In order for a claim to be considered eligible and expenses to be reimbursed, all of the following conditions must be adhered to:

  1. Collection of medical evidence took place in accordance with §19.2-165.1 of the Code of Virginia. NOTE: if the patient declines collection of evidence, the claim is not eligible for reimbursement.
  2. The alleged assault occurred within the Commonwealth of Virginia. NOTE: If the crime occurred in a military installation or base, or is being investigated by the military, the claim should be submitted to the military entity responsible for payment of forensic examinations.
  3. Both pages of the REQUEST FOR PAYMENT FORM (RPF) must be completed. Instructions on how to complete the form can be found in the SAFE PAYMENT PROGRAM POLICY AND GUIDELINES. NOTE: A claim is not set up within our system and a bill is not considered eligible for reimbursement without this completed form.
  4. An itemized, detailed bill must accompany the RPF. Health Insurance Claim Forms (HICF) may not be considered.
  5. If the patient has a federally-funded health insurance, or, elects to bill their private insurance, and wants the SAFE Payment Program to pay any remaining out-of-pocket patient responsibility, an explanation of benefits must accompany the RPF and itemized bill. NOTE: Due to CICF’s status as payer of last resort, providers are required to bill any federally-funded health insurance prior to the SAFE Payment Program.
  6. The RPF and all documentation necessary to process the claim must be submitted within one (1) year of the date of service.

Please see the SAFE PAYMENT PROGRAM POLICY AND GUIDELINES for additional information regarding submission of claims.

The RPF and accompanying documentation may be sent to the SAFE Payment Program by any of the following means:

            Mail to:  PO Box 26927, Richmond, VA  23261
            Fax to:  877.377.5164
            Email to:

IMPORTANT: Per 19.2-368.5:2 and 19.2-368.11:1(F) of the Code of Virginia, the patient may not be placed into collections once this form is filed with CICF.

Forms and useful information for forensic examiners and billing providers:


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