7.6 Good Cause Reasons for dropping insurance coverage

Any of the following reasons are considered good cause for dropping insurance coverage:

The individual was covered by a group health plan that was provided through his or her employer, and the employment ended for a reason other than voluntary termination, unless the voluntary termination was a result of the incapacitation of the individual or because of an immediate family member’s health condition.
The individual was covered by a group health plan that was provided through his or her employer, but the individual changed employers and the new employer does not offer health insurance coverage.
The individual was covered by a group health plan that was provided through his or her employer, and the individual’s employer discontinued health plan coverage for all employees.
The individual’s coverage terminated due to the death or change in marital status of the policy holder.
For BadgerCare Plus Prenatal Program applicants or members only:

1. Her coverage was COBRA continuation coverage and the coverage was exhausted in accordance with federal regulations concerning COBRA.
2. The insurance does not pay for pregnancy-related services.
3. The insurance is owned by someone not residing with the pregnant woman and continuation of the coverage is beyond her control.
4. The insurance only covers services provided in a service area that is beyond a reasonable driving distance.

Any other reason determined by the department to be a good cause reason.

Example: Joanne applies for BadgerCare Plus in June for herself and her family after being fired from her job. Although it was determined that she had "dropped coverage”, she has a good cause exemption because her employment was involuntarily terminated.

When good cause for dropping insurance coverage is approved, begin BadgerCare Plus eligibility the day after the last day of the insurance coverage or the applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. date, whichever is later if the applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. applies prior to losing insurance. If the applicant applies after losing insurance, coverage can begin on the day after the last day of insurance if they apply in the same month insurance is lost.

This page last updated in Release Number: 10-01

Release Date: 02/25/10

Effective Date : 02/25/10