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7.3 Current Access to Health Insurance

7.3.1 The Current Access Test

7.3.2 Good Cause for the Current Access Test

 

7.3.1 The Current Access Test

The Current Access Test policies apply to non-exempt children (see Section 7.1 Health Insurance Conditions of Eligibility). These children and BadgerCare Plus Prenatal Program members with access to health insurance, including access due to a qualifying event , through an employed family member who is currently living in the household are not eligible for BadgerCare Plus benefits if:

  1. The access is to a HIPAA health insurance plan through a current employer for which the employer pays at least 80 percent of the premium or the state of Wisconsin’s health care plan (regardless of plan type, or premium amount contributed by state or local government); and
  2. The applicant or member is a child under age 19 and the child is not exempt; and
  3. The coverage would begin within three calendar months following:
    1. The BadgerCare Plus application filing date ; or
    2. Annual review month; or
    3. Employment start date

 

The child or BadgerCare Plus Prenatal Program member who could have been covered by the health insurance plan is ineligible for BadgerCare Plus benefits. Children under 19 years of age can become eligible by meeting a deductible (see Chapter 17 Deductibles)

 

Note: There are no good cause reasons for not enrolling in a health insurance plan when a person has current access.

 

Example 1: Janelle applies for BadgerCare Plus in January for herself and her child. She can enroll in a health insurance plan through her employer in March and her employer pays 80 percent of the premium. However, since coverage would not begin until May, Janelle does not have "current access” so her child is eligible for BC + until the next eligibility renewal (assuming there are no other changes that resulted in ineligibility).  If Janelle’s circumstances remain unchanged, her child will be disenrolled at his or her next review because she had "past access”. Janelle is not eligible because her income is over the limit for the parent and caretaker coverage group.

 

Example 2: Bill applies for BadgerCare Plus in January for himself and his family. He can enroll in family health insurance through his employer and the employer pays 80 percent of the premium.  Coverage would start in April. Bill chooses not to sign up because he thinks he will be eligible for BadgerCare Plus. His children are not eligible for BadgerCare Plus because Bill can sign up in this month and coverage would begin within the next three calendar months. Bill is not eligible because his income is over the limit for the parent and caretaker coverage group.

7.3.2 Good Cause for the Current Access Test

The only good cause reason for failing to enroll in a currently available employer-sponsored health insurance plan is that the insurance only covers services provided in a service area that is beyond a reasonable driving distance from a person's residence.

 

 

 

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017