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7.4 Current Health Insurance Coverage

7.4.1 The Current Coverage Test for Children

7.4.2 Current Coverage Test for BadgerCare Plus Prenatal Program

 

7.4.1 The Current Coverage Test for Children

The Current Coverage Test policy applies to non-exempt children (see Section 7.1 Health Insurance Conditions of Eligibility). These children who currently have individual or family health insurance coverage through an employed family member currently living in the household and who meets the following criteria are not eligible for BadgerCare Plus:

  1. The child is not exempt from access and coverage policies (see Section 7.1 Health Insurance Conditions of Eligibility); and
  2. Coverage is provided by an employer; and the employer pays at least 80% of the premium or
  3. Coverage is available under the state of Wisconsin employee health plan (regardless of plan type or premium amount contributed by state or local government), and
  4. The insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

 

Example 1: Dave applies for BadgerCare Plus in March for his family. The children's income exceeds 191 percent of the FPL . Dave is currently covered by family health insurance through his employer and the employer pays 80 percent of the premium. His children are not eligible for BadgerCare Plus because they are currently covered.

 

Children under 19 years of age who are ineligible for BadgerCare Plus due to current coverage can become eligible by meeting a deductible (see Chapter 17 Deductibles).

7.4.2 Current Coverage Test for BadgerCare Plus Prenatal Program

Pregnant women who are otherwise eligible only for the BadgerCare Plus Prenatal Program are not eligible for the BadgerCare Plus Prenatal Program if they are covered by any HIPAA health insurance policy. The plan does not have to be employer-sponsored, but the insurance must cover services provided in a service area that is within a reasonable driving distance from the woman’s residence.

 

 

 

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017