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Effective Date: April 1, 2009

Approval Date: ____________ 27

period without coverage under a group health plan is three months. The requirements for the minimum period without coverage under a group health program are the same for NJ FamilyCare and the Premium Assistance program.

Exceptions based on access to health care coverage are made for:

A child who is eligible for coverage under a health insurance policy which is not readily accessible to the child;

A child who has coverage under a government-funded, non- employee based health insurance program which is targeted for low-income uninsured individuals;

A child recently terminated under COBRA, if the reason for the termination is expiration of the COBRA continuation rights. (If the coverage was voluntarily terminated by the family prior to the expiration of continuation rights, the child is precluded only from participation in the NJ FamilyCare- Children's Program-Plan D for three months from the date of COBRA termination.)

Exceptions based on income are also made for:

A child who is otherwise eligible as Medically Needy but for an unmet "spend-down" liability. (The child is not precluded from Plan B, C or D eligibility during the spend-down period.)

Exceptions based on health care coverage discontinued less than three months prior to application are made for:

A child who is otherwise eligible for NJ FamilyCare- Children's Program-Plans B, C and D coverage, as applicable, under a group health benefits plan, whether sponsored through a governing entity or private employer, when:

The employer has ceased operations in the State, and there is no succeeding employer for that business;

The employer has ceased operations in the State, and the succeeding employer has not retained the group health plan;

The employer has ceased operations in the State,