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insurance, or voluntarily ended their job because of the incapacitation of the individual or because of an immediate family member’s health condition, o Employment of the individual through whom the insurance was available changed and the new employer does not offer health insurance coverage, or the employer discontinued health plan coverage for all employees o COBRA continuation coverage was exhausted in accordance with federal regulations, o Coverage was lost due to the death or change in marital status of the policy holder, or o The insurance was provided by someone not residing with the unborn child;

A good cause exemption is granted to individuals with current, future or past access to an employer’s group health plan, if the available insurance is through a person who is not a member of the unborn child’s household or the employer contributes less than 80 percent of the premium cost. The percentage of employer contribution is not applicable for the State employee’s health plan.

A good cause exemption is granted to those unborn children who, in the past 12 months, had access to a group health plan or had access to access to a State employee’s health benefits plan if: o Employment of the individual through whom the insurance was available ended, or the employer discontinued health plan coverage for all employees; or o At the time the individual failed to enroll in the employer’s health insurance coverage, one or more members of the individual’s family were covered through: o A private health insurance policy or Medicaid, and o No one in the family was covered through SCHIP.

Children covered under Separate SCHIP

May not be covered under a group health plan or under health insurance coverage, as defined in section 2791 of the Public Health Service Act, during the month of application or in the previous three months, unless a good cause exemption is granted.

May not have access to a State employee’s health benefits plan or to an employer’s group health plan at the time of application or within the three calendar months following the month of an application, annual review or

WISCONSIN

Effective Date:

Approval Date: 15