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the start of new employment, or in the previous 12 months, unless a good cause exemption is granted.

A good cause exemption is granted to those children who are covered by health insurance or a group health plan during the month of application or in the previous three months, if the individual is covered by health insurance: o That only covers services provided in a service area that is beyond a reasonable driving distance from the individual’s residence, o Provided by someone who is not a member of the child’s household, or o Which is not a group health plan, or for which an employer contributes less than 80 percent of the premium cost. This reason does not apply to State employee’s health benefits plan.

A good cause exemption is granted to those children who were covered by a group health plan in the three months prior to application, if: o The individual through whom the insurance was available involuntarily lost their job with the employer providing that 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, or o Coverage was lost due to the death or change in marital status of the policy holder.

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 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 individuals who, in the past 12 months, had access to a group health plan or 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

WISCONSIN

Effective Date:

Approval Date: 16