An individual who is not disabled and not pregnant, who is over 18 years of age, and whose family income exceeds 133 percent of the poverty line is not eligible for BadgerCare Plus if all of the following apply: 1.
(1)#
The individual has any of the following: a. Access to individual or family health coverage provided by an employer in which the monthly premium that an employee would pay for an employee-only policy does not exceed 9.5 percent of the family’s monthly income. b. Access to individual or family health coverage under the state employee health plan.
(1)(a)#
Access to individual or family health coverage provided by an employer in which the monthly premium that an employee would pay for an employee-only policy does not exceed 9.5 percent of the family’s monthly income.
(1)(b)#
Access to individual or family health coverage under the state employee health plan.
(2)#
The individual has access to any coverage described in subd. 1. during any of the following times: a. The 12 months before the first day of the month in which an individual applies for and the month in which an individual applies for BadgerCare Plus. b. The 3 months after the last day of the month in which the individual applies for BadgerCare Plus. c. The month including the date of the annual determination of the individual’s eligibility for Medical Assistance.
(2)(a)#
The 12 months before the first day of the month in which an individual applies for and the month in which an individual applies for BadgerCare Plus.
(2)(b)#
The 3 months after the last day of the month in which the individual applies for BadgerCare Plus.
(2)(c)#
The month including the date of the annual determination of the individual’s eligibility for Medical Assistance.
(3)#
The individual does not have as a reason for not obtaining health insurance any of the good cause reasons under par. (d) 2. a. to e.