49.471(8)(d)1.a.a. A pregnant woman, except as provided in par. (cr) 1. c.
49.471(8)(d)1.b.b. A child described in sub. (4) (a) 2. or 2m.
49.471(8)(d)1.c.c. Except as provided in par. (c), a child who has health insurance coverage, or access to health insurance coverage, as a dependent of an absent parent but who resides outside of the service area of the absent parent’s plan.
49.471(8)(d)1.d.d. An individual described in sub. (4) (a) 5.
49.471(8)(d)1.e.e. A child who obtains eligibility under sub. (7) (b) 2., but only for the remainder of the child’s eligibility period under sub. (7) (b) 2.
49.471(8)(d)1.f.f. An individual described in sub. (4) (a) 7.
49.471(8)(d)1.g.g. An adult who is disabled.
49.471(8)(d)2.2. An individual under par. (b) 2., or an individual who is an unborn child or an unborn child’s mother under par. (c) 2., is not ineligible if any of the following good cause reasons is the reason that the individual did not obtain the health insurance coverage under par. (b) 1. to which they had access:
49.471(8)(d)2.a.a. The individual’s employment ended.
49.471(8)(d)2.b.b. The individual’s employer discontinued health insurance coverage for all employees.
49.471(8)(d)2.c.c. One or more members of the individual’s family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual’s family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7.
49.471(8)(d)2.d.d. The individual’s access to health insurance coverage has ended due to the death or change in marital status of the subscriber.
49.471(8)(d)2.dg.dg. The insurance is owned by someone not residing with the family and continuation of the coverage is beyond the family’s control.
49.471(8)(d)2.dr.dr. The insurance only covers services provided in a service area that is beyond a reasonable driving distance.
49.471(8)(d)2.e.e. Any other reason that the department determines is a good cause reason.
49.471(8)(e)(e) If a pregnant woman has health insurance coverage and her family income exceeds 200 percent of the poverty line, the woman is required, as a condition of eligibility, to maintain the health insurance coverage.
49.471(9)(9)Employer verification of insurance coverage.
49.471(9)(a)(a)
49.471(9)(a)1.1. Except as provided in subd. 2., for an applicant or recipient with a family income that exceeds 150 percent of the poverty line, the department shall verify insurance coverage and access information directly with the employer through which the applicant or recipient may have health insurance coverage or access to coverage.
49.471(9)(a)2.2. Subdivision 1. does not apply to any of the following:
49.471(9)(a)2.a.a. A pregnant woman.
49.471(9)(a)2.b.b. A child described in sub. (4) (a) 2. or 2m.
49.471(9)(a)2.c.c. An individual described in sub. (4) (a) 5.
49.471(9)(b)(b) An employer that receives a request from the department for insurance coverage and access to coverage information shall supply the information requested by the department in the format specified by the department within 30 calendar days after receiving the request.
49.471(9)(c)(c)
49.471(9)(c)1.1. Subject to subds. 2. and 3., an employer that does not comply with the requirements under par. (b) shall be required to pay, within 45 days after the requested information was due, a penalty equal to the full per member per month cost of coverage under BadgerCare Plus for the individual about whom the information is requested, and for each of the individual’s family members with coverage under BadgerCare Plus, for each month in which the individual and the individual’s family members are covered before the employer provides the information.
49.471(9)(c)2.2. An employer with fewer than 250 employees may not be required to pay more than $1,000 in penalties under this paragraph that are attributable to any 6-month period. An employer with 250 or more employees may not be required to pay more than $15,000 in penalties under this paragraph that are attributable to any 6-month period.
49.471(9)(c)3.3. Notwithstanding subd. 1., an employer shall not be subject to any penalties if the employer, at least once per year, timely provides to the department, in the manner and format specified by the department, information from which the department may determine whether the employer provides its employees with access to health insurance coverage.
49.471(9)(c)4.4. All penalty assessments collected under this paragraph shall be credited to the appropriation accounts under s. 20.435 (4) (jw) and (jz).