DHS 103.03(1)(f)1. 1. The person meets one of the conditions in par. (b).

DHS 103.03(1)(f)2. 2. Except as provided in subd. 5m., the person is a child age 1 through 5 with household income over 191% of the federal poverty line or age 6 through 18 with household income over 156% of the federal poverty line, and does not have health insurance coverage that meets both of the following criteria:

DHS 103.03(1)(f)2.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is provided under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)2.b. b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)2m. 2m. The person is an unborn child and the unborn child’s mother does not have health insurance coverage that covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)3. 3. Except as provided in subd. 5m., the person is a child age 1 through 5 with household income over 191% of the federal poverty line or age 6 through 18 with household income over 156% of the federal poverty line, and the person does not have access to coverage under a group health insurance plan that meets all of the following criteria:

DHS 103.03(1)(f)3.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)3.b. b. The health insurance coverage would begin within 3 calendar months following the BadgerCare Plus application filing date, the BadgerCare Plus annual renewal month, or the start date of the employment through which the child can access the health insurance coverage.

DHS 103.03(1)(f)3.c. c. The employer of the person’s parent, step-parent or other caretaker relative residing with the person, when the person is under 19 years of age.

DHS 103.03(1)(f)3.cm. cm. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)3.d. d. The health insurance policy is through the child’s employer, the employer of the child’s spouse when the spouse is residing with the child, or the employer of the child’s parent, step-parent or other caretaker relative residing with the child.

DHS 103.03(1)(f)3m. 3m. If the person is an unborn child, the unborn child’s mother does not have access to coverage under a group health insurance plan that meets all of the following criteria:

DHS 103.03(1)(f)3m.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)3m.b. b. The health insurance coverage would begin within 3 calendar months following the BadgerCare Plus application filing date, the BadgerCare Plus annual renewal month, or the start date of the employment through which the mother can access the health insurance coverage.

DHS 103.03(1)(f)3m.c. c. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)3m.d. d. The health insurance policy is through the mother’s employer or the employer of the mother’s spouse when the spouse is residing with the mother.

DHS 103.03(1)(f)3m.e. e. When the mother is under 19 years old, the health insurance coverage is through the employer of the mother’s parent, step-parent, or other caretaker relative residing with the mother.

DHS 103.03(1)(f)4. 4. Except as provided in subd. 5. or 5m., if the person did not, at any time in the 12 months immediately preceding application for BadgerCare Plus, have access to employer-subsidized health care coverage or a state employee health plan and is any of the following:

DHS 103.03(1)(f)4.a. a. A child ages 1 through 5 with household income over 191% of the federal poverty level.

DHS 103.03(1)(f)4.b. b. A child ages 6 through 18 with household income over 156% of the federal poverty line.

DHS 103.03(1)(f)4g. 4g. The child under subd. 4. is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the child if the family had been enrolled in the plan. The child remains ineligible for each month that coverage would have been available up to 18 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4g.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4g.b. b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4g.c. c. The health insurance policy is through the child’s employer, the employer of the child’s spouse when the spouse is residing with the child, or the employer of the child’s parent, step-parent or other caretaker relative residing with the child.

DHS 103.03(1)(f)4r. 4r. Except as provided in subd. 5., if the person is an unborn child, the unborn child’s mother did not, at any time in the 12 months immediately preceding application for BadgerCare Plus, have access to employer-subsidized health care coverage, or a state employee’s health plan. The unborn child is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the unborn child’s mother if the family had been enrolled in the plan. The unborn child remains ineligible for each month that coverage would have been available up to 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4r.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4r.b. b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4r.c. c. The health insurance policy is provided through the mother’s employer, the employer of the mother’s spouse when the spouse is residing with the mother, or the employer of the mother’s parent, step-parent or other caretaker relative residing with the child, if the mother is under 19 years of age.

DHS 103.03(1)(f)5. 5. The 12 month period in subds. 4. and 4m. does not apply if one of the following statements is true about access to employer-subsidized health care coverage: