WAC 182-505-0230 Waiting period for premium-based healthcare coverage under programs included in apple health for kids following employer coverage.

 The department requires applicants to serve a waiting period of four full consecutive months before  

     receiving premium-based coverage under programs included in apple health for kids if the client or family:

            a.  Chooses to end employer sponsored dependent coverage.   The waiting period begins the day

                 after the employment-based coverage ends; or

            b.   Fails to exercise an optional coverage extension (e.g., COBRA) that meets the following

                 conditions.   The waiting period begins on the day there is a documented refusal of the  

                 coverage extension when the extended coverage is:

                        i.  Subsidized in part or in whole by the employer or union;

                        ii. Available and accessible to the applicant or family; and

                        iii.At a monthly cost to the family meeting the limitation of

                           subsection (2)(b)(iv).

2.  The department does not require a waiting period prior to premium-based coverage under a program included in apple health for kids when:

            a.   The client or family member has a medical condition that, without

                 treatment, would be life-threatening or cause serious disability or loss of function; or

            b.  The loss of employer-sponsored dependent coverage is due to any of the                        

                 following:

                        i.  Loss of employment with no post-employment subsidized coverage as described in

                            subsection (1)(b);

                        ii. Death of the employee;

                        iii.The employer discontinues employer-sponsored dependent coverage;

                        iv. The family's total out-of-pocket maximum cost for employer-sponsored                        

                            dependent coverage is two and one-half percent or more of the family's countable

                            monthly income;

                        v.  The plan terminates employer-sponsored dependent coverage for  the client because

                             the client reached the maximum lifetime coverage amount;

                        vi. Coverage under a COBRA extension period expired;

                        vii.Employer-sponsored dependent coverage is not reasonably available (e.g., client

                            would have to travel to another city or state to access care); or

                        viii.Domestic violence caused the loss of coverage for the victim.