Family Healthcare (FAMIS) Manual – Table of Contents

0920.020.05.15 Good Cause For Dropping Insurance

IM-99 October 2, 2007,��IM-#67 July 13, 2004,��IM-98 July 29, 2003

If “good cause” exists for dropping health insurance, the six-month ineligibility period does not apply. Good cause is defined as loss of insurance coverage resulting from no action taken by insured. Good cause reasons are:

  • the parent lost a job but did not quit the job;
  • the parent changed jobs and the new job does not offer insurance for children;
  • COBRA insurance ends; or
  • an individual other than the custodial parent or guardian drops health insurance coverage on the children; or
  • discontinuance of HIPP ( Refer to Section 0920.020.05.05 )

Health insurance being unaffordable is not a “good cause” reason for dropping coverage. However, there is an exception to the six month penalty for children with special healthcare needs who do not have access to affordable, employer sponsored healthcare coverage. Refer to Section 0920.020.05.20.