WAC 182-505-0230

Effective October 1, 2013

WAC 182-505-0230 REPEALED -- Waiting period for premium-based healthcare coverage under programs included in apple health for kids following employer coverage.


1.  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                        


                        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.


This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.