Some Exceptions Apply....

Is my child considered "insured"?

Depending on the type of insurance, your child may or may not be considered insured. The child is not considered to be insured now if the insurance:

• Is through Medicare or the state/local hospitalization program.
• Does not have doctors in the area where the child lives.
• Is an accident-only policy.
• Only covers dental or vision.
• Only covers a specific disease such as cancer.
• Is a disability policy.
• Only covers hospitalization.
• Is a long-term care policy.
• Is a Workers’ Compensation policy.
• Is an auto policy that covers medical expenses.

When does the four month waiting period apply?

If the child was covered by a health insurance plan any time in the four months before applying for FAMIS, the child may not qualify for FAMIS. A waiting period of four months from the month the health insurance stopped may apply. A four month waiting period will not apply if any one of the following is true:

• The parent or stepparent who had insurance for the child changed jobs or stopped working and no other parent’s employer pays part of the cost for family health insurance.
• The employer providing the health insurance stopped paying part of the cost for family coverage and no other parent's employer pays part of the cost for family health insurance.
• The child's insurance was cancelled by an insurance company for a reason which is not related to unpaid or late payments. For example: The child has used up lifetime benefits. A copy of the letter from the insurance company is required.
• The child’s insurance was dropped by a parent or stepparent who was paying the full insurance payment under a COBRA policy and no other parent's employer pays part of the cost for family health insurance.
• The child’s insurance was dropped by a family member other than the parent or stepparent living in the home with the child. For example: A parent not living in the home with the child, a grandparent, aunt, uncle, or godmother paid for health insurance for the child and later dropped it.
• The child’s insurance was dropped because the cost is more than 10% of the family's current gross monthly income or was more than 10% of the family's gross monthly income at the time the insurance was dropped. Some additional documents are required.
• The child’s prior health insurance was through Medicaid, HIPP, FAMIS, or FAMIS Select.
• The prior health insurance did not have doctors in the area where the child lives.
• The child is pregnant at the time the family applies for FAMIS.