Section 457.805 - [Effective until 6/3/2024] State plan requirement: Procedures to address substitution under group health plans(a)State plan requirements. The state plan must include a description of reasonable procedures to ensure that health benefits coverage provided under the State plan does not substitute for coverage provided under group health plans as defined at § 457.10 .(b)Limitations.(1) A state may not, under this section, impose a period of uninsurance which exceeds 90 days from the date a child otherwise eligible for CHIP is disenrolled from coverage under a group health plan.(2) A waiting period may not be applied to a child following the loss of eligibility for and enrollment in Medicaid or another insurance affordability program.(3) If a state elects to impose a period of uninsurance following the loss of coverage under a group health plan under this section, such period may not be imposed in the case of any child if: (i) The premium paid by the family for coverage of the child under the group health plan exceeded 5 percent of household income;(ii) The child's parent is determined eligible for advance payment of the premium tax credit for enrollment in a QHP through the Exchange because the ESI in which the family was enrolled is determined unaffordable in accordance with 26 CFR 1.36B-2(c)(3)(v) .(iii) The cost of family coverage that includes the child exceeds 9.5 percent of the household income.(iv) The employer stopped offering coverage of dependents (or any coverage) under an employer-sponsored health insurance plan;(v) A change in employment, including involuntary separation, resulted in the child's loss of employer-sponsored insurance (other than through full payment of the premium by the parent under COBRA);(vi) The child has special health care needs; or(vii) The child lost coverage due to the death or divorce of a parent.78 FR 42313, July 15, 2013, as amended at 81 FR 86466, Nov. 30, 2016