As explained in HI 01001.290, termination notices are not sent until about 30 days after the end of the grace
period as some premium payments received late in the grace period cannot be processed
until after the end of the grace period. In processing premium payments received immediately
after the grace period up to the day selections are made for the following months'
premium billing, it is not necessary to check the date the premium was mailed: it
will be presumed that either the premium was mailed timely or there was good cause
for the few days' delay. Thus, receipt of all premiums due during this period reverses
the termination.
Similarly, a beneficiary in suspense will not have SMI terminated for nonpayment of
premiums if benefits are resumed in the first month following the end of initial grace period. If, however, monthly benefits are
resumed in the last
two months of the extended period, the termination is not automatically cancelled. In this situation,
request reinstatement and establish good cause for failure to pay premiums timely.
There may be cases in which an enrollee's coverage is terminated for nonpayment of
premiums and subsequently SSA/HCFA is notified that a group payer has arranged to
pay premiums (including those for months prior to the termination). Experience has
shown that delay in adding an enrollee's name to the group account is invariably due
to causes over which one has no control. Therefore, in such situations, good cause
will be deemed to exist and the enrollee's coverage reinstated upon payment by the
group payer of all premiums due.