“Good cause” will be found when the enrollee establishes by a credible statement, not contradicted
by any evidence available to the adjudicating office, that failure to pay premiums
within the normal period resulted from conditions over which he had no control, or
which he could not reasonably be expected to guard against, considering his education,
competence, health, and any other pertinent circumstances. For example, good cause
would be found if payment was late because the enrollee was mentally or physically
unable to make the payment on time and no one was acting on his behalf to protect
his interests; or because he had some reasonable basis for his belief that the payment
had been made when actually, it had not; or because of some administrative fault or
error, e.g., billing notices were misaddressed and thus, not received.
Straitened circumstances or poverty do not constitute good cause per se; a person enrolling is expected to take into account his ability to pay premiums.
On the other hand, a financial emergency arising because of unavoidable and unexpected
circumstances might constitute good cause. A reasonable doubt should be resolved in favor of a good cause finding, especially if the enrollee
has not previously been late in making payment. However, each good cause determination
is based on the pertinent facts in the particular case, including previous extensions