“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 the enrollee had no control,
or which they could not reasonably be expected to guard against, considering their
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 their behalf
to protect their interests; or because they had some reasonable basis for 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 their 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