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| Gag Rule Laws |
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Special laws that make sure that Health Plans let doctors tell their patients complete health care information. This includes information about treatments not covered by the Health Plan.
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| GAMC |
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See General Agents and Managers Conference (GAMC).
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| Gatekeeper |
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A Primary Care Physician (PCP) in a Managed Care environment who is responsible for managing the patient's overall care and who must authorize all specialist Referrals. In most Health Maintenance Organization (HMO), the Secondary Care is not covered by insurance if the Primary Care Physician (PCP) does not approve it.
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| Gatekeeper Model |
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Under this model of HMO and PPO organizations, the Primary Care Physician (PCP) (the Gatekeeper) is the initial contact for the patient for medical care and for Referrals. This is also called a Closed Access or Closed Panel.
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| General Agent (GA) |
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An individual appointed by a Life or Health insurer to administer its business in a given territory. He is responsible for building his own agency and service force and is compensated on a commission basis, although he possibly has some additional expense allowances.
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| General Agents and Managers Conference (GAMC) |
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An association of insurance General Agent (GA)s and managers affiliated with the National Association of Life Underwriters.
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| General LTC Rider |
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A LTC Rider which is attached to a life insurance Policy but stands alone or is independent of the life policy. Any LTC Benefits paid do not reduce any of the life insurance Benefits.
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| Generic Drug |
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Prescription Drugs that have the same active ingredient formula as a Outpatient Rx - Brand Name Drug. Generic Drugs usually cost less than a fraction of their Brand name counterpart. They are rated by the Food and Drug Administration (FDA) to be as safe and effective as Outpatient Rx - Brand Name Drugs. It is allowed to be produced after the Outpatient Rx - Brand Name Drug's patent has expired. It is also called a "generic equivalent." Also see Generic Equivalence.
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| Generic Equivalence |
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See Generic Drug.
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| Generic Substitution |
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The dispensing of a drug that is the generic equivalent of a drug listed on the Formulary of a Pharmacy Benefit Management (PBM) Plan. In most cases, generic substitution can be performed without physician approval.
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| Geographic Accessibility |
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Health Plan Accessibility, generally determined by Drive Time or number of Primary Care Provider (PCP)s in a Service Area.
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| GPWW |
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See Group Practice Without Walls (GPWW).
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| Grievance |
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Request made to a Health Plan to reconsider Coverage of a health care service that the Health Plan has not interpreted to be a Covered Benefit.
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| Grievance Procedure |
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A procedure which allows a Member of a Health Plan or a Provider of Benefits to express complaints and seek remedies.
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| Group |
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Coverage of a number of individuals under one contract. The most common "group" is employees of the same employer.
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| Group Certificate |
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The document provided to each Member of a group plan. It shows the Benefits provided under the Group Contract issued to the employer or other Insured.
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| Group Contract |
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A contract of insurance made with an employer or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare or employee Benefit association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.
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| Group Credit Insurance |
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Insurance on the Life or Health of debtors of a creditor, payable for reduction or extinguishment of the debts in case of the disability or death of the debtor.
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| Group Disability Insurance |
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Coverage provided for a group of individuals for loss of compensation due to accident or Sickness.
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| Group Health Insurance |
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The same definition as Life Insurance but with the application to Health Insurance (HI) Coverages. See Group Life Insurance.
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| Group Health Plan |
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A Health Plan that provides health Coverage to employees and their families, and is supported by an employer or employee organization
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| Group Market |
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A market segment that includes groups of two or more people that enter into a Group Contract with an MCO under which the MCO provides healthcare Coverage to the Members of the group.
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| Group Model HMO |
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A Health Plan where a group of physicians is reimbursed for services they provide at a Negotiated Rate. The HMO also contracts with Hospitals for the care of the patients of the physicians who belong to the group.
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| Group Practice Model HMO |
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See Group Model HMO.
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| Group Practice Without Walls (GPWW) |
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A legal entity that combines multiple independent physician practices under one umbrella organization and performs certain business operations for the member practices or arranges for these operations to be performed. The GPWW may maintain its own facility for business operations or it may hire another company to provide this function.
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| Guaranteed Issue |
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Under guarantee issue, a Health Insurance (HI) company or HMO must issue Coverage to an applicant regardless of prior medical history. In Illinois and Indiana, small employers (defined as 2 to 50 employees) cannot be refused Coverage for their employees regardless of the medical history of one or more employees.
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| Guaranteed Renewable |
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An agreement by an insurance company to insure a person for as long as Premiums are paid.
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| Guaranteed Standard Issue (GSI) |
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An Underwriting term used to describe the fact that a group insurance contract was issued without reference to any Medical Underwriting. All group Participants are covered regardless of Health History.
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