GAG RULE LAWS:
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.
This typically refers to a “middle man” agent who facilitates business between “retail” agents and the insurance company.
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.
GROUP HEALTH PLAN:
A health plan that provides health coverage to employees and their families, and is supported by an employer or employee organization.
Under guarantee issue, a health insurance 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.