GLOSSARY OF HEALTH INSURANCE TERMS

G

Gastroenterologist — a physician who specializes in diseases of the stomach and intestines.

Gatekeeper — an informal though widely used term that refers to a primary care physician management model health plan. In this model, all care from providers, other than in true emergencies, must be authorized by the primary care physician before care is rendered. This is a predominant feature of most HMOs. The term can also refer to a utilization review, case management, local agency or managed care entity responsible for determining the services a patient can access and receive reimbursement for.

Generic Drug or Generic Equivalent — a drug which is exactly the same as a brand name drug and which may be manufactured and marketed after the brand name drug's patent expires (approximately 9-10 years after the brand-name drug entered the market). Generic drugs cost significantly less than brand name drugs, and are identical in terms of efficacy, safety, side effect profile, and dosing. Important exceptions to this may include drugs such as immunosuppressants or drugs with a ''narrow therapeutic index'' such as anti-arrhythmics. ''Narrow therapeutic index'' refers to drugs that have a high rate of side effects at commonly administered dosages.

Grace Period — a period past the due date of a premium during which coverage may not be cancelled.

Grievance Procedures — the process by which an insured can air complaints and seek remedies.

Group Health Plan — a health plan that provides health coverage to employees, former employees, and their families, and is supported by an employer, employee organization or other organized group.

Guaranteed Eligibility — a defined period of time (3-6 months) that all patients enrolled in prepaid health programs are considered eligible for Medicaid, regardless of their actual eligibility for Medicaid. A State may apply to CMS for a waiver to incorporate this into their contracts.

Gynecologist — a physician who specializes in women's health.