Provision in a managed care contract that either limits the amount of information that a health care provider may share with a patient or limits the situations in which a provider may recommend a certain alternative treatment when the plan does not cover it. This may be experimental treatments or treatment that may be expensive even if this might be the best course of action for the patient.
Insurance Encyclopedia
Gain from operations
Amount of income that is in excess after benefit and administrative expenses have been accounted for.
Gain-or-loss report
Financial statement for insurance that shows underwriting and investment gains and losses for either an individual case, group of cases, or an entire category of group business.
Gale
A wind with a speed of from 34 to 40 knots (39 to 46 miles per hour; 63 to 74 kilometres per hour), according to the Beaufort scale. Also called fresh gale . On the water a storm at sea. Moderately high (18-25 ft) waves of greater length, edges of crests begin to break into spindrift, foam blown in streaks. On the land Twigs breaking off trees, generally impedes progress. Also refer “Strong Gale.”
Gambling
The creation of a situation where there is a chance of either loss or gain. This is the opposite of insurance, which either eliminates or reduces the risk of loss and presents no chance or gain.
Gambling policies
Policies that contravene the Marine Insurance (Gambling Policies) Act 1909. It is not legal to enter into a marine insurance without a bona fide interest, or possibility thereof, in the subject matter insured. It is also an offence for a shipowner’s employee, not being a part-owner, to effect a policy on PPI terms. The Act prevents gambling in marine insurance.
Gambling Policy
A Policy in respect of which the assured or reassured has no insurable interest, and no reasonable expectation of acquiring such interest.
Game cover
Specialised cover for printers and vendors of instant ticket sales and online lottery services. The policy covers: (a) contractual obligations with first party principals; (b) increased cost of failing to conform to these contracts, e.g. print re-runs; (c) printer’s liability following machinery or computer breakdown, etc., not covered under an errors and omissions policy or professional indemnity policy.
Gaming
Illegal or unethical attempt to manipulate a system for financial gain such as billing to maximize income by listing a principal diagnosis that puts the patient in the highest-priced diagnosis-related group (DRG) in a prospective payment system (PPS) when a lower-priced diagnosis more precisely depicts the services given for a patient’s medical problem.
Gaming Act 1845
Makes all wagering or gaming contracts null and void. An insurance on goods without insurable interest is a wager and therefore unenforceable.