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Anti-steering clause

A contract rule that stops an insurance company or health plan from telling or encouraging a patient to choose a less expensive hospital or doctor, sometimes even offering incentives.

Anti-tiering clause

A contract rule that prevents an insurance company from sorting doctors or hospitals into different cost categories (tiers) or requires all providers within a large system to be in the same cost category.

All-or-nothing clause

A contract rule that forces an insurance company to include all parts of a healthcare provider's system in their network, or to contract with an affiliated group, if they want to contract with any part of that provider.

Gag clause

A contract rule that stops an insurance company, health plan, or healthcare provider from sharing price or quality information (like negotiated rates or out-of-pocket costs) with certain people or groups, including patients or government entities.

Tiered network plan

A health insurance plan that groups healthcare providers into different categories, often based on cost or quality, and then applies different prices or requirements for patients choosing providers from those different groups.

Government Accountability Office (GAO)

An independent agency that investigates how the federal government spends taxpayer dollars, often by conducting studies, audits, and evaluations for Congress.