Terms to Know

Below are some of the most frequently misunderstood or confusing parts of health insurance. Please feel free to call us for further explanation.

Deductible: This is the amount a person has to pay out-of-pocket for health services before their insurance benefits kick in.

Premium: This is the amount a person pays every month for their insurance plan.

Out-of-pocket max: This is the maximum amount a person has to pay with their own money for covered healthcare services. Once this maximum is reached, the insurance company pays for 100% of all covered costs for the rest of the year. Deductibles, co-insurance, and co-payments count towards this maximum, but plan premiums and out-of-network care and services do not.

Co-payments: This is the amount a person pays for their health services. For example, if a session costs $100 and a person’s deductible has already been paid, their co-pay may be only $20 for the visit.

Co-insurance: Basically, the same as co-payments but instead of a fixed dollar amount, it is the percentage of that amount. For example, if a session costs $100 and a person has a coinsurance rate of 20% after meeting their deductible, they would pay $20 for the session.

Superbill and claims: A superbill is a document that generates a claim to prove to the insurance company that services were necessary. ​Thrive can provide a superbill to our clients, who can then file the claim with their insurance company. This is typical for out of network benefits.

Reimbursement: Insurance includes reimbursement policies in which a person may pay out of pocket for a service but can receive money back after submitting a claim. Plans differ on their reimbursement policies, so it’s important for clients to understand their individual benefits.

Allowable amount: This is the maximum amount an insurance company will pay for a specific healthcare service. Can also be known as eligible expense, payment allowance, or negotiated rate.

Insurance we take: Blue Cross Blue Shield Illinois, Health Alliance, Cigna, HealthLink, United Healthcare

435 W. Washington
Springfield, IL 62702

(217) 203-6600

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