Health Plan

Frequently Asked Questions

Answers for questions about Firefly's health plan, including how your plan works, how to get care, and how you can save with our unique model.

How do I get the Firefly Health mobile app?

To get our mobile app, go to the App Store (iOS) or Google Play (Android) and search "Firefly Health."

Can I really get $0 copays?

Yes. Choose us as your primary care provider (PCP) and you won't pay anything for care you receive from us. Need more than primary care? Contact us. We’ll guide you to providers who get great results — and you'll have lower costs for any care that qualifies for Care Pass.

Do I have to choose Firefly as my PCP?

Nope. We’re just one of your options. We offer easy, coordinated care at no cost to you and you’ll receive the best financial benefit if you do choose Firefly as your PCP. If you don’t choose Firefly as your PCP, be sure to pick an in-network PCP.

Do I have to see in-network providers?

Technically, you don’t have to. But you’re going to pay a lot more for out-of-network care. For example, you have to reach your out-of-network deductible before you get any coverage for even a routine doctor visit. Even then, you’ll pay more than if you just stayed in-network.

How do I find an in-network provider?

Chat with us in the app or call us. We’ll find you a great one.

Do I need a referral to see a specialist?

No, your plan doesn’t have referrals. But if you want check on getting a $0 copay for your visit, be sure to contact us so we can guide the way.

What is a copay?

Copays are flat fees you pay for some services, like $50 for an urgent care visit. (That’s just an example. Check your plan documents for your actual costs.)

What is coinsurance?

Coinsurance means you pay a percentage of the cost of a service. Here’s an example. If you don’t have a Care Pass for an MRI, you have a deductible and coinsurance.Let’s say you’ve already reached your deductible and you have 20% coinsurance. For an MRI that costs $800, you pay 20% of $800 (that’s $160). Your plan pays the rest.

What is a deductible?

It’s an amount you have to pay out of your own pocket before your coverage kicks in. The deductible applies to only certain services. So, suppose you have a $2,000 deductible and you need an MRI that costs $800. If you haven’t paid anything toward your deductible yet, you pay the full $800.And for any other services where the deductible applies, you keep paying out of pocket until you reach that $2,000 mark. (This is just an example. Check your plan documents for your actual costs.)Note that your plan has separate deductibles for in-network and out-of-network care. If you have dependents on your plan, you also have individual and family deductibles.

What is an out-of-pocket maximum?

It’s the most you’ll pay for covered healthcare services in a plan year. Note that your plan has separate out-of-pocket maximums for in-network and out-of-network care. If you have dependents on your plan, you also have individual and family out-of-pocket maximums.

Do I ever need to get prior authorization?

For some types of care, you need to get approval ahead of time — called prior authorization — to make sure your plan will pay for the service. A good rule of thumb is that if it happens outside a doctor’s office, like a surgery or MRI, you might need prior authorization. An in-network provider will usually take care of it for you behind the scenes. If you see an out-of-network provider, contact us so we can walk you through it.

Do copays and coinsurance count toward my deductible?

No, they don’t. Also, when you make payments toward your in-network deductible, they do count toward your out-of-network deductible. But payments toward your out-of-network deductible don’t count toward your in-network deductible.

What payments count toward my out-of-pocket maximum?

Copays, coinsurance, and deductibles all count toward your out-of-pocket maximum. That includes copays and coinsurance you pay for prescriptions. When you pay for in-network care, it does count toward the out-of-pocket maximum for out-of-network care. But when you pay for out-of-network care, it doesn’t count toward your out-of-pocket maximum for in-network care.

How much do I pay for medical care like doctor visits, labs, and hospital stays?

Call us, chat with us in the app, or check your plan documents for details. And remember, you can get a lot of $0 copays with Firefly primary care and Care Pass.

Do I need the Firefly Health app?

It’s highly encouraged – with the Firefly app, you’ll have anytime access to the in-app chat with Firefly member guides, your digital member ID card, viewing your claims and more. If you want to use Firefly virtual primary care, you’ll need to download the app to schedule visits, chat with your team, and view care plans (video visits are available on the web for hands-free convenience). You can also always access Firefly’s member support by phone.

What’s that First Health logo on my ID card mean?

First Health is the network we use for our in-network providers. The logo is on the card to help staff at the doctor’s office know that we use First Health.

Does each family member have to meet the family deductible?

No. If your plan covers more than one person, each member has an individual deductible. And those deductibles all count toward the family deductible. So together, you can meet the family deductible without any members meeting their individual deductibles. And once you do that, your coverage kicks in for all family members. Let’s look at a family with three members: Luisa, Stewart, and Jackson. Their individual deductible is $3,000 and the family deductible is $6,000. Let’s say that:

  • For Luisa’s care, they pay $2,500
  • For Stewart’s care, they pay $2,000
  • For Jackson’s care, they pay $1,500

None of them have met their individual deductibles, but together, they’ve reached the $6,000 family deductible. So now, when they need any care that has a deductible, they’ve already reached it. (This is just an example. Check your plan documents for your actual costs.)

Does each family member have to meet the family out-of-pocket maximum?

No. It works just like the family deductible, where everyone’s individual out-of-pocket maximum counts toward the family out-of-pocket maximum. So the most your family will pay for care in a plan year is the family out-of-pocket maximum.

How does urgent care coverage work?

It’s similar to getting other types of care. Your best bet is to go to an in-network urgent care center. You’ll pay much less compared to going out-of-network. During regular business hours, you can contact us for a Care Pass to get a $0 copay at urgent care centers we recommend. If Firefly is your primary care provider (PCP), be sure to get in touch with us first. You can always page us in the app after hours. We’ll help you figure out what you need, guide you to the right provider, and give you a Care Pass. Check your plan documents for more details about urgent care coverage.

How does emergency care coverage work?

First, if you’re having a life-threatening emergency, call 911 right away. Your plan covers emergency room services at both in-network and out-of-network hospitals.Check your plan documents for more details. But if you’re not feeling well and want to get checked out — or you’re not sure it’s an emergency — contact your primary care provider (PCP). It might save you a trip to the emergency room and spare you the extra costs. And remember, if we’re your PCP, you can use the app to page us after hours to get the guidance you need.

Do I need a phone or computer with a camera to use Firefly?

You will need a video-enabled iOS or Android device or desktop computer to receive the best possible care.

How do I schedule an appointment?

We make it easy to schedule same- or next-day appointments through the Firefly Health app. And when questions pop up, your care team has answers. Chat them day or night, at no cost to you.

What do I do in an emergency?

When something urgent comes up, we want to be your first point of contact. In the event of a non-life-threatening emergency, your Firefly care team will guide you to where you need to go. You can message them on weekdays between 7 AM-7 PM and expect a response within 30 minutes. If it's after hours, you can page us through the app. We’ll call you within an hour. If you have a life-threatening emergency, call 911.

What is a Firefly care team?

At Firefly, we believe that many heads are better than one. Instead of one doctor, we give you an entire care team: a trusted physician, nurse practitioner, health guide, and behavioral health specialist—all working together to help you feel your very best. Your Firefly team supports you over time, making sure you get the best care science has to offer for staying healthy and achieving your goals.

What is the role of a Behavioral Health Specialist?

We believe mental health is essential to overall health and well-being. That’s why Firefly members have the option to work with a licensed behavioral health specialist for short-term, solution-based therapy. Our Behavioral Health Specialists collaborate with your physician, NP, and health guide to create a plan for your mental and behavioral health concerns. They'll work to understand your unique needs, then create a complete treatment plan that may include medications, lifestyle changes, specialists for long-term therapy, or other treatments.

What is the role of a Health Guide?

Getting healthy can feel overwhelming at first. Wouldn’t it be nice to have someone to guide you towards objectives, keep you motivated, and establish behaviors that stick? At Firefly Health, you do. Our Health Guides work closely with our team of physicians and nurse practitioners to actively support your unique health and wellness goals, offer information about healthier habits, and keep you on track to meet your objectives. They're a regular point of contact, full of resources and information—and ready to any solve problems that arise.

What is the role of a Medical Doctor (MD)?

At Firefly, MDs collaborate with and support our NPs on complex workups and illnesses. They're available to meet with our members on request.

What is the role of a Nurse Practitioner (NP) at Firefly?

In most cases, a Nurse Practitioner is the point person on your Firefly care team. They're available on demand to answer your questions and provide continuous support for your routine care. NPs are trained at the master's level to diagnose and prescribe medications to patients. When it comes to performing routine physical exams, diagnosing and treating acute conditions, managing chronic diseases, and counseling on preventative healthcare, you can count on your NP to deliver high-quality, personalized care. In fact, several scientific studies show that NPs provide primary care that is indistinguishable from physician care.

What is Virtual Primary Care, anyways?

Think of it as a modern house call. Instead of going to the doctor, the doctor comes to you through video and chat. As a Firefly member, you can look forward to personalized primary care from wherever you are: on the go, in the office, or on the couch. You'll have a dedicated care team that gets to know you over time, helping you manage chronic conditions, plan preventative care, and direct you to the right in-person treatment when needed.

What medical needs does Firefly address?

Your Firefly care team can manage many health concerns virtually, including:

Chronic conditions: We have advanced approaches to managing your chronic conditions such as diabetes or high blood pressure.
Acute concerns: We’re great for common ailments like back pain, stomach flu, headaches, sinus infections, and more.
Health coaching: We help you be your best self by supporting long-term health goals such as losing weight, quitting smoking, or sleeping better.
Women’s health: From birth control counseling to menstrual cycle concerns, we're here to keep you on track with your women's health needs.
Behavioral health: As a Firefly member, you’ll have the option to work with a licensed behavioral health specialist to assess your concerns, provide support, and monitor your progress along the way.

Will I talk to my personal care team every time?

Most of the time, but not always. Because we want to help you as quickly and conveniently as possible, you may occasionally talk to someone outside your personal care team. Suppose you need after-hours care or help with routine problems like a sinus infection or urinary tract infection. In that case, you may receive care from providers who are not on your personal care team.

Is virtual care as good as in-person care?

It’s not about one versus the other. Sometimes, you absolutely need hands-on care. But very often, you don’t. Going virtual means you avoid a lot of hassle, like waiting weeks for an appointment, juggling time off from work, or a million other things that get in the way of seeing your doctor.

Firefly builds upon decades of research on virtual care, and takes the best ideas from the in-person way of doing things and builds on them to give you more complete healthcare that fits your life. Firefly can handle most primary care needs virtually, including preventative care, chronic conditions, acute concerns, health coaching, women’s health, behavioral health. And when our board-certified providers determine you do need in-person care, we have a nationwide footprint of Firefly Nearby partners that will deliver the specific hands-on care you need such as a swab or exam.

Can I see my Firefly care team in-person?

Firefly’s providers practice virtually. But when you need in-person care, we’ve got you covered. We’ll connect you to the right provider for your needs, whether that’s a Firefly Nearby provider, or an in-network specialist.

How do I make Firefly my PCP?

Download the app. Create your account and answer a few basic questions. Then, choose your doctor and care team and you’re on your way!

Can my children use Firefly as their PCP?

Firefly's primary care offering is only available for adults 18+. Dependents on the Firefly plan can see any pediatrician or family doctor in the First Health network for primary care.

What’s Firefly-guided care?

Firefly’s health plan is all about connecting you with high-quality care. When you need specialist care or other care, reach out to us. We’ll help you find high-quality doctors and providers and when you get and follow recommendations from Firefly on an in-network provider, your care will be more affordable.

What’s a Care Pass?

It’s your ticket to more affordable care. When we guide you to care, we’ll also add a Care Pass in your app. Just show the pass at your visit and you’ll get lower costs. 

Why should I trust you to choose my providers?

Because we’ve done the research. We use data to find providers that are high-quality, cost-efficient and have good member ratings. Of course, we’ll also take your preferences into account. We do all that legwork so you don’t have to do any guesswork.

Can I get Firefly-guided care even if you’re not my PCP?

Yes, of course! When you need other care, get in touch. This is another great reason to download the app — you can send us requests quickly by chat.

How do I get a Care Pass?

Contact us (by in-app chat or phone) and let us know what you need.

What if a provider says I owe a copay even though I have a Care Pass?

Ask them to call us. Our number is in the app and on your member ID card.