Refreshingly convenient healthcare

Firefly takes care of getting you the best care. Electing the Firefly health plan ensures you'll receive anytime, anywhere primary care, as well as complete healthcare coverage. The outcome? Exceptional and convenient healthcare for all your needs.

The Firefly Health plan is an ACA-compliant health plan structured as a PPO. This means that you will have healthcare coverage for almost everything, including primary care, specialists, urgent care, medications including birth control, hospitalizations and surgeries.

The Firefly health plan’s benefit structure follows three tiers. See FAQ #4 below “How does the tiered benefit work?” for details on expected costs for each tier for you and any dependents you may have.

For more details on copays and coinsurance for specific services, please view the plan table.

Like any other health plan, you will pay a bi-weekly premium for your healthcare coverage that automatically deducts from your paycheck.

The Firefly health plan follows a tiered plan design. With Firefly’s health plan, you’ll be able to get no-cost care for many services including Firefly's virtual primary care, and no-cost in-network care if you follow Firefly’s network guidance. If you pick your own in-network providers, you’ll have a copay or a coinsurance.

For prescriptions, your cost will depend on where the medication falls within the Capital Rx formulary.

The Firefly health plan’s benefit structure follows three tiers.

Tier 1- Guided by Firefly: This tier has the lowest member responsibility. Your costs will fall under this tier when:

• You ask for and follow Firefly’s guidance to high-quality in-network providers each time you need a new provider. Firefly’s team is available to help you find high-quality providers in the Cigna PPO network based on data on which providers create the best outcomes – only providers that meet this criteria will qualify for Tier 1. Firefly’s recommendations are provider-specific, meaning you will need to visit the specific individual provider recommended, not any provider within the practice. Firefly will give you a Care Key for the recommended provider(s), taking into account any preferences you have. When you use the provider on the Care Key, you will get the best financial benefit, such as a $0 copay or a reduced co-insurance. 
• Any care you get from Firefly’s virtual primary care also falls under Tier 1.

Tier 2 - Self-Guided: If you find a provider on your own within the Cigna PPO network and do not use Firefly’s guidance, your costs will fall into this tier. Your costs will be higher in this tier than if you used Firefly’s guidance. 

Tier 3 - Out of Network: If you visit a provider that is not in the Cigna PPO network, your costs will be much higher. 

Dependents under age 18 are not eligible to get Firefly’s virtual primary care but can still get Tier 1 benefits. Here’s how:

• If members under 18 have existing providers, (a preferred primary care provider such as a pediatrician/family doctor, or a specialist), reach out to see if this provider qualifies for Tier 1 costs. If they do not qualify but are in-network with Cigna, you will experience Tier 2 costs with this provider. If you’re open to switching providers, we’d be happy to provide you with recommendations for Tier 1 providers. Firefly’s recommendations are provider-specific, meaning you will need to visit the specific individual provider recommended, not any provider within the practice.
• For expectant parents and new babies, feel free to reach out to us ahead of time to see what pediatricians are available in your area for Tier 1 costs.
• If a member under 18 needs a new provider (for example, if their pediatrician recommends them to see a specialist), you must reach out to Firefly for recommendations to Tier 1 providers in order to have the lowest member responsibility. We’ll give you a Care Key, and when you see that provider, you’ll experience Tier 1 (Firefly-guided) costs. Otherwise, you may have higher costs if you visit a Tier 2 or a Tier 3 provider.
• If you find providers (including PCPs and specialists) that are in-network with Cigna PPO on your own without Firefly’s guidance, you will experience Tier 2 costs.
• If you visit an out-of-network provider, you’ll experience much higher costs in Tier 3.

Firefly uses the Cigna PPO network starting 1/1/25. Any provider in the Cigna PPO network is an in-network provider. In Maine, InterMed providers are also in-network except for adult primary care.

If you reach out to Firefly to get guidance to high-quality in-network providers for your needs, your copays will be waived in most cases. If you self-guide to a provider in the Cigna PPO Network, you will have a copay. You will have even higher out-of-pocket costs for providers outside of the Cigna network.

Please see the FAQ #4 “How does the tiered benefit work?” for more details on how you can make the most of your Firefly benefit by following Firefly’s guidance to specific high-quality providers.

If you're experiencing delays in scheduling an appointment with the provider Firefly referred you to or gave you a Care Key for, please reach out to your Firefly team via chat. Sometimes, the delay could be due to scheduling conflicts or administrative issues that Firefly member guides can resolve for you. If this cannot be solved, your Firefly team can find you another doctor with more availability that can accommodate your needs within your timeframe.

We keep administrative costs low by offering care virtually. We don’t build clinics or stock tongue depressors. When in-person care becomes necessary, our collaboration with nearby healthcare providers ensures that you receive the majority of your primary care services without incurring any expenses.

Yes, prescription medications are covered. Your medical benefits will be through Firefly, the pharmacy benefit manager is Capital Rx. Please check the Capital Rx formulary to understand if your prescriptions are covered, and to get a sense of your expected costs.

You will get the most out of the Firefly health plan when you use Firefly as your primary care provider (PCP) too, but it is not mandatory. We understand that it may not be comfortable discussing your health concerns or receiving medical care from your colleagues. It's perfectly acceptable to use an in-network PCP of your choice.

When you begin with Firefly virtual care, Firefly will become your new primary care provider (PCP). Because you cannot have two PCPs, you will not be able to keep your old PCP and use Firefly primary care. You can leave Firefly primary care at any time, this will not affect your Firefly health plan or medical coverage, but will increase your cost-share for primary care.

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 Cigna network for primary 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.

If you need a controlled substance, please see FAQ #13 below “Can Firefly’s providers prescribe controlled substances?” for more information.

The short answer is, unfortunately, no. Firefly’s virtual providers cannot prescribe controlled substances, but we will help you get the medication you need. Here’s why – while the extension of the pandemic-era regulations on the federal level removes one of the barriers to prescribing controlled substances via telehealth, there are additional state-level laws and rules that prevent us from being able to prescribe in all locations. For this reason, Firefly’s primary care providers cannot write a prescription for a controlled substance via virtual visit.

Here’s what you need to know:

• If you have an existing prescription with refills left, go ahead and refill as usual at your pharmacy.
• If you are switching to make Firefly your PCP and your old PCP prescribed the controlled substance, you’ll need to find a new provider to prescribe the medication once your refills are up. Firefly can recommend new provider(s) that will fall under Tier 1 benefits that can prescribe the medication. To ensure uninterrupted medical care, we’ll follow a Transition of Care process to ensure you have your medication while you get established with a new provider. We recommend getting a renewed prescription if possible before switching your PCP to Firefly so you won’t be rushed for time.
• If you are currently prescribed this medication by a specialist who is in-network with Cigna, you can continue to see that specialist. Let us know who the provider is and we can check if they qualify for Tier 1 benefits. If they do not qualify, you will experience Tier 2 costs if they are in-network.
• If the previous prescriber is out-of-network, you’ll experience Tier 3 costs or we’ll follow a Transition of Care process to ensure you have your medication while you get established with a new in-network provider (Tier 1 or Tier 2). Depending on your specific case, the plan may also allow for out-of-network providers to be paid at the in-network benefit level during this Transition of Care process.
• If you are a Firefly primary care patient and need a new prescription, we will guide you to an in-person, in-network provider that qualifies for Tier 1 who can prescribe the medication you need.

We're always thinking of ways to simplify the healthcare experience. We changed the name to help members understand a unique part of the Firefly plan — how Care Keys give Firefly members exclusively affordable access to high-quality care.