Page 3 of 8 Common Medical Event Services You May Need What You Will Pay Limitations, Exceptions, & Other Important Information In-Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need drugs to treat your illness or condition Tier 1 drugs Not covered Not covered No coverage for prescription drug with surest. Tier 2 drugs Not covered Not covered Tier 3 drugs Not covered Not covered Specialty drugs Not covered Not covered