The plan One Georgia Gold-Level EPO
One plan. Nothing hidden.
You get one plan at one price, with all ten essential health benefits the Affordable Care Act requires. Every copay is listed on this page, and none of them depend on meeting a deductible first.
One Georgia
Gold EPO
Plan 100-0
Plan 100-0
PCP $15
SPEC $40
URGENT $30
ER $250
RX $5/$35/$70
SPEC $40
URGENT $30
ER $250
RX $5/$35/$70
Your Name Here
Member IDGroupDeductible
OGC-000000GA-INDV$0
Everyday care
What most people use most.
These are the visits that fill up a normal year. All of them have a flat copay from your first visit.
| Service | You pay | Details |
|---|---|---|
| Preventive & wellness | $0 | Annual physical, immunizations, cancer screenings (mammogram, colonoscopy, Pap), well-child visits, contraception. |
| Primary care | $15 | Sick visits, follow-ups and chronic care. Pick any in-network PCP, or let us match you with one. |
| SpecialistNo referral | $40 | Cardiology, dermatology, OB-GYN, orthopedics and more. You can book directly. |
| Telehealth, 24/7 | $0 | Video or phone visits with Georgia-licensed clinicians. Includes e-prescribing. |
| Urgent care | $30 | For sprains, stitches, fevers, or anything that can't wait but isn't life-threatening. |
| Lab work & X-ray | $10 | Lab work and standard imaging. MRI and CT scans are $150 per scan. |
Prescriptions
A four-tier formulary that's easy to read.
Accepted at CVS, Walgreens, Kroger, Publix, Walmart and most independent pharmacies in Georgia. A 90-day supply by mail costs twice the 30-day copay.
| Tier | 30-day | Examples |
|---|---|---|
| Tier 1 · Generic | $5 | Lisinopril, metformin, atorvastatin, sertraline, levothyroxine, amoxicillin. |
| Tier 2 · Preferred brand | $35 | Brand-name drugs on our preferred list, including inhalers and some newer blood thinners. |
| Tier 3 · Non-preferred | $70 | Brand-name drugs with a lower-cost alternative. Your doctor can request an exception. |
| Tier 4 · Specialty | 20% | Biologics and specialty medications, capped at $250 per fill. Insulin is capped at $35 a month. |
The big stuff
When life goes sideways.
The bad days are why you have insurance. These costs are capped by your $3,500 out-of-pocket maximum. Once you reach it, everything covered is $0 for the rest of the year.
| Service | You pay | Details |
|---|---|---|
| Emergency room | $250 | Waived if you're admitted. Covered at in-network cost at any ER in the country. |
| Ambulance | $150 | For emergency ground transport. Air ambulance is protected under the federal No Surprises Act. |
| Hospital stay | $500 | Per admission, not per day. Covers surgeon, anesthesia, room and board. |
| Outpatient surgery | $200 | Includes knee scopes, hernia repair, cataract surgery and colonoscopy with biopsy. |
| Maternity & delivery | $500 | One copay covers prenatal visits, delivery and postpartum care. Prenatal visits are $0. |
| Mental health inpatient | $500 | Covered the same as physical health, as required by federal parity law. |
The fine print, enlarged
What it doesn't do.
A plan that seems to cover everything usually has a catch. Here's what ours leaves out.
AOut-of-network care isn't covered
This is an EPO. You use in-network doctors and hospitals, except in a true emergency, which is covered anywhere. The network is large, but check your doctor before you enroll. We'll check for you if you'd like.
BAdult dental and vision are add-ons
Pediatric dental and vision are included, since the ACA requires them. Adults can add both for $18 a month.
CNo cosmetic procedures
Reconstructive surgery after an injury or mastectomy is covered. Elective cosmetic surgery isn't.
DSome services need prior authorization
Planned MRIs, inpatient surgery and specialty drugs need approval first. Your doctor's office handles it, and we decide within 72 hours, or 24 for urgent requests.
Plain-English FAQ
What people actually ask us.
These are the questions our Georgia-based agents hear most.
01Can I really be denied for a pre-existing condition?
No. Diabetes, asthma, cancer history, pregnancy and depression can't raise your price or keep you off this plan. That's federal law under the ACA, and we'd do it anyway.
02When can I sign up?
Open Enrollment for 2027 runs from November 1 to January 15 on Georgia Access, the state's marketplace. If you enroll by December 31, coverage starts January 1. Outside that window, you'll need a Qualifying Life Event, such as losing other coverage, moving, getting married, or having a baby. You then have 60 days to enroll.
03I just lost Medicaid. Can I switch to this?
Yes. Losing Medicaid or PeachCare for Kids eligibility counts as a Qualifying Life Event. You have 60 days from the date coverage ends to enroll, and we'll help you file the paperwork.
04Will a tax credit lower my $100?
Possibly. Depending on household income, Advance Premium Tax Credits (APTC) can lower your premium further, sometimes to $0. Our intake form gives an estimate, and an agent confirms the exact amount when you apply.
05What's an EPO, and how is it different from an HMO or PPO?
An HMO usually needs a referral before you see a specialist. A PPO covers out-of-network care, but at a higher price. Our EPO sits in between. You can see any in-network specialist without a referral, but we don't cover out-of-network care unless it's an emergency.
06I'm on COBRA from my last job. Is this cheaper?
Almost certainly. COBRA in Georgia often costs $500 to $800 a month for a single person. You can drop COBRA and enroll with us during Open Enrollment, or within 60 days of when your COBRA coverage started.
07Does my kid stay covered until 26?
Yes. Children can stay on your plan until they turn 26, whether they're married, in school, or living somewhere else.
08What if my bill doesn't match the estimate?
Then we pay the difference. Every in-network cost is confirmed in writing before your visit. If the final bill comes in higher than the estimate because of our error, you owe the estimated amount and we cover the rest. This is our billing guarantee, and it applies to every member on every visit.
09What happens if one of my claims is denied?
First, it's rare: we approve 97 of every 100 claims on first review. If yours is one of the other 3, a Georgia-based advocate calls you within one business day, explains in plain language why it was denied, and files the appeal with you. Denials for covered care are reviewed by a licensed Georgia physician, not an algorithm. If the appeal fails, you have the right to an independent external review through the Georgia Office of Commissioner of Insurance, and we'll prepare that filing too.
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