G Home is pleased to offer you a comprehensive benefits package to help protect your well-being and financial health. This guide provides details of the benefits available to you and your eligible dependents beginning January 1, 2026.
If you would like to see a Summary of Benefits and Coverage (SBC), which is a summary of your health benefits in a standard format, visit www.benefitsinhand.com or contact People Operations.
You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective on the first of the month following your date of hire. You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll and the benefits you choose. When covering dependents, you must select and be on the same plans.
¥ Your legal spouse
¥ Children under the age of 26, regardless of student, dependency, or marital status
¥ Children over the age of 26 who are fully dependent on you for support due to a mental or physical disability, and who are indicated as such on your federal tax return
Once you elect your benefit options, they remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event (QLE), some of which include:
¥ Marriage, divorce, legal separation, or annulment
¥ Birth, adoption, or placement for adoption of an eligible child
¥ Death of your spouse or child
¥ Change in your spouse’s employment status that affects benefits eligibility
¥ Change in your child’s eligibility for benefits
¥ Significant change in benefit plan coverage for you, your spouse, or child
¥ FMLA leave, COBRA event, judgment, or decree
¥ Becoming eligible for Medicare, Medicaid, or TRICARE
¥ Receiving a Qualified Medical Child Support Order
If you have a QLE and want to change your elections, you must notify People Operations and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Contact People Operations for specific details.
Open Enrollment is your opportunity to choose benefits for the upcoming plan year, January 1–December 31, 2026. You may make changes to your benefit elections during the year if you experience a QLE.
You must make your enrollment selections no later than 30 days from your eligibility date. If the 30-day deadline is missed, you will not have benefits coverage (except for company-paid benefits) and you must wait until Open Enrollment to enroll, unless you experience a QLE during the year.
¥ Log on to www.benefitsinhand.com and select New User Registration to create your account.
¥ Enter or update your personal information and add your dependents.
¥ The Company Identifier is Gutterglove
¥ Select your elections for each line of coverage. Remember to specify your beneficiary(ies) for life insurance.
If you have any questions regarding your benefits or the enrollment process, or if you have difficulty accessing your account, call People Operations at 615-910-6400 or email aderiggi@gutterglove.com
Our medical plan options protect you and your family from major financial hardship in the event of illness or injury.
¥ Options 1 and 2 are PPO Plans through HealthEZ (available to all employees)
Preferred Provider Organization (PPO)
A PPO plan allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers. When you see in-network providers, your office visits, urgent care visits, and prescription drugs are covered with a copay, and most other network services are covered at the coinsurance level.
¥ Visit www.myhealthez.com and click Login
¥ Enter your credentials
Your subscriber ID is on your ID card
You password must have upper and lowercase letters, one number, and one special character
Click Activate Your Account
HealthEZ is an independent Third-Party Administrator (TPA), which means they manage your health benefits and process your medical claims. Our custom-designed PPO plans give you direct access to member support, including:
¥ Dedicated Phone Number – Call 844-449-5553 to speak with live support 7:00 a.m. and 7:00 p.m. CT. If you call after hours, press 3 to reach a 24/7 help line.
¥ myHealthEZ Benefits Website – Visit www.myhealthez.com to view and manage your benefits, review pharmacy information, find a doctor, and more. Use your ID card information to set up an online account for access to monthly statements, account balances, and recently processed claims. If you have any questions on the activation process or any content in your myHealthEZ account, call 844-839-6741 or send an email to service@healthez.com
¥ Medical Network – Your primary medical network is Cigna for doctors, specialists, hospitals, surgical centers, and other facilities. If you visit out-of-network providers, you will pay more. Visit www.healthez.com or www.mycigna.com to locate an in-network provider.
Cigna One Guide connects you with specially trained personal guides who can help maximize your health benefits and provide support.
¥ Learn about incentives and rewards
¥ Connect with a nurse
¥ Display ID cards
¥ Show recent claims and account balances
¥ Locate doctors, dentists, and other providers and facilities
¥ Refill prescriptions and estimate drug costs
Download the Cigna One Guide app to your mobile device, or call 800-244-6224 to talk with your personal guide.
In a Physician’s Office or Freestanding Diagnostic Center
At an Outpatient Hospital-Based Diagnostic Center
Outpatient Surgery 2
In a Physician’s Office or Ambulatory Surgical Center
At an Outpatient Hospital-Based Surgical Center
Tier 1 ($)
Tier 2 ($$)
Tier 3 ($$$)
Specialty Drugs (Tier 1/Tier 2/Tier 3)
1 All individual deductible and out-of-pocket amounts count toward the family deductible, but an
and out-of-pocket amounts before the plan will begin paying benefits for that individual.
2 Prior authorization required.
3 Prescription drugs are assigned to Tier 1, 2, or 3. Determine tier status at www.healthez.com
4 Only certain prescription drugs are available through mail order. Visit www.healthez.com or call the customer service phone number on the back of your ID card for more information. To maximize your mail order benefit, ask your physician to write your order or refill for a 90-day supply, rather than a 30-day supply with three refills.
WellDyne is the Pharmacy Benefit Manager (PBM) administering our prescription drug plan. They offer home delivery of medications and a network of pharmacies that provides affordable medications.
Use the WellDyne member website or mobile app to access these resources:
¥ Prescription Dashboard – gives you quick insights into your upcoming refills, prescription costs, and more.
¥ Cost Calculator – allows you to accurately price medications across multiple pharmacies.
¥ Pharmacy Locator – helps you locate in-network pharmacies within your ZIP code.
¥ Accumulator Tracker – displays how much you have contributed toward your deductible.
¥ Formulary Look-Up Tool – enables you to search for drugs covered under your plan.
Register at www.welldyne.com or download the WellView App to your mobile device.
Your medical coverage with HealthEZ offers telemedicine services through Recuro Health. Connect anytime day or night with a board-certified doctor via your mobile device or computer for the same cost than a visit to your regular physician.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
¥ Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
¥ Are on a business trip, vacation, or away from home
¥ Are unable to see your primary care physician
Registration
Register with Recuro Health so you are ready to use this valuable service when and where you need it.
¥ Online – www.member.recurohealth.com
¥ Phone – 855-6RECURO (855-673-2876)
¥ Mobile – download the mobile app
Use telemedicine services for minor conditions such as:
¥ Acne/Rash
¥ Allergies
¥ Cold/Flu
¥ GI issues
¥ Ear problems
Scan the QR code to download the mobile app
¥ Insect bites
¥ Nausea
¥ Pink eye
¥ Respiratory
¥ UTIs
¥ HealthEZ Plans – G Home pays the majority of cost for employee coverage in the two PPO plans.
If you enroll in a HealthEZ medical plan, Crumdale Advocates can help you find costsensible, non-urgent care. This service is free and available if you need assistance understanding your benefits, finding in-network care, and assuring your claims are processed correctly.
¥ Call – 855-255-7060
¥ Email – askme@careadvocacycenter.com
¥ Some of your unused benefit maximum can be carried over to the next year. To qualify, you must have had a dental service performed within the calendar year and used less than the maximum threshold. The threshold is equal to the lesser of 50% of the out-of-network maximum or $1,000. If the qualification is met, 50% of the threshold is carried over to next year’s maximum benefit.
¥ If you are pregnant or have diabetes or heart disease, you may receive scaling and root planing covered at 100% (if dentally necessary), or one additional cleaning (routine or periodontal) subject to deductible and coinsurance.
¥ If you have cancer and are undergoing chemotherapy or head/neck radiation therapy, you may receive up to three fluoride treatments every 12 months covered at 100%, plus one additional routine cleaning.
For your dependents
1 In network providers have agreed to discounted negotiated fees for their services. If you seek care from an out-of-network provider, benefits will be based on the 90th percentile of the usual and customary charges (you could be balance billed). You will also need to submit your own claims.
Exams
Prescription Glasses (Lenses)
Single lenses
Lined bifocal lenses
Lined trifocal lenses
Lenticular lenses
copay
$10 copay $10 copay $10 copay $10 copay
Frames Covered up to $130; 20% off amount over $1301
Contact Lenses (in lieu of glasses)
Fitting and evaluation
Elective contacts
Necessary contacts Up to $60 copay Covered up to $130 Covered in full after $10 copay
Lens Enhancements
Laser Vision Correction
Standard progressive lenses covered 100%.
Most other popular lens enhancements are covered after a copay with savings on average of 30%.
15% off the regular price and 5% off the promotional price.
1 The frame allowance at Costco, Walmart, and Sam’s Club is $70, which is equivalent to a $130 allowance at other VSP doctor locations. Benefits may vary by location due to state law.
+ Child(ren)
+ Family
G Home’s Flexible Spending Accounts (FSAs) let you save on taxes for certain medical, dental, vision, hearing, and dependent care expenses. Our FSA administrator is Ameriflex
When you enroll, you decide how much you want to contribute to your account(s) for the year. Deductions are taken pretax from your paycheck and deposited into your account(s). When you incur expenses, you are reimbursed with pretax dollars from your account.
You may contribute up to $3,400 to your account in 2026. Your election amount will be deducted from your paycheck throughout the year, but your entire annual contribution is immediately available to pay for eligible health, dental, vision, and hearing expenses.
Claims must occur between January 1, 2026 and December 31, 2026. If you do not use all of your dollars by December 31, 2026, you can carry over up to $680 of unused dollars into 2027. Any amount over $680 left in your account will be forfeited, per the IRS.
Log on to: www.myameriflex.com to view your account and obtain forms.
You may contribute up to $7,500 to your account ($3,750 if married and filing separate tax returns) so you or your spouse can work or attend school full-time. Your election amount will be deducted from your paycheck throughout the year and you may receive reimbursement for the amount of your claim up to the amount currently available in your account at the time of your claim. The Dependent Care FSA cannot be used for a dependent’s medical expenses.
Life and Accidental Death and Dismemberment (AD&D) insurance through Sun Life are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 35% at age 65 and an additional 15% at age 70.
Company Paid
Basic Life and AD&D insurance are provided at no cost to you if you are an active, full-time employee.
Special features include:
¥ Accelerated Death Benefit – If you are diagnosed with a terminal illness and have a life expectancy of 12 months or less, you may request an advanced lumpsum payment up to 75% of your coverage amount.
¥ Conversion of Coverage – If coverage terminates, you may be able to convert coverage to an individual policy.
You may buy more Life and AD&D insurance for you and your eligible dependents. If you do not elect Voluntary Life and AD&D insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before you may elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
14 days and older – $10,000
Not to exceed 100% of employee election
Income replacement benefits assist you and your family if you become disabled and cannot work due to a non-work-related illness or injury. Coverage is provided through Sun Life
Short Term Disability (STD) insurance is provided at no cost if you are an active, full-time employee. If you die while receiving benefits, the plan will pay a survivor benefit to your spouse, eligible child(ren), or estate.
Long Term Disability (LTD) is provided for you to purchase if you are an active, full-time employee. LTD protects a portion of your income if you become partially or totally disabled.
1 A pre-existing condition means a sickness or injury for which you received treatment, care, or services for a diagnosed condition, or took prescription medications for a diagnosed condition in the 3 month period before your effective date. No benefits will be paid for a disability that is caused or substantially contributed by a pre-existing condition unless, on the date you become disabled, you have been actively at work for one full day after completing 12 consecutive months after your effective date.
If you experience a change in salary or move to a different age bracket during the plan year, your premium will increase accordingly.
Family Leave Insurance through Sun Life supplements your income when you need time away for family bonding (such as welcoming a new child) or caregiving. Designed to work seamlessly with your existing leave benefits, this coverage, paid for by G Home, ensures you have financial stability and flexibility during significant family events.
Family leave works similarly to Short-Term Disability, but for family events. Covered leave reasons include one or both of the following:
¥ Child Bonding – Bonding leave for birth, adoption, foster care, legal ward, stepchild, or in loco parentis.
¥ Family Care – Time off to care for a family member (parent, spouse, child, grandparent, grandchild, sibling, or in-laws) with a serious health condition, including an injured service member.
You can take your leave all at once (continuous leave) or split it up using a full day at a time (intermittent leave). You can only receive one type of Family Leave at a time. You must be actively working the day before your family leave begins. The plan tracks your total leave over the past 12 months to determine how much leave you have left.
There is no waiting period before child bonding leave starts or between separate child bonding leaves. However, for family care leave, there is a seven-day elimination period as well as a 90-day break required between separate family care leaves.
Note: If you have state-paid family leave or other employerpaid leave, those payments may reduce your Family Leave Insurance benefits.
Ineligible states include California, Montana, Idaho, North Dakota, Kansas, New Mexico, Indiana, Ohio, Virginia, North Carolina, Vermont, and New Hampshire.
Maximum Benefit Duration1
Benefit Year 12 months rolling backward
Leave Schedule Continuous, Intermittent (must be taken in full day increments)
Successive Period
Child Bonding Family Care None 90 days
¹Employee may only receive one Family Leave Benefit at a time.
The Employee Assistance Program (EAP) from GuidanceResources helps you and family members cope with a variety of personal or work-related issues. This program provides confidential counseling and support services at little or no cost to you to help with:
¥ Relationships
¥ Work/life balance
¥ Stress and anxiety
¥ Will preparation and estate resolution
¥ Legal support and resources
¥ Financial information and resources
¥ Grief and loss
¥ Child and eldercare resources
¥ Parenting
¥ Substance abuse
¥ And more
The EAP is strictly confidential. No information about your participation in the program is provided to your employer.
¥ Call 877-595-5281 (TTY 800-697-0353)
¥ Visit www.guidanceresources.com Web ID: EAPBusiness
The Self Care+ app empowers employees and their families with 24/7 access to tools that support mental health and resilience. Users can explore personalized activities to manage stress, improve their mood, and build healthy habits. Weekly check-ins provide tailored content and resources, helping participants set achievable goals, develop mindfulness, and create a balanced perspective through:
¥ Mood tracking
¥ Meditations
¥ Collections
¥ Habit tracking
¥ Journaling
Designed to fit any schedule, Self Care+ makes mental wellbeing a manageable and rewarding part of everyday life.
Your Sun Life coverage includes Emergency Travel Assistance and IDtheft protection services which are provided through Assist America
If you experience a medical or non-medical emergency while traveling 100+ miles away from your permanent residence, the emergency travel assistance program can immediately connect you to doctors, hospitals, pharmacies and other services. One phone call to Assist America will connect you to:
¥ A state-of-the-art 24/7 Operations Center
¥ Experienced, multilingual crisis management professionals
¥ Worldwide emergency response capabilities
¥ Ground and air ambulance service providers
Medical travel assistance services include:
¥ Medical consultation, evaluation and referral
¥ Foreign hospital admissions assistance
¥ Emergency medical evacuation
¥ Medical monitoring
¥ Medical repatriation
¥ Prescription assistance
¥ Care of minor children
¥ Compassionate visit
¥ Return of mortal remains
Non-medical emergency assistance services include:
¥ Return of vehicle
¥ Lost luggage & document assistance
¥ Legal & interpreter referrals
¥ Emergency message transmission
¥ Call 800-460-4374
¥ Bail bond & emergency cash coordination
¥ Emergency trauma counseling
¥ Pre-trip information
¥ Email www.guidanceresources.com and use
Web ID: EAPEssential
Assist America offers prevention and resolution tools to safeguard your data and restore its integrity if it is used fraudulently. Services include:
¥ 24/7 access to identity protection experts
¥ Credit card and document registration
¥ Internet fraud monitoring
¥ 24/7 identity fraud support
Claimant Support Services offer compassionate assistance to help navigate the challenges of loss or disability. Available to Life Insurance beneficiaries and Waiver of Premium claimants, this no-cost service includes up to five sessions with licensed professionals for legal, financial, or emotional support. Specialists are available 24/7 to provide guidance on topics like inheritance taxes, loss of income, probate, and emotional adjustment. With access to clinicians, attorneys, CPAs, and financial planners, Claimant Support ensures claimants and their families receive the expert help they need during difficult times.
Identity Theft Resolution services provide education on how to prevent identity theft and guidance to help restore your credit if you have an issue. Coverage is provided through AssistAmerica
¥ You and your household members can receive one free 60-minute telephone consultation per issue, per year. You have the option to purchase resolution services on a self-pay basis and have the company work under power of attorney until all issues are resolved.
The Fraud Resolution Specialist will provide you with an ID Theft Emergency Response Kit and assist with:
¥ Completing and submitting a Uniform ID Theft Affidavit to the proper authorities, Credit Reporting Agencies, and creditors.
¥ Providing fraudulent account forms or letters to itemize each fraudulent occurrence.
¥ Obtaining a free copy of your credit report.
¥ Reporting fraudulent activity and notifying local and Federal authorities and creditor fraud departments.
¥ Placing a fraud alert and/or credit freeze (if allowed by State law) on your credit file.
¥ Call 800-460-4374
¥ Visit www.guidanceresources.com and enter our company name.
Will Preparation makes estate planning simple and secure, allowing employees and their spouses to create a personalized will in about 20 minutes at no cost. Through a secure, password-protected website, users receive stepby-step guidance to customize their will based on their unique circumstances. Features include naming an executor, appointing a guardian for minor children, and access to a glossary of legal terms. Employees can download their completed will directly, with an option to create a living will for an additional fee. Protect your assets and loved ones with ease.
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
¥ All stages of reconstruction of the breast on which the mastectomy was performed;
¥ Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
¥ Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
To request special enrollment or obtain more information, contact:
G Home
4020 Aspen Grove Dr Ste 350 Franklin, TN 37067 615-502-1947
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with G Home and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. G Home has determined that the prescription drug coverage offered by the G Home medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting G Home at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current G Home prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact People Operations at 615-502-1947
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
¥ Visit www.medicare.gov
¥ Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
¥ Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity. gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
January 1, 2026 G Home
4020 Aspen Grove Dr Ste 350 Franklin, TN 37067
615-502-1947
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by G Home, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask People Operations to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact People Operations.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
4020 Aspen Grove Dr Ste 350 Franklin, TN 37067 615-502-1947
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call
1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility.
Health Insurance Premium Payment (HIPP) Program Website: http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: hipp@dhcs.ca.gov
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the G Home group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the G Home plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your People Operations Department for the applicable deadlines to elect coverage and pay the initial premium.
4020 Aspen Grove Dr Ste 350 Franklin, TN 37067
615-502-1947
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
¥ Emergency services – If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s innetwork cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
¥ Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, outof-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
¥ You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was innetwork). Your health plan will pay out-of-network providers and facilities directly.
¥ Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/ nosurprises for more information about your rights under federal law.
This brochure highlights the main features of the G Home employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. G Home reserves the right to change or discontinue its employee benefits plans at anytime.
