BENEFITS Your benefits as a full-time associate at Republic Bank.
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EMPLOYEE GUIDE TO 2022
BENEFITS
Your benefits as a full-time associate at Republic Bank.
EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Table of Contents
Welcome to Republic Bank........................................................................................................................................................................................................................... 1
Human Resouces Department Contact Info........................................................................................................................................................................................ 2
Republic Bank Mission Statement........................................................................................................................................................................................................... 3
Medical and Vision.......................................................................................................................................................................................................................................... 4
Provider Name - Humana
Provider Phone Number for Medical Coverage – 800-872-7207
Provider Web Address – www.humana.com
Provider Name – Humana Vision Plan
Provider Phone Number for Vision Coverage – 866-995-9316
Provider Web Address – www.myhumana.com
Dental................................................................................................................................................................................................................................................................. 10
Provider Name – Delta Dental
Provider Phone Number – 800-955-2030
Provider Web Address – www.deltadentalky.com
Medical Dental Vision Costs......................................................................................................................................................................................................................12
Flexible Spending Accounts (FSA).........................................................................................................................................................................................................13
Provider Name – Sheakley
Provider Phone Number – 800-877-6630
Provider Web address – www.sheakley.com/myrsc.asp
Health Savings Account (HSA)............................................................................................................................................................................................................... 18
WellSteps Premium Discount.................................................................................................................................................................................................................. 20
Tobacco User Premium Surcharge.......................................................................................................................................................................................................... 21
Life and Accidental Death and Dismemberment Insurance........................................................................................................................................................22
Provider Name – Guardian Life Insurance Company
Provider Phone Number – 888-600-1600
Provider Web Address – www.guardiananytime.com
Disability Benefits........................................................................................................................................................................................................................................ 24
Provider Name – Guardian Life Insurance Company
Provider Phone Number – 888-889-2953
Provider Web Address – www.guardiananytime.com
AFLAC Accident, Critical Care and Cancer Benefits....................................................................................................................................................................25
Provider Name – AFLAC
Provider Email – Iris Goodall at iris_goodall@us.aflac.com
Employee Assistance Program(EAP)....................................................................................................................................................................................................26
Provider Name – ESI Total Care EAP
Provider Phone Number – 800-252-4555 or 1-800-225-2527
Provider Web Address – www.theEAP.com
401(k) Retirement Plan.............................................................................................................................................................................................................................. 27
Provider Name – Empower
Provider Phone Number – 844-465-4455
Provider Web Address – www.empowermyretirement.com
Financial Advisor – Iron Administration, LLC
Phone Number – 888-396-4766
Employee Stock Purchase Plan (ESPP).............................................................................................................................................................................................. 30
Provider Name – Computershare
Provider Phone Number – 1-866-658-6773
Provider Web Address – www.computershare.com/employee/us
Other Benefits................................................................................................................................................................................................................................................ 31
Making Changes............................................................................................................................................................................................................................................33
Legal and Other Important Information............................................................................................................................................................................................. 34
EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Welcome to Republic Bank!
We are proud to offer a full array of benefit options to our Associates. We have created a benefits package that helps provide
important financial protection for each associate and their family. This comprehensive benefit package includes the following
benefit options:
• Health Insurance • Flexible Medical and Dependent Care Spending Accounts
• Dental Insurance • AFLAC Accident, Critical Care and Cancer Benefits
• Vision Plan • Employee Assistance Program
• Health Savings Account (HSA – set up as a Republic • 401(k) Plan
Bank account) • Employee Stock Purchase Plan (ESPP)
• Basic Life & Accidental Death & Dismemberment • Paid Time Off (PTO)
Insurance
• Paid Holidays
• Optional Life Insurance for Associates & Dependents
• Disability Benefits (Short-Term and Long-Term)
Please take the time to evaluate your benefit options and choose those that meet the needs of you & your family.
WE ARE HAPPY TO HAVE YOU ON OUR TEAM!
This booklet highlights selected benefits available to you from Republic Bank. While every effort has been made to ensure the
accuracy of this information, the actual operation of the plans is governed by the applicable plan documents. In case of a conflict
between this brochure and the plan documents, the plan documents will take precedence. For additional information regarding your
benefits such as, Summary Plan Descriptions, Certificates of Coverage, and benefit forms, please go to the Human Resources page
on Republic Bank’s Intranet site.
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EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Human Resources
Margaret Wendler Employee Relations/Payroll
Executive Vice President Robin White
Chief Human Resources Officer VP - Director of Employee Relations
Ext. 4840 Ext. 4847
mwendler@republicbank.com rwhite@republicbank.com
Christie Ramsey Erin Zimmer
VP - HR Manager Payroll/Research Records Administrator
Ext. 3918 Ext. 3916
cramsey@republicbank.com ezimmer@republicbank.com
Mary Bramblett Jim Yung
Executive Administrative Assistant Advanced Payroll Specialist
Ext. 2203 Ext. 4811
mbramblett@republicbank.com jyung@republicbank.com
Terri McGill Selena Luney
HR Specialist Employee Relations Specialist
Ext. 4812 Ext. 3917
tmcgill@republicbank.com sluney@republicbank.com
Recruitment
Susan Stuckey Benefits
VP - Director of Talent Recruitment Holly Haggard
Ext. 1805 VP - Benefits Manager
sstuckey@republicbank.com Ext. 1804
Adam Perito hhaggard@republicbank.com
VP - Talent Recruitment Officer Tammy Pate
Ext. 2408 Benefits Analyst
aperito@republicbank.com Ext. 2446
Kristen Nelson tpate@republicbank.com
Recruiting Specialist
Ext. 3919
knelson2@republicbank.com
Maggie Reimer
AVP – Talent and Recruitment Advisor
Ext. 3924
mreimer@republicbank.com
Sheila Eaves
Talent Recruiting Specialist
Ext. 2429
seaves@republicbank.com
Gayle Milam
Talent Recruiting Specialist
Ext. 3920
gmilam@republicbank.com
Jennifer Smith
AVP – Talent and Recruitment Advisor
Ext. 3925
jsmith3@republicbank.com
2
EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Why We Exist. This is our mission.
To enable our clients, company, associates and the communities we serve to thrive.
At Republic Bank, we believe that by living our values we can make an IMPACT!
Innovate for the Future
Partner to transform existing processes, practices and services to drive greater quality and strengthen internal
and external outcomes.
Make it Easy
Discover and deliver ways to reduce complexity in everything we do, creating simple, high-quality experiences.
Provide Exceptional Service
Anticipate the needs of others, and provide positive, memorable and personalized experiences and service –
both internally and externally.
Acknowledge & Celebrate Success
Practice gratitude, share your appreciation and recognize the contribution of others.
Commit to Caring
Strive to do the right thing with compassion for clients, coworkers, the community, the bank, your loved ones
and yourself.
Thrive Together
Collaborate openly and build trusting relationships in order to create a positive work environment and attain
strong results for us and the people we serve.
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EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Medical Plan Options
Who is eligible?
Full-time associates regularly scheduled to work at least 37 1/2 hours per week are eligible to enroll themselves, their spouse* and/or
their dependent children under age 26, with coverage effective on their first day of employment. Eligible dependent children include
your natural blood-related children, stepchildren, legally adopted children, children placed for adoption in your home or children for
which you have legal guardianship.
*IMPORTANT NOTICE: Spouses who have access to their own employer-provided health plan as a full-time employee
working 30 or more hours per week are not eligible to be covered under Republic Bank’s health plan. However, any spouse that
does not have access to an employer provided health plan continues to be eligible. Legally recognized same sex marriages will
follow the same eligibility rules stated above. When completing the online enrollment, be sure to include information for any
eligible dependents you wish to cover. If requesting spousal coverage, you will be required to certify in writing that your
spouse is not eligible for their own coverage. The certification form is part of the on-line enrollment.
What are my medical plan options?
There are four Humana health plan options from which to choose – Two options (Standard and Enhanced PPO Plans) are traditional
Preferred Provider Organization (PPO) medical plans, which provide a higher level of coverage for care received from participating
doctors and other health care providers. Both plans cover routine/wellness-related services at 100% with no copays or deductible.
The plans differ primarily by deductibles, co-payment amounts and coinsurance levels, as shown on the chart on pages 7-8.
Premiums are on page 12.
Maximum out-of-pocket limits: Historically, copays for office visits and prescriptions were unlimited. However, due to Healthcare
Reform, all health plans are now required to have an annual “Plan” out-of-pocket maximum of $6,350 individual / $12,700 family.
This means no covered individual will pay more than the $6,350 out-of-pocket for in-network related medical and pharmacy
expenses combined with the deductible and copays.
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EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Both the High Deductible Health Plan (HDHP) and the CoverageFirst plans are designed to provide more control over health
expenses. Both plans cover routine/wellness-related services at 100% with no copays or deductible. However, the CoverageFirst plan
includes an additional $500 benefit allowance to cover in-network expenses (except for required co-payments) each year for each
covered member of your family. Think of this allowance as an account used to pay for health care services. As you receive covered
services, the plan will pay for those services from the account until $500 has been paid. As long as money is available in the account,
you will only pay your applicable co-payment. Once the $500 in the account has been used up, the normal plan benefits apply and
you will be responsible for the annual deductible and applicable coinsurance. You will continue to pay only a co-payment for office visits.
The High Deductible Health Plan covers all routine exams and wellness related services at 100% - with no copay and no deductible
- for eligible in-network expenses each year. However, you may want to consider opening a Health Savings Account (HSA)
through Republic Bank to cover non-routine/wellness related out-of-pocket expenses that are applied to your deductible ($2,800
individual/$5,600 family). The HSA is used to pay for health care services with pre-tax dollars (similar to an FSA). As you receive
covered services, you use available funds in the HSA to pay for expenses that are applied to your deductible. Once your deductible
is met, the plan will pay for all future eligible in-network services at 100% after the applicable copay for office visits for primary care
physician and specialist, hospital emergency room or urgent care services, and prescription drugs.
Why you might want a High Deductible Health Plan
A High Deductible Health Plan offers several ways to save on healthcare:
• Lower premiums: The HDHP has lower premiums than the other health plan options.
• Integrated deductible: Prescription drug costs apply to the same deductible as medical costs. And for members who choose
family coverage, costs for all covered members apply to the same deductible. These differences make it easier for you to meet
the deductible.
• Out-of-pocket maximum: The yearly “cap” on your costs for covered services from in-network providers gives you peace of
mind. And budgeting is easy, since medical and drug costs that apply to your deductible count toward the maximum, too.
• Opportunity to save tax-free money: Having an HDHP allows you to contribute tax-free dollars via payroll deduction to a
Republic Bank HSA. You can spend the money on healthcare costs without paying taxes on it — or use it for other expenses
after you retire, when it may be taxed at a lower rate.
Using your High Deductible Health Plan
The HDHP has three key components: an integrated deductible, coinsurance and out-of-pocket maximum.
• Integrated deductible: Even though your pharmacy benefits kick in only after you’ve met the deductible, you always get
Humana’s discounted price when you fill prescriptions at in-network pharmacies. And since your health plan and pharmacy
benefits share the same deductible, your prescription costs help you meet the deductible faster. You can view the list of covered
drugs under the HDHP at Humana.com.
• Coinsurance: After you reach your annual deductible, the plan pays a percentage of your costs for both medical services and
prescription drugs after the applicable copays.
Example of how copays and coinsurance apply after meeting annual deductible:
You have single coverage in the HDHP and you have met your $2,800 deductible. You are visiting your primary care physician
regarding a health issue. You will be responsible for the $20 office visit copay. The Plan covers the remaining cost of the visit at
100%. You may use your health savings account to pay for the office visit.
• Plan Out-of-Pocket Maximum: Important Notice: Historically, copays for office visits and prescriptions were unlimited.
However, due to Healthcare Reform, all health plans are now required to have an annual “Plan” out-of-pocket maximum of
$6,350 individual / $12,700 family. This means no covered individual will pay more than the $6,350 out-of-pocket for in-
network related medical and pharmacy expenses combined with deductible and copays.
You have the option to enroll in a qualified High Deductible Health Plan (HDHP) and a “companion” Health Savings Account
(HSA) offered through Republic Bank to help cover your out-of-pocket expenses. See Page 18 for more information regarding the
Health Savings Account.
For the most current information about participating network providers in the Humana plans, go online to www.humana.com and
look under the Humana Choice Care Network.
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EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
How does the RX4 Prescription Drug benefit work?
No matter which medical plan you choose, the prescription drug benefit will be administered by RightSource. You will use the same
identification card that you use for all other medical care services.
The amount you pay for prescription drugs depends on which medical plan you are in and the Level in which the medication that you
and your doctor select is classified. You may check the classification of drugs by logging onto www.humana.com and selecting the
Rx-4 Drug List.
The plan provides four levels of coverage based on the prescription. In addition, if you purchase a brand name drug, you must
first satisfy a *$250 annual deductible before the copay will apply (the brand deductible does not apply to the Health Deductible
Health Plan).
• Level One: This level includes designated *brand name and generic drugs that are the most cost effective while still providing
high quality medical efficacy. You’ll pay just $10 for up to a 30-day supply.
• Level Two: Preferred drugs are those generic or *brand names included in the RX-4 drug formulary. (A formulary is a list of
commonly prescribed drugs that have been selected by a panel of pharmacists and physicians based on their effectiveness and
cost.) You’ll pay just $40 for up to a 30-day supply.
• Level Three: Non-preferred drugs are *brand names or generics not listed on the plan’s formulary. For these drugs, you’ll pay
$60 for up to a 30-day supply. If you take a prescription medication in this category, keep in mind that alternative preferred
brand name or generic drugs are usually available and allow you to save money.
• Level Four: This level covers high cost, high tech specialty medications and injectables. You’ll pay a 25% coinsurance per
prescription.
The mail order prescription benefit lets you order up to a 90-day supply of maintenance drugs for the same price as a 60-day supply
equal to 2 copays. To use this benefit, have your physician write a prescription for a 90-day supply.
PLEASE NOTE: Some drugs, such as weight management and cosmetic drugs are not covered by the plan. Because Humana’s
drug list is continually updated with prescription drugs approved or not approved for coverage, you must call the toll-free
customer service phone number on the back of your ID card or visit Humana’s website at www.humana.com to verify whether
a prescription drug is covered or not covered under the Plan.
6EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Medical Plan Options
STANDARD PPO ENHANCED PPO
Network Non-Network Network Non-Network
Benefit Allowance N/A N/A N/A N/A
Annual Deductible
Individual $500 $1,000 $250 $500
Family $1,000 $2,000 $500 $1,000
Annual Out of Pocket Expense Limit
Individual $2,500 $5,000 - includes deductible $2,250 $4,500 - includes deductible
Family $5,000 - includes deductible $10,000 - includes deductible $4,500 - includes deductible $9,000 - includes deductible
Routine Wellness Services, including
all generic birth control pills and 100% Not Covered 100% Not Covered
surgical sterilization services
Hospital Services
Inpatient 80% after deductible 70% after deductible 90% after deductible 60% after deductible
Outpatient Surgery 80% after deductible 70% after deductible 90% after deductible 60% after deductible
Outpatient Diagnostic 80% after deductible 70% after deductible 90% after deductible 60% after deductible
70% after deductible; paid 60% after deductible; paid
Emergency Room (true 100% after $300 copay (waived if 100% after $300 copay (waived if
at participating level for emergency at participating level for emergency
emergency, as defined by plan) admitted) admitted)
medical condition medical condition
Urgent Care 100% after $75 copay 70% after deductible 100% after $75 copay 60% after deductible
Physician Services
Inpatient 80% after deductible 70% after deductible 90% after deductible 60% after deductible
Office Visit
Primary Care 100% after $20 copay 70% after deductible 100% after $15 copay 60% after deductible
Specialist 100% after $35 copay 70% after deductible 100% after $30 copay 60% after deductible
Allergy Services
Allergy Injections 100% after $10 copay 70% after deductible 100% after $10 copay 60% after deductible
Allergy Serum 100% after OV copay 70% after deductible 100% after OV copay 60% after deductible
Behavioral Health
Inpatient 80% after deductible 70% after deductible 90% after deductible 60% after deductible
Inpatient physician services 80% after deductible 90% after deductible
Outpatient therapy sessions 100% after $20 copay 100% after $15 copay
100% after $35 copay; max of 20 70% after deductible; max. 20 visits 100% after $30 copay; max of 20 60% after deductible; max of 20
Chiropractic Services
visits per calendar year per year visits per calendar year visits per year
Prescription Drugs (only covered at Note: Brand Name Drugs subject to $250 annual deductible. Note: Brand Name Drugs subject to $250 annual deductible.
participating pharmacies)
Retail
Level 1 $10 copay $10 copay
Level 2 $40 copay $40 copay
Level 3 $60 copay $60 copay
Level 4 25% copay 25% copay
Mail Order
Level 1 $20 copay $20 copay
Level 2 $80 copay $80 copay
Level 3 $120 copay $120 copay
Level 4 25% copay 25% copay
7EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Medical Plan Options
COVERAGE FIRST HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
Network Non-Network Network Non-Network
Benefit Allowance $500 N/A N/A N/A
Annual Deductible
Individual $2,500 $5,000 $2,800 $5,600
Family $7,500 $15,000 $5,600 $11,200
Annual Out of Pocket Expense Limit
Individual $2,500 - includes deductible $9,000 - includes deductible $2,800 - includes deductible $15,000 - includes deductible
Family $7,500 - includes deductible $27,000 - includes deductible $5,600 - includes deductible $30,000 - includes deductible
Routine Wellness Services, including
all generic birth control pills and 100% Not Covered 100% Not Covered
surgical sterilization services
Hospital Services
100% after $150 copay per day for
first five days per admission, and
Inpatient 70% after deductible 100% after deductible 70% after deductible
after deductible
100% after $100 copay per visit and
Outpatient Surgery 70% after deductible 100% after deductible 70% after deductible
after deductible
Outpatient Diagnostic 100% after deductible 70% after deductible 100% after deductible 70% after deductible
100% after $300 copay per visit, 70% after deductible; paid at 70% after deductible; paid at
Emergency Room (true
and after deductible; copay (waived participating level for emergency $300 copay after deductible participating level for emergency
emergency, as defined by plan)
if admitted) medical condition medical condition
Urgent Care 100% after $75 copay 70% after deductible $75 copay after deductible 70% after deductible
Physician Services
Inpatient 100% after deductible 70% after deductible 100% after deductible 70% after deductible
Office Visit
Primary Care 100% after $25 copay 70% after deductible $20 copay after deductible 70% after deductible
Specialist 100% after $40 copay 70% after deductible $35 copay after deductible 70% after deductible
Allergy Services
Allergy Injections 100% after $5 copay 70% after deductible 100% after deductible 70% after deductible
Allergy Serum 100% after deductible 70% after deductible 100% after deductible 70% after deductible
Behavioral Health
100% after $150 copay per day for
Inpatient first five days per admission, and 70% after deductible 100% after deductible 70% after deductible
after deductible
Inpatient physician services 100% after deductible 70% after deductible 100% after deductible 70% after deductible
Outpatient therapy sessions 100% after $25 copay 70% after deductible $20 copay after deductible 70% after deductible
100% after $40 copay; limited to 70% after deductible; max. 20 visits 100% after deductible; max of 20 70% after deductible; max. of 20
Chiropractic Services
20 visits per calendar year per year visits per year visits per year
Prescription Drugs (only covered at Note: Brand Name Drugs subject to $250 annual deductible. Note: All RX expenses subject to annual plan deductible prior to copays being applied.
participating pharmacies)
Retail
Level 1 $10 copay Not covered $10 copay after deductible Not covered
Level 2 $40 copay $40 copay after deductible
Level 3 $60 copay $60 copay after deductible
Level 4 25% copay 25% coinsurance after deductible
Mail Order
Level 1 $20 copay Not covered $20 copay after deductible
Level 2 $80 copay $80 copay after deductible
Level 3 $120 copay $120 copay after deductible
Level 4 25% copay 25% coinsurance after deductible
8EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Vision Benefits
Vision health impacts overall health.
Routine eye exams can lead to early detection of vision problems and other diseases such as diabetes, multiple sclerosis, high blood
pressure, osteoporosis, and rheumatoid arthritis.
Who is eligible?
If you are a full-time and regularly scheduled to work at least 37 1/2 or more hours per week, you may enroll yourself, your spouse
and/or your dependent children under 26 years of age.
If you see a participating provider If you see a non-participating Additional plan discounts:
Vision Care Benefit Summary (Member Cost) provider (Reimbursement) Member may receive a 20% discount on items
not covered by the plan at network Providers.
Exam, with dilation as necessary Retinal Imaging $10 co-pay / $39 allowance Up to $30 / Not covered
Members may contact their participating
Contact lens exam options: provider to determine what costs or discounts
Standard contact lens fit and follow-up $55 allowance Not covered are available. Discount does not apply to Insight
Provider’s professional services or contact
Premium contact lens fit and follow-up 10% off retail Not covered lenses. Plan discounts cannot be combined
Lenses: with any other discounts or promotional offers.
Services or materials provided by any other
Single $25 co-pay Up to $25 group benefit plan providing vision care may
Bifocal $25 co-pay Up to $40 not be covered. Certain brand name Vision
Materials may not be eligible for a discount if the
Trifocal $25 co-pay Up to $60
manufacturer imposes a no-discount practice.
Lenticular $25 co-pay Up to $100 Frame, Lens, & Lens Option discounts apply only
when purchasing a complete pair of eyeglasses. If
Covered Lens Options:
purchased separately, members receive 20% off
UV coating $15 Not covered the retail price.
Tint (solid and gradient) $15 Not covered
Members may also receive 15% off retail price or
Standard scratch-resistance $15 Not covered 5% off promotional price for LASIK or PRK from
Standard polycarbonate - adults $40 Not covered the US Laser Network, owned and operated
by LCA Vision. Since LASIK or PRK vision
Standard polycarbonate - childrenEMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Dental Plan
Who is eligible?
If you are a full-time associate scheduled to work a minimum of 37 1/2 hours per week, you may enroll yourself, your spouse and/or
your dependent children under age 26 with coverage effective on your first day of employment. (Eligible dependent children include
your natural blood-related children, stepchildren, legally adopted children, children placed for adoption in your home or children for
which you have legal guardianship.)
What are my choices?
Republic Bank offers associates the Delta Premier PPO Plus plan through Delta Dental of Kentucky. The dental plan is a unique
blend of Delta Dental’s Premier and Preferred provider networks. If you use a dentist from the Preferred provider network, your
out-of-pocket costs are lower because these network providers offer a greater discount for their services.
Benefits are based on the allowable amount for each specific service. Participating dentists have agreed not to bill plan members
more than the allowable amount. Please refer to the summary of the dental plan benefits provided on page 11.
How do I find a participating dentist?
For the most current information about dentists who participate in the plan, go online to www.deltadentalky.com and Select the
Delta Dental PPO+ Premier Network in the drop down box. The participating dentists may be different for the Premier and the
Preferred networks. If your dentist participates in both networks, they have agreed to accept the allowable amount based on the
Preferred provider network.
10EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Dental Plan Summary
Premier or Preferred Network Non-Network
Annual deductible
Individual $25 $25
Family $75 $75
Maximum Benefits $1,500 $1,500
(per covered person each Benefit Period)
Covered Services
Preventive Care – Oral exam, emergency exam, palliative
emergency treatment, periapical x-rays, bitewing x-rays, 100% of the *Allowable Amount, 100% of the *Allowable Amount, No Deductible; Does not
panoramic or complete series, topical fluoride application, No Deductible; Does not Apply toward Annual Maximum Apply toward Annual Maximum
prophylaxis, sealants, space maintainers.
Class I
Routine fillings, simple extractions, root canal therapy,
80% of the Allowable Amount, Subject to Deductible 80% of the Allowable Amount, Subject to Deductible
oral surgery
Class II
Periodontics services 80% of the Allowable Amount, Subject to Deductible 80% of the Allowable Amount, Subject to Deductible
Class III
Simple prosthetic repairs 80% of the Allowable Amount, Subject to Deductible 80% of the Allowable Amount, Subject to Deductible
Class IV
Inlays and Crowns, dental implants 50% of the Allowable Amount, Subject to Deductible 50% of the Allowable Amount, Subject to Deductible
Orthodontics
Diagnosis and treatment plan, minor treatment for tooth 50% of the Allowable Amount, No Deductible. Benefits are 50% of the Allowable Amount, No Deductible. Benefits are
guidance, interceptive orthodontic treatment, comprehensive limited to $1,000 lifetime maximum for covered dependents limited to $1,000 lifetime maximum for covered dependents
orthodontic treatment. under age 19. under age 19.
Healthy Mouth, Healthy Body is a voluntary program for those Associates who are pregnant, or have diabetes, renal failure,
suppressed immune systems, or are at risk for infective endocarditis. It allows for an additional cleaning (or periodontal maintenance
procedure if you have a history of periodontal surgery) beyond the plan’s ordinary limit per benefit period. Information is available
on the Human Resources webpage of the Republic Bank Intranet regarding enrollment in this program.
*Allowable Amount
Dentists who have signed participating agreements with Delta Dental of Kentucky agree to accept the Allowable Amount as
payment in full for Covered Services as these terms are defined in the Certificate of Coverage. Each Covered Person is responsible
for the amount of Coinsurance, Deductible, and non-covered charges. Dentists who have not signed a participating agreement may
bill you directly for any amount of their charge in excess of the Allowable Amount. In cases where the dentist’s charges exceed the
Allowable Amount, your coinsurance will be larger. Certain procedures require preauthorization and/or are subject to limitations.
11EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Medical, Dental and Vision Plan Costs 2022
Your cost depends upon several factors:
• Employment status (full-time or part-time)
• Level of coverage you select (Associate only, Associate + spouse, Associate + child(ren), or family)
• The $35/pay Medical Premium Discount (see page 20 for details)
• The $35/pay Tobacco Surcharge (see page 21 for details)
Full-Time Associates – Benefits Costs Per Pay Period (26X per year)
Medical Plan Options Dental Plan Vision Plan
High Deductible
Standard PPO Enhance PPO Coverage First Delta Dental Humana Vision
Health Plan
Associate Only
Without Premium Discount $111.22 $135.46 $89.84 $41.08** $9.01 $2.28
With Premium Discount $ 76.22 $100.46 $54.84 $6.08
Associate + Spouse*
Without Premium Discount $215.36* $265.61* $170.90* $145.70* $16.22 $4.55
With Premium Discount $180.35* $230.61* $135.90* $110.70*
Associate+Child(ren)
Without Premium Discount $195.38 $229.99 $145.78 $121.57 $18.65 $4.32
With Premium Discount $160.38 $194.99 $110.78 $86.57
Family*
Without Premium Discount $291.51* $371.28* $221.25* $179.26* $25.95 $6.79
With Premium Discount $256.51* $336.28* $186.25* $144.26*
* If your spouse is eligible for medical coverage through their employer, they will not be eligible for coverage under a Republic Bank
medical plan. You will be required to certify in writing whether or not your spouse is eligible for their own coverage – certification
form is included in this packet.
** The employee premium for single coverage in the High Deductible Health Plan meets Health Care Reform’s safe harbor for
affordable and adequate coverage.
12EMPLOYEE GUIDE TO 2022 BENEFITS
Full-time associate
Flexible Spending Accounts
Health Care, Limited Purpose and Dependent
Flexible Spending Accounts provide you with an important tax advantage that can help you pay health care and dependent care
expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next year, you can lower your
taxable income. Full-time associates are eligible to participate effective on their first day of employment.
Who is eligible?
If you are a full-time associate regularly scheduled to work at least 37 1/2 hours per week. You may submit eligible healthcare related`
expenses for yourself, your spouse, and any dependents you claim on your tax return under the age of 27 at the end of your tax year,
as defined by IRS Code Section 105(b) and Code Section 152.
Health Care Flexible Spending Account (FSA) – including a Limited Purpose Account (LPFSA)
The Flexible Spending Account program lets Republic Bank associates pay up to $2,750 for the 2022 calendar year for certain IRS-
approved medical, dental and vision care expenses not covered by their insurance plan with pre-tax dollars. Most people don’t realize
just how much they spend each year on expenses like co-pays, insurance deductibles and other items for their medical, dental, vision
and preventive care, but these types of expenses really do add up – and that’s money straight out of your pocket. Enrolling in the
Health Care Flexible Spending Account (FSA) can save you up to 40% on the medical, dental, vision and preventive care expenses
you already pay. Can you really afford to pass up an opportunity to save hundreds of dollars every year?
Limited Purpose Health Care FSA (LP-FSA)
Limited Purpose FSA plans are designed to work hand-in-hand with a Health Savings Account (HSA) in conjunction with a High
Deductible Health Plan (HDHP). The 2022 contribution limit for the LP-FSA is $2750. One important thing to keep in mind
is that if the expense is eligible for reimbursement from a Health Savings Account (HSA), it is not eligible under the LP-FSA. (If
you are not participating in a Health Savings Account (HSA), you may still participate in the standard Health Care FSA.) Please
contact the Benefits Department (ext. 2100), if you need assistance in determining if you should enroll in the LP-FSA or the
standard Health Care FSA.
Eligible Expenses under both the FSA and LPFSA* include (*not eligible under LPFSA):
• Hearing services, including hearing aids and batteries
• Ambulance*
• Vision services, including contact lenses, contact lens solution, eye examinations, and eyeglasses
• Laser vision corrective eye surgery
• Obesity Weight-Loss Programs
• Dental services and orthodontia
• Dentures
• Prosthesis*
• Chiropractic services*
• Acupuncture*
• In vitro fertilization and Infertility treatments
• Prescription drugs for medically necessary reasons, including contraceptives*
• Over the counter supplies including (but not limited to):
• Bandages
• Blood Pressure Monitor
• Colorectal Cancer Screening Tests
• Knee & Wrist Supports
• Crutches & Mobility Aids
Eligible FSA Expenses – click here
• Diabetes Monitors & Supplies, including insulin*
If you’re uncertain about how a Health Care FSA can help you, check out the additional information links below and be sure to
review the list of Eligible Expenses. If you use any of these services or purchase any of these items, you could be missing out on big
savings every year!
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Pay For Eligible Expenses With Your Spending Account Debit Card
Paper claims can be submitted to Sheakley, or you can use your Sheakley Health Care
Account Debit Card (Card). You will not receive a new card each year because the original
card will work for three plan years.
You can typically spend up to $50 using your Debit Card to pay for prescription drug co-
pays or physician co-pays, etc., and you should not need to send substantiation for your eligible purchases.
For all other eligible expenses where you use the Card, however, you may need to substantiate your purchases (this means faxing
or uploading your itemized receipts for Card purchases along with a claim form to prove the eligibility of the items or services
purchased). If you’ve not submitted required substantiation within 30 days from date of purchase, your account will be suspended,
and your Card deactivated until substantiation is submitted to Sheakley.
For all eligible FSA purchases, even those where you use the Card, the IRS requires you to retain receipts a proof of your qualified
purchase, and you may be required to provide these receipts to Sheakley at any time during the year.
What happens if you don’t use all the money in your medical spending account?
To avoid having any leftover unused contributions at plan year end, you simply need to plan your contributions and monitor your
account balance regularly. The planning part occurs during the annual enrollment period for the upcoming new plan year. You
are asked to re-elect your annual contribution to your FSA each year. Before you make your election, you should make a list of
anticipated eligible expenses for yourself and any covered dependents. It is also a good idea to identify in advance a few eligible
expenses and hold them “in reserve” in case you find you have an account balance remaining as the end of the benefit plan year
approaches. For example, in order to use up any remaining account balance, you could purchase a pair of prescription sunglasses,
have your teeth cleaned or replace an expiring prescription.
It is always a good rule of thumb to be conservative when estimating how much you wish to contribute. To assist you in determining
your annual expenses, please utilize the following Health Care Reimbursement Account Worksheet.
How does an FSA lower my taxes?
Here’s an example of tax savings with the flexible spending accounts:
With FSA Without FSA
Annual Salary (before taxes) $25,000 $25,000
Less:
Medical Spending Account Contribution -$1,500 $0
Dependent Spending Account Contribution -$4,000 $0
Taxable Income $19,000 $25,000
Less:
Income/Social Security Taxes -$4,290 -$5,500
Take home pay: $15,210 $19,500
Less:
Health care expenses $0 -$1,500
Dependent care expenses $0 -$4,000
Net Pay Remaining $15,210 $14,000
Tax Savings $1,210 $0
Note: This example is for illustrative purposes only. Your actual savings will depend on your personal tax situation.
14EMPLOYEE GUIDE TO 2022 BENEFITS
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Health Care Reimbursement Account Worksheet
Example:
100
Medical................................................................................................................................................................................................................ $_______________
(Include deductibles plus all out of pocket expenses not covered by medical
plans such as doctor office visit copays, prescription drug copays)
150
Dental.................................................................................................................................................................................................................. $_______________
(Include copays, deductibles and coinsurance amounts due to the dentist or orthodontist)
300
Vision.................................................................................................................................................................................................................... $_______________
(Include expenses for eyeglasses and contacts)
75
Miscellaneous.................................................................................................................................................................................................. $_______________
625
Total out of pocket expenses................................................................................................................................................................... $_______________
28%
Multiply total out of pocket expenses by your current tax bracket................................................................................... X_______________
175
Savings................................................................................................................................................................................................................. $_______________
450
Grand Total Expenses.................................................................................................................................................................................. $_______________
(out of pocket expenses minus savings)
Your Calculations:
Medical................................................................................................................................................................................................................ $_______________
(Include deductibles plus all out of pocket expenses not covered by medical
plans such as doctor office visit copays, prescription drug copays)
Dental.................................................................................................................................................................................................................. $_______________
(Include copays, deductibles and coinsurance amounts due to the dentist or orthodontist)
Vision.................................................................................................................................................................................................................... $_______________
(Include expenses for eyeglasses and contacts)
Miscellaneous.................................................................................................................................................................................................. $_______________
Total out of pocket expenses................................................................................................................................................................... $_______________
Multiply total out of pocket expenses by your current tax bracket................................................................................... X_______________
Savings................................................................................................................................................................................................................. $_______________
Grand Total Expenses.................................................................................................................................................................................. $_______________
(out of pocket expenses minus savings)
You may also use the easy “Savings Calculator” at https://fsastore.com/services/FSAcalculator.aspx. Simply check off the items
you wish to save for and budget how much you will spend in the upcoming year.
15EMPLOYEE GUIDE TO 2022 BENEFITS
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Dependent Care FSA
The Dependent Care FSA lets Republic Bank’s associates use pre-tax dollars towards qualified dependent care such as caring for
children under the age 13 or an incapacitated parent or spouse. The provider may be a licensed day care provider or an individual who
provides a Social Security Number per IRS regulations. The calendar year maximum amount you may contribute to the Dependent
Care FSA is $5,000 (or $2,500 if married and filing separately) per calendar year.
You are qualified for this plan if you are a single working parent, you have a working spouse, or your spouse is a full-time student for
at least five months during the plan year while you are working, or your spouse or dependent parent is disabled and unable to provide
for their own care.
PLEASE NOTE: You may not be eligible to fully take advantage of the “Child and Dependent Care Credit” when you
file your income taxes if you are participating in a Dependent Care FSA. Please consult with your tax advisor regarding
your options.
Eligible Expenses
The following list represents expenses that are generally eligible for reimbursement under a Dependent Care FSA. This list is not
exhaustive and is intended only to be used as a general guide. Consequently, expenses contained in this list may be denied if the
supporting claims documentation is insufficient or shows that the expense was incurred for services not considered dependent care,
such as educational expenses.
• After school care - For custodial care for a dependent child under 13 years of age. Exceptions may be allowed if documentation
verifies that a dependent is incapable of self-care. The care must be provided in order to allow the parent(s) or legal guardian(s) to
work or seek employment.
• Agency fee - If expense must be paid to obtain related care. Expense cannot be reimbursed until actual care is provided.
• Application fee - If expense must be paid to obtain related care. Expense cannot be reimbursed until actual care is provided.
• Au pair - Amounts paid to care for a qualifying individual.
• Babysitter - Will qualify for care of eligible individual UNLESS babysitter is under 19 and the employee’s child, stepchild or foster
child, a tax dependent of the employee or the spouse of an employee or a parent of the child.
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• Before school care - For custodial care for a dependent child under 13 years of age. Exceptions may be allowed if documentation
verifies that a dependent is incapable of self-care. The care must be provided in order to allow the parent(s) or legal guardian(s) to
work or seek employment.
• Day camp - Generally eligible for a dependent child under 13 years of age even if day camp specializes in specific activity such as
basketball or computers. Exceptions may be allowed if documentation verifies that a dependent is incapable of self-care.
• Dependent care center - For a dependent child under 13 years of age as long as establishment complies with state and or local
licensing requirements. Exceptions may be allowed if documentation verifies that a dependent is incapable of self-care.
• Deposit - If expense must be paid to obtain related care. Expense cannot be reimbursed until actual care is provided.
• Elder care - If expenses not attributable to medical care. Individual is a tax dependent of the employee and spends at least 8 hours
a day in the employee’s household.
• Nanny - Amounts paid to care for a qualifying individual.
• Preschool (nursery school) - Generally eligible even if school furnishes other services such as meals or education.
• Registration fee - If expense must be paid to obtain related care. Expense cannot be reimbursed until actual care is provided.
• Sick-child facility - For a dependent child under 13 years of age where the child is sick and primary purpose is child care. Exceptions
may be allowed if documentation verifies that a dependent is incapable of self-care.
• Transportation expenses - If for transporting a qualifying individual to or from a place where care is provided, and transportation
is provided by a dependent care provider.
Ineligible Expenses
Flexible Spending Account (FSA) expenses for Dependent Care are generally only considered eligible for reimbursement where the
expense enables the employee and spouse (if applicable) to be gainfully employed or seek employment. An exception may apply
where the spouse is a full-time student or incapable of self-care.
The following list represents expenses that are generally considered ineligible under the Dependent Care FSA. This list is not
exhaustive and is intended only to be used as a general guide. Consequently, expenses contained in this list may be denied if the
supporting claims documentation shows that the expense was incurred for eligible dependent care expenses.
• Educational expenses - Except where child is in preschool or nursery school.
• Housecleaning services
• Au pair travel expenses
• Incidental expenses (field trips, t-shirts or other clothing, diaper changing fee)
• Kindergarten - Such expenses considered educational in nature.
• Late Payment Fees
• Overnight camp - Even if expenses split out between day and night
• Tuition expenses - Such expenses considered educational in nature.
17EMPLOYEE GUIDE TO 2022 BENEFITS
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Health Savings Account (HSA)
You must be enrolled in a qualified High Deductible Health Plan (HDHP) to be eligible to enroll in a Health Savings Account.
The Republic Bank HSA is a tax-favored account that allows you to set aside funds to save and pay for qualified medical expenses
incurred by you, your spouse, and any of your qualified dependents. The HSA takes the form of a tax-exempt trust or custodial account.
IMPORTANT NOTE: Per the IRS - if you can’t claim a child as a dependent on your tax returns, then you can’t spend
HSA dollars on services provided to that child.
Paying for healthcare expenses using your health savings account:
When you have not yet met your deductible, you can pay the entire amount when you get medical care or pick up a prescription.
Give your Health Savings Account - Republic Bank MasterCard® CheckCard to your healthcare provider, and if you have enough
money in your HSA to cover the service or prescription, the amount will be paid from your HSA and applied to your deductible. If
your HSA balance doesn’t cover the cost, you’ll have to pay out of pocket, but the amount will still be applied to your deductible.
Note: Once you have deposited enough money in your HSA account, you can reimburse yourself for the out-of-pocket cost of the
service or prescription.
HSAs are different from other types of account-based plans you might already be familiar with. The most important difference is
that HSAs are individually-owned accounts. That means that each account holder will have their own account/account number and
will receive personalized monthly statements. It also means that as the account holder, you must be the one to contact Republic
Bank with any questions or concerns pertaining to your personal account. You may open a Republic Bank HSA account at any
banking center and have your contributions deducted on pre-tax basis and direct deposited into your account.
Features of the Republic Bank Health Savings Account
The Republic Bank HSA is a personal checking account, and provides you with many of the same features offered in our traditional
checking accounts, including:
• No minimum balance or opening deposit required
• No set-up fee
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• No transaction fees
• Free Republic Bank MasterCard® CheckCard
• Free checks
• Free Internet Banking, Mobile Banking, Online Statements and Online Bill Pay
• Competitive tiered-rate interest
• No monthly account maintenance fees
No matter how you access the funds in your HSA, be sure to retain copies of all receipts as proof that funds were used to
pay for qualified medical expenses.
Determining eligibility for an HSA
To be eligible, you must meet the following criteria:
• You must be covered by a qualified High Deductible Health Plan
• You can’t be claimed as someone’s dependent
• You aren’t covered by other disqualifying insurance (such as a PPO Plan or Flexible Spending Plan*)
• You aren’t enrolled in Medicare
* You must exhaust all funds available in your Flexible Medical Spending Account before opening an HSA account.
If I enroll in a High Deductible Health Plan but waive the HSA, can I establish an HSA later?
Yes, an HSA can be established any time after enrolling in a qualified High Deductible Health Plan. You can contribute the maximum
amount for the year – in 2022, that’s $3,650 if you have single coverage or $7,300 for family coverage. Individuals age 55 and older
can also make an additional $1,000 catch-up contribution each year.
Account holders who are HSA-eligible for only part of the year can still make the full, tax-deductible contribution for that year.
However, they must remain HSA-eligible for at least twelve months after benefiting from this special rule in order to avoid potential
taxes and penalties.
What is the latest date I can make a contribution to my HSA?
You have until April 15 of the following year to make contributions for the current tax year. The contribution must be credited to the
account by April 15. All deposits are credited as current year contributions unless otherwise noted.
How do I make contributions to my HSA?
• Make contributions via payroll deduction (recommended method) – you may elect to have pre-tax contributions to your account
via payroll deduction.
• Make automatic monthly contributions – Arrange to have funds transferred automatically from your personal checking account
to your HSA on a specific day each month. You can set up automatic deposits when you use online enrollment to open your HSA,
or you can set them up at any time by completing an ACH authorization form (visit www.republicbank.com to obtain a copy of
this form).
• Send contributions by mail – Mail your contributions to Republic Bank using a Mail-in Contribution Form (available online at
www.republicbank.com).
How to open an HSA at Republic Bank
Simply visit a Banking Center and an associate will be happy to assist you. Request to open an Associate HSA. Show your Republic
Bank ID to be eligible for this free account. In addition, you may call the IRA/HSA Department at (502) 561-7143 (internal dial
ext. 7143), if you have questions regarding the health savings account. Email your account number and the amount of your per pay
contribution to your HSA to payroll@republicbank.com.
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