2022 Open Enrollment Guide

November 08-19

Benefits Hotline — extension 2100 or 502.585.0915

Benefits Email — benefits@republicbank.com

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OPEN ENROLLMENT CHECKLIST

Determine Medical Election

Determine Dental Election

Determine Vision Election

Complete Tobacco-Free Affidavit (if electing Medical Coverage)

Complete 2022 online Spouse Confirmation of Medical Coverage form (if enrolling spouse under medical coverage)

1. Download and print the Spouse Employer Benefit Verification form 2. Submit to spouse’s employer to complete form 3. Upload completed form to 2022 Open Enrollment docs folder on

your Documents tab in UKG-Pro.

Enroll in FSA (if applicable) Must be elected annually.

1. Health (Full Service or Limited Purpose) 2. Dependent Care

Open Republic Bank Health Savings Account (HSA only if elected HDHP)

1. Visit Banking Center to open account

2. Email info to payroll (payroll@republicbank.com)

→ Account Number → $ Amount of Contribution → Coverage Tier (Associate Only, Family etc.) → Catch Up Contribution (if applicable)

Achieve Premium Discount by December 16th (if applicable)

Add, change or cancel Optional Life Insurance (go to Life Events in UKG-

Pro)

→ For Self, Spouse and/or Dependents → Complete Evidence of Insurability and Submit to HR (if adding or in-

creasing coverage)

Check to ensure your current address, phone number and home email

address is recorded in UKG-Pro.

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Open Enrollment FAQ

When will my benefit elections and/or changes take effect? Medical, Dental, FSA and Vision elections will become effective January 1, for the 2022 calendar year with deductions reflected on the 1/14/2022 paycheck. If you applied for Optional Life Insurance during Open Enrollment and submitted your Evidence of Insurability, you will receive a notice from Guardian after a coverage determination has been made. Coverage will be added as soon as administratively possible.

Are any of our benefits changing? Yes, the Medical Premium Discount and the Tobacco Surcharge are both increasing to $35 per paycheck. In addition, the COVID-19 vaccination has been added as a required activity to earn the Medical Premium Discount in 2022. All other benefits and employee deductions remain the same.

What if I just want to keep what I have? If you are making no changes to your medical, dental, vision or optional life benefits, you do not need to re-enroll. However, there are still important steps that you will need to complete.

→ You MUST complete the enrollment session in UKG-Pro if you want to participate in the Flexible Spending Account (FSA) during the new Plan Year. New elections must be made

every year for all FSA’s. → You MUST complete the Tobacco Free Affidavit every year if you have Medical Coverage.

→ You MUST complete the Spouse Confirmation of Coverage every year if you are covering your spouse under Medical Coverage.

Will my Medical Premium Discount continue? If you (including your spouse) are currently enrolled in a Humana health plan, it is recommended that you (and your covered spouse) complete the three 2021 WellSteps requirements by December 16, 2021 to ensure the premium discount will begin and/or continue on your first paycheck in 2022.

The new year for WellSteps program begins on 1/1/2022. Associates will receive an email during the first week of January from WellSteps that includes log in information for first time users. To earn the $35 per pay medical premium discount in 2022, you only need to complete 3 requirements - a confidential on-line personal health assessment, a preventative annual physical and the COVID-19 vaccination. If your spouse is covered on our medical plan, both you and your spouse must meet the requirements to qualify for the discount. All requirements must be met in 2022 to earn the discount. Once the requirements are met the premium discount will be applied as soon as administratively possible. Discounts earned in 2022 will apply to 2022 and 2023.

If I enroll in the High Deductible Health Plan, how do I open a Health Savings Account (HSA)? Visit any banking center to establish a Health Savings Account. Be sure to show your Republic ID for the free associate account. After your account is opened, email payroll@republicbank.com with your account number and let them know the per pay amount you want deposited into your HSA.

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Benefits Hotline Extension: 2100

From outside the Bank call: 502-585-0915

Take time to review the online resources available when making your 2022 elections. You can access benefits information and sum-maries of benefits and coverage from your home or office located on the Republic Bank open access website by clicking here.

ENROLLING FOR MEDICAL, DENTAL,

VISION AND FSA BENEFITS

1. Log into UKG-Pro and navigate to “Myself > Open Enrollment” and select

→ “2022 OE Medical Dental Vision ” to enroll in medical, dental and vision benefits, and

→ “2022 FSA Open Enrollment” to enroll for healthcare and dependent care FSA

→ “Tobacco-Free Affidavit” to complete the online form (required if electing medical cover-

age)

→ “2022 Spouse Coverage Verification” (required if covering Spouse under medical)

2. The enrollment system will take you to the “About Open Enrollment” landing page. To begin the

process and view your benefits options available during open enrollment, click on “Next” at the

top of the screen to navigate to the next page, or click on the actual “benefit” option link listed in

the far left column to go straight to a specific benefit.

3. You have the option to participate and/or waive coverage in each plan. You can check your pro-

gress or stop in the middle to return later (save progress as “Draft”) and the system will remem-

ber where you left off. Once you are finished making your elections, you must select “Submit”

If you elected medical coverage for 2022, please see the next page regarding additional forms that are required to be completed annually.

HOW TO ENROLL

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The Tobacco Free Affidavit must be completed annually if you elect Medical Coverage.

Complete the online Tobacco-Free Affidavit (the “Affidavit”). If you or any covered adult dependents (age 18 or over) smoke or use tobacco products, you will be as-sessed a $35 per pay period tobacco surcharge beginning the first full pay period fol-lowing January 1, 2022. In addition, even if you or a covered family member do not use Tobacco products—if the form is not completed, the surcharge will be assessed until a completed form is received or upon verified completion of the smoking cessa-tion program — Freedom From Smoking. No refunds will be given.

The Spouse Coverage Verification online form must be complet-ed annually if you elect Employee + Spouse or Family Medical Coverage.

Spouse Coverage Verification*

There are two sections of this form. One that you complete online as part of Open Enrollment and the other paper form to be completed by you and your spouse’s em-ployer.

If you are covering your spouse under the medical plan, you must also complete the online certification that they do not have access to or are not eligible for their own employer-sponsored group medical plan as a full-time employee.

• If they are employed but not eligible for coverage through their employer, down-load and print the “Employer Section” (page two) of the Spouse Coverage Verifica-tion form titled “Spouse Employer Benefit Verification” form. This page must be completed by their employer. When complete upload to the 2022 Open Enroll-ment docs folder located on your Documents tab in UKG-Pro by December 5th. Your spouse will not be eligible to be covered on a Republic Bank Medical Plan un-til this form is received.

*Please note that if your spouse is eligible for their own employer-sponsored medical plan as a full-time employee working 30 or more hours, they will not be eligible as a covered dependent under a Republic Bank-sponsored medical plan.

IMPORTANT ACTIONS REQUIRED IF

YOU ELECT MEDICAL COVERAGE

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Open Enrollment is also the time to review your designated Beneficiaries and Life Insurance coverage for yourself, your spouse and dependents.

Electing/Changing Optional Life Insurance

for yourself, your spouse or your children

Access the enrollment system through the UKG-Pro “Life Event” link on your UKG-Pro Dashboard.

You will have the option to waive or elect Optional Life Insurance for yourself, your spouse and/or

your child(ren) even if you do not elect medical, dental or vision coverage. Once you have completed

your elections, please save and print a benefits confirmation summary for your records.

IMPORTANT NOTICE—PLEASE DO NOT ACCESS THIS LIFE EVENT IF YOU DO NOT WANT TO ENROLL

OR MAKE CHANGES TO YOUR OPTIONAL LIFE INSURANCE COVERAGE(S).

1. Log into UKG-Pro and navigate to “Myself > Life Events” and select:

→ “2022 Open Enrollment for Optional Life” in the option menu to make changes to or elect

optional life benefits for yourself, spouse and dependent child(ren).

2. The enrollment system will take you to the “About Life Events” landing page. To begin the

process and view your benefits options, click on “Next” at the top of the screen to navigate to

the next page, or click on the actual “benefit” option link listed in the far left column to go

straight to a specific benefit.

3. Required Evidence of Insurability form: If you elect optional life benefits outside of your new

hire elections or are increasing your level of coverage for yourself or eligible dependents, you

must complete an Evidence of Insurability (EOI) form to be approved by Guardian Life. Once

completed, scan and send your completed EOI form to Tammy Pate in Human Resources.

4. At any time during your elections, you can check your progress or stop in the middle to return

later (save progress as “Draft”) and the system will remember where you left off. Once you

are finished making your elections, you must select “Submit” to save your elections.

HOW TO ENROLL CONTINUED

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Flexible Spending Accounts

Health FSA - up to $2,750 for 2022

You do not have to be enrolled in the Bank’s medical plan to participate in the FSA. You have the option to enroll in a standard Health Care FSA. An FSA can be used to pay for health expenses for you, your spouse and dependents that you claim on your income tax return. Common expenses that qualify are doctor visits, deductibles, copays, prescriptions, dental care, orthodontics, glasses, contact lenses and supplies, hearing aids and hearing aid batteries.

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). 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 LPFSA. (If you are not participating in a Health Savings Account (HSA), you may still participate in the standard Health Care FSA.)

You can use the provided debit card to pay for expenses and they will be deducted from your account balance. You need to keep all receipts in case Sheakley, our FSA Administrator, has to request the receipt to verify the expense is FSA eligible. A list of eligible expenses can be found on www.fsa.feds.com.

IMPORTANT - You can claim your unused funds up through March 15th of the following year. If you do not use your balance by the deadline, you will forfeit any amount remaining.

When you save for medical and dependent care expenses using a flexible spending account (FSA), you are saving in more than one way. Because money you put into an FSA account is not taxed, you end up with more money in your pocket.

Dependent Care FSA - $5,000 for 2022

Dependent care accounts are used for expenses related to care for your child under age 13, or a dependent you can claim on your income tax return who is incapable of self-care and spends at least 8 hours per day in your household, so you can work. If you are married, your spouse must be working, looking for work or attending school full time in order for you to be eligible for this benefit.

The maximum amount you can contribute per the IRS is $5,000 per year or $2,500 if you are married but filing separately. The $5,000 limit for married couples is a combined limit even if each has access to a separate FSA through their employer.

Common expenses are child and adult daycare centers, preschool, before/after school care, and summer camp.

YOU MUST MAKE A NEW ELECTION FOR 2022. YOUR PREVIOUS PLAN YEAR ELECTION WILL NOT CARRY OVER.

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2022 Rates Your cost depends upon several factors:

• Your employment status (full-time or part-time)

• The level of coverage you select (Associate only, Associate + spouse,

Associate + Child(ren), or Family);

• Whether or not you achieve the wellness plan requirements to receive the $35/pay medical premium discount;

• Whether or not you are subject to the $35/per pay Tobacco Surcharge.

MEDICAL PLAN OPTIONS DENTAL VISION

Coverage Tier

Standard PPO

Enhanced PPO

Coverage First

High Deductible Health Plan

Delta

Dental

Humana Vision 100

Associate Only Without Discount

With Discount

$111.22 $ 76.22

$135.46 $100.46

$89.84 $54.84

**$41.08

$6.08

$9.01

$2.28

*Associate + Spouse Without Discount

With Discount

*$215.36 *$180.35

*$265.61 *$230.61

*$170.90 *$135.90

*$145.70 *$110.70

$16.22

$4.55

Associate +Child(ren) Without Discount

With Discount

$195.38 $160.38

$229.99 $194.99

$145.78 $110.78

$121.57 $ 86.57

$18.65

$4.32

*Family Without Discount

With Discount

*$291.51 *$256.51

*$371.28 *$336.28

*$221.25 *$186.25

*$179.26 *$144.26

$25.95

$6.79

*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 whether or not your spouse is eligible for their own coverage – certification forms are available in Open Enrollment on UKG-Pro. **The employee premium for single coverage in the High Deductible Health Plan meets Health Care Reform’s safe harbor for affordable and adequate coverage.

Part-Time Associates – Benefit Costs Per Pay Period (26 x per year)

MEDICAL PLAN OPTIONS DENTAL VISION

Coverage Tier

Standard PPO

Enhanced PPO

Coverage First

High Deductible Health Plan

Delta Dental

Humana Vision 100

Associate Only Without Discount With Discount

$193.75 $158.75

$242.22 $207.22

$151.02 $116.02

**$41.08 $6.08

$12.96

$2.28

Associate + Spouse $4.55

Associate +Child(ren) Without Discount With Discount

$462.72 $427.72

$492.86 $457.86

$421.41 $386.41

$342.13 $307.13

$29.82 $4.32

Family $6.79

Full-Time Associates – Benefit Costs Per Pay Period (26 x per year)

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Humana Medical Plans

STANDARD PPO PLAN In

Network Out of

Network

Copay Based Services The set amount you pay to visit a particular doctor or facility (no deductible required)

Primary Physician Office Visit (Family Dr, Pediatrician, Gynecologist, Walk-in Clinic)

$20

30% after deductible

Mental Health Professional $20

Specialist Physician Office Visit $35

Urgent Care Center $75

Emergency Room (true emergency, as defined by plan) $300 $300

Deductible Amount you must pay for non-copay services BEFORE the insurance will share the cost

Per Individual $500 $1,000

Family Maximum $1,000 $2,000

Co-Insurance Amount you pay for non-copay services AFTER reaching the deductible

Out patient procedures/surgery, imaging (MRI, CT, etc.), hospitalization, etc.

20% after deductible

70% after deductible

Out of Pocket Maximum The maximum amount you will pay per calendar year before benefits are paid at

100% (not including prescription drugs).

Per Individual $2,500 $5,000

Family Maximum $5,000 $10,000

To find an in network provider, login to www.Humana.com or if you are not yet a subscriber, follow these instructions

• Visit www.humana.com • Go to Physician Finder > Just Looking > Insurance through Employer • When prompted, choose the “Humana/ Choice Care + Network PPO”

Please refer to the documents on the HR SharePoint page, or contact the HR department for more detailed information.

Prescriptions: Prescriptions can be filled at an in network pharmacy or through Humana’s mail order pharmacy. Brand Name Drugs subject to $250 annual deductible. Retail Mail-Order (up to 90 day supply) Level One $10 $20 Level Two $40 $80 Level Three $60 $120 Level Four 25% coinsurance 25% coinsurance

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Humana Medical Plans (CONTINUED)

ENHANCED PPO PLAN In

Network Out of

Network

Copay Based Services The set amount you pay to visit a particular doctor or facility (no deductible required)

Primary Physician Office Visit (Family Dr, Pediatrician, Gynecologist, Walk-in Clinic)

$15

40% after deductible

Mental Health Professional $15

Specialist Physician Office Visit $30

Urgent Care Center $75

Emergency Room (true emergency, as defined by plan) $300 $300

Deductible Amount you must pay for non-copay services BEFORE the insurance will share the cost

Per Individual $250 $500

Family Maximum $500 $1,000

Co-Insurance Amount you pay for non-copay services AFTER reaching the deductible

Out patient procedures/surgery, imaging (MRI, CT, etc.), hospitalization, etc.

10% after deductible

40% after deductible

Out of Pocket Maximum The maximum amount you will pay per calendar year before benefits are paid at 100% (not includ-

ing prescription drugs).

Per Individual $2,250 $4,500

Family Maximum $4,500 $9,000

Prescriptions: Prescriptions can be filled at an in network pharmacy or through Humana’s mail order pharmacy. Brand Name Drugs subject to $250 annual deductible. Retail Mail-Order (up to 90 day supply) Level One $10 $20 Level Two $40 $80 Level Three $60 $120 Level Four 25% coinsurance 25% coinsurance

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Humana Medical Plans (CONTINUED)

COVERAGEFIRST PPO PLAN In

Network Out of

Network

Annual Per person Benefit Allowance $500 N/A

Copay Based Services The set amount you pay to visit a particular doctor or facility

Primary Physician Office Visit (Family Dr, Pediatrician, Gynecologist, Walk-in Clinic)

$25

40% after deductible

Mental Health Professional $25

Specialist Physician Office Visit $40

Urgent Care Center $75

In-Patient Hospitalization 100% after $150 copay per day for first five days per admission, and after deductible

40% after deductible

Emergency Room (true emergency, as defined plan) Deductible plus $300

Deductible plus $300

Deductible Amount you must pay for non-copay services BEFORE the insurance will share the cost

Per Individual $2,500 $5,000

Family Maximum $7,500 $15,000

Co-Insurance Amount you pay for non-copay services AFTER reaching the deductible

Out patient procedures/surgery, imaging (MRI, CT, etc.), hospitalization, etc.

0% after de-ductible

30% after deductible

Out of Pocket Maximum The maximum amount you will pay per calendar year before benefits are paid at 100% (not includ-

ing prescription drugs).

Per Individual $2,500 $9,000

Family Maximum $7,500 27,000

Prescriptions: Prescriptions can be filled at an in network pharmacy or through Humana’s mail order pharmacy. Brand Name Drugs subject to $250 annual deductible.

Retail Mail-Order (up to 90 day supply) Level One $10 $20 Level Two $40 $80 Level Three $60 $120 Level Four 25% coinsurance 25% coinsurance

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Humana Medical Plans (CONTINUED)

HIGH DEDUCTIBLE HEALTH PLAN In

Network Out of

Network

Copay Based Services AFTER deductible is satisfied. The set amount you pay to visit a particular doctor or facility

Primary Physician Office Visit (Family Dr, Pediatrician, Gynecologist, Walk-in Clinic)

$20

40% after deductible

Mental Health Professional $20

Specialist Physician Office Visit $35

Urgent Care Center $75

Emergency Room (true emergency, as defined plan) $300 $300

Deductible Amount you must pay for non-copay services BEFORE the insurance will share the cost

Per Individual $2,800 $5,600

Family Maximum $5,600 $11,200

Co-Insurance Amount you pay for non-copay services AFTER reaching the deductible

Out patient procedures/surgery, imaging (MRI, CT, etc.), hospitalization, etc.

0% after de-ductible

30% after deductible

Out of Pocket Maximum The maximum amount you will pay per calendar year before benefits are paid at 100% (not includ-

ing prescription drugs).

Per Individual $2,800 $15,000

Family Maximum $5,600 $30,000

Prescriptions: Prescriptions can be filled at an in network pharmacy or through Humana’s mail order pharmacy. All RX expenses subject to annual deductible prior to copays being applied.

Visit the Humana Website to research specific medication costs.

Retail Mail-Order (up to 90 day supply) Level One $10 $20 Level Two $40 $80 Level Three $60 $120 Level Four 25% coinsurance 25% coinsurance

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Delta Dental Plan

You can find an in network provider at www.deltadentalky.com. Select Delta Dental PPO Plus Premier Network.

Annual deductible Premier or Preferred Network *Non-Network

Individual $25 $25

Family $75 $75

Maximum Benefits (per covered person each Benefit Period) $1,500 $1,500

Preventive Care

Oral exam, emergency exam, pallia-tive emergency treatment, periapical x-rays, bitewing x-rays, panoramic or complete series, topical fluoride applica-tion, prophylaxis, sealants, space main-tainers.

100% of the Allowable Amount, No Deductible; Does not Apply toward Annual Maximum

100% of the Allowable Amount, No Deductible; Does not Apply toward Annual Maximum

Minor Services 80% of the Allowable Amount, Subject to Deductible

80% of the Allowable Amount, Subject to Deductible

Routine fillings, simple extractions, root canal therapy, oral surgery.

Periodontic services, simple pros-thetic repairs

Major Services

50% of the Allowable Amount, Subject to Deductible

50% of the Allowable Amount, Subject to Deductible

Prosthetic services, inlays and Crowns, dental implants

Orthodontics Diagnosis and treatment plan, minor treatment for tooth guidance, intercep-tive orthodontic treatment, comprehen-sive orthodontic treatment.

50% of the Allowable Amount, No Deductible. Benefits are limited to $1,000 lifetime maximum for covered dependents under age 19.

50% of the Allowable Amount, No Deductible. Benefits are limited to $1,000 lifetime maximum for covered dependents under age 19.

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.

*Claims are paid based on the Allowable Amount.

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Humana Vision Care The vision plan is administered through Humana Vision Care. You can verify eligibil-ity or find a provider on their website at www.humana.com/vision/ad/provider-finder and select the “Insight” network, by calling 1-866-995-9316.

Frequency of Services

Vision Exam 12 months

Lenses 12 months

Frames 24 months

Vision Care Benefit Summary

Participating provider (Member Cost)

Non-participating provider (Reimbursement)

Exam, with dilation as necessary Retinal Imaging

$10 co-pay

$39 allowance

Up to $30

Not covered

Contact lens exam options:

Standard contact lens fit and follow-up Premium contact lens fit and follow-up

$55 allowance 10% off retail

Not covered

Lenses:

Single Bifocal Trifocal Lenticular

$25 co-pay $25 co-pay $25 co-pay $25 co-pay

Up to $25 Up to $40 Up to $60

Up to $100

Covered Lens Options:

UV coating Tint (solid and gradient) Standard scratch-resistance Standard polycarbonate - adults Standard polycarbonate - children <19 Standard anti-reflective coating Premium anti-reflective coating:

- Tier 1 - Tier 2 - Tier 3

Standard progressive (add-on to bifocal) Premium progressive:

- Tier 1 - Tier 2

- Tier 3 - Tier 4

Photochromatic / plastic transitions Polarized

$15 $15 $15 $40 $40 $45

$57 $68

80% of charge $25

$110 $120 $135

$90, 80% of charge, then up to $120

$75 20% off retail

Not covered Not covered Not covered Not covered Not covered Not covered

Not covered Not covered Not covered

Up to $40

Not covered Not covered Not covered Not covered

Not covered Not covered

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Humana Vision Care continued

Vision Care Benefit Summary

Participating provider (Member Cost)

Non-participating provider (Reimbursement)

Frames $100 retail allowance 20% off balance over $100

Up to $50

Contact Lenses (applies to materials only)

Conventional

Disposable Medically Necessary

$100 allowance (15% off balance over $100)

$100 allowance Covered at 100%

Up to $80

Up to $80 Up to $200

Frequency**

Examination Lenses or contact lenses Frame

**Frequency based on date of service

Once every 12 months Once every 12 months Once every 24 months

Once every 12 months Once every 12 months Once every 24 months

Diabetic Eye Care (care and testing for dia-betic members):

Examination - Up to (2) services per year

Retinal Imaging - Up to (2) services per year Extended Ophthalmoscopy - Up to (2) services per year

Gonioscopy - Up to (2) services per year Scanning Laser

- Up to (2) services per year

Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Up to $77

Up to $50

Up to $15

Up to $15

Up to $33

Additional plan discounts:

• Member may receive a 20% discount on items not covered by the plan at network Providers. Members may contact their participating provider to determine what costs or discounts are available. Discount does not apply to Insight Provider’s professional services, or contact lenses. Plan discounts cannot be combined with any other discounts or promotional offers. Services or materials provided by any other group benefit plan providing vision care may not be covered. Certain brand name Vision Materials may not be eligible for a discount if the manufacturer imposes a no-discount practice. Frame, Lens, & Lens Option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members re-ceive 20% off the retail price.

• Members may also receive 15% off retail price or 5% off promotional price for LASIK or PRK from the US Laser Network, owned and operated by LCA Vision. Since LASIK or PRK vision correction is an elective procedure, performed by specialty trained providers, this discount may not always be available from a provider in your immediate location.

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Voluntary Life Insurance

Employee, Spouse, Child

Life insurance is part of a sound financial plan as it provides for those you love when you can’t. Although the Bank does provide Basic Term Life Insurance benefits at no cost to eligible associates, you also have the opportunity to purchase additional Life Insurance on yourself, your spouse and your eligible child(ren) at group term rates.

1. Employee Optional Life Insurance – available in increments of $25,000 from $25,000 to $700,000. Cost is dependent upon your age & the amount of coverage requested. (Note: The benefit is reduced by 75% at age 75.)

→ If you currently have optional employee life coverage:

You may elect to increase your current benefit (Example: increase from $300,000 to $350,000). Evidence of Insurability is required.

→ If you currently do not have optional employee life coverage:

You may elect to purchase a benefit between $25,000 and $700,000 in $25,000 increments. Evidence of Insurability is required.

2. Optional Spouse Coverage – Whether you wish to purchase for the first time or upgrade coverage, you may purchase coverage for your spouse up thru age 69 in $10,000 increments up to $50,000. Cost is dependent upon the spouse’s age and amount of coverage requested. (Note: Coverage automatically terminates on your spouse’s 70th birthday and there are no continuation options due to age.)

3. Optional Child Life Coverage – Provides a $10,000 benefit for a flat rate of $1.11 per month, for dependent children up to age 26. This rate does not vary depending on the number of children covered. (Eligible dependent children include your natural blood-related children, stepchildren and legally adopted children.)

Important notes:

• Do I need to submit Evidence of Insurability (EOI)?

If you are increasing your coverage for yourself or your spouse, or are enrolling for coverage for the first time for yourself , spouse or eligible dependents, you must complete a medical questionnaire (EOI). Your new election(s) will begin on the date you are approved by the carrier.

• You do not need to re-enroll for Optional Life Coverage if you want to keep your current election. No EOI is required if you are not making any changes.

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VOLUNTARY LIFE INSURANCE

Employee, Spouse, Child Rates

Associate Cost

Monthly Cost Monthly Cost Monthly Cost Age per $1,000 Age per $1,000 Age per $1,000 Under 25 $0.06 40-44 $0.14 60-64 $0.81 25-29 $0.06 45-49 $0.20 65-69 $1.40 30-34 $0.08 50-54 $0.34 *70 and over $2.26 35-39 $0.11 55-59 $0.60 *benefit reduced by 75% at age 75

Spouse Cost:

Monthly Cost Monthly Cost Monthly Cost Age per $1,000 Age per $1,000 Age per $1,000 Under 20 $0.05 35-39 $0.09 55-59 $0.44 20-24 $0.04 40-44 $0.11 60-64 $0.78 25-29 $0.06 45-49 $0.16 *65-69 $1.35 30-34 $0.07 50-54 $0.28 *No benefits for age 70 and above

Child Life Option

Flat rate of $1.11 per month for Child Coverage regardless of the number of children covered up to age 26).

How to Calculate Your Voluntary Benefit Costs:

First, determine the amount of coverage for which you are applying. Then, using the table above, find your age range to determine the monthly cost of coverage per $1,000 increments. Multiply the number of thousands of coverage by the table rate to determine your monthly cost.

How To Calculate Rates

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MEDICAL PREMIUM DISCOUNT

If you are currently enrolled in our health plan, it is recommended that you complete your wellness activities by December 16, 2021 to ensure the premium discount will begin on your first paycheck in 2022.

The following applies to associates who are covered under our medical plan during 2021 and elect to continue medical coverage in 2022.

• If you achieved and/or re-earned the premium discount in 2021 under WellSteps, you will continue to receive the discount in 2022.

• If you have not achieved and/or re-earned the premium discount in 2021 the regular rate will be applied beginning with the first check in January 2022. However, once you do complete your wellness tasks, the medical premium discount will apply.

WellSteps is our wellness partner, providing tools to help you lead a more healthy life style. The benefit is available for all associates and their spouses who are enrolled in our medical plan.

GETTING STARTED WITH WELLSTEPS: The first step is to register for your account at WellSteps using your UKG-Pro ID as your user name. Spouses register by using the as-sociate’s ID followed by “-s”.

Associates and their spouses covered on the Republic Bank medical plan are eligible to earn a medical premium discount. There are 3 steps to obtain the $35 per pay discount:

1) Complete a confidential online personal health assessment on the WellSteps portal;

2) Visit your primary care doctor for an annual physical; and

3) Receive and/or show proof of receiving a full series COVID vaccination.

If your spouse is also covered, they will need to complete the same 3 requirements to help you earn the discount. By earning the discount this year, the discount will apply for the remainder of this year and all of 2022.

Before going to your physician download the confirmation form available on the Well-Steps site. Simply have your provider complete the form so you can upload it to your WellSteps account. To show proof of receiving a full series COVID vaccination, simply up-load a copy of your vaccination card.

Forgot to take the form? Not to worry – you can also upload your EOB when received from your medical insurance carrier.

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ID Cards

You can only make changes to your medical, dental, and vision coverage during open enrollment or if you have certain life changes such as those listed below. The IRS defines what changes you can make. Examples of qualifying events include:

• Marital changes (marriage, divorce, death of spouse) • Birth/adoption of a child • Dependent becomes ineligible (e.g. child turns 26) • Coverage from another group plan is gained or lost (e.g. open enrollment, Medicare,

change in employment, etc.) • Employment status change (e.g. full time to part time)

You must notify HR and provide documentation within 30 days of your life event to make a change. If notification and documenta-tion is not received within 30 days, no changes can be made until the next Open Enrollment Period.

Coverage Changes/ Life

Events

• Humana Medical: New ID cards will be mailed to employees at the address on file in UKG-Pro if you enrolled for the first time or changed medical plans for 2022. If you have questions regarding your ID cards, please contact Humana at 800-872-7207, or log into your account at www.humana.com to print an ID card.

• Humana Vision: ID cards will be mailed to newly enrolled employees at the address on file in UKG-Pro. If you have questions regarding your ID cards, please contact Humana at 800-872-7207, or log into your account at www.humana.com to print an ID card.

• Delta Dental: ID cards will be mailed to newly enrolled employees at the address on file in UKG-Pro. If you need a replacement ID card, please register and log into your account at www.deltadentalky.com, or call Delta Dental at 800-955-2030.

• Flexible Spending Account: You will receive a new debit card in the mail if you are new to the Plan or your current debit card is three years old. Do not discard your FSA Debit Card if it has not expired! Contact Sheakley at 800-877-6630 for assistance.

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IMPORTANT REMINDERS

• Open Enrollment is from November 8th - November 19th.

• YOU MUST RE-ENROLL IN THE HEALTH AND DEPENDENT CARE FLEXIBLE SPENDING

ACCOUNTS EACH YEAR. YOUR PREVIOUS ELECTION(S) DO NOT CARRY OVER.

• If you keep and or enroll in medical coverage you are required to complete the online

Tobacco-Free Affidavit each year. If you elect Medical coverage and the online form is

not completed during Open Enrollment, the $20 Tobacco surcharge will be assessed un-

til a completed form is received – no refunds will be given.

• If you cover your spouse under our medical plan, you are required to complete the online Spouse Verification of Coverage form each year as part of the on-line Open En-rollment process.

1. The employee portion of the form, 2022 Spouse Verification of Coverage, is completed in the Open Enrollment system.

2. The Spouse’s Employer Benefit Verification Form is available in the Open Enroll-ment system and must be completed by the employer of the spouse and then uploaded in your Documents File in UKG-Pro.

• Optional Life Insurance Benefits: If you elect optional life benefits for yourself or an

eligible dependent, you must complete an Evidence of Insurability form. You can optain a copy of the EOI form on the benefit enrollment website. Please scan and email your completed EOI form to Tammy Pate at tpate@republicbank.com.

• How can I get additional information or help?

Call the Benefits Hotline at ext. 2100 or 502.585.0915

Email the Benefits department at Benefits@republicbank.com

This brochure 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 applica-ble 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 Intra-net site. Rev. August 2021