Documents and Forms

Your Benefits

Health (Medical, Dental, Vision, Wellness)

Health Documents 

2021 Dental Plan Summary

2021 Medical SBC

2021 Summary of Benefits

2021 VSP Summary

VSP Diabetic Eyecare Plus Program

90Day My Way


Drug Tiers Explanation

Generics Brochure

ACA Preventive Drug List

HSA Preventive Drug List

HSA Member Brochure

Know Where To Go

Medical Plan Differences

Nicotine Replacement Therapy Coverage

Preventive Services

SourceRx 1.0 Formulary Drug List

SourceRx 1.0 Guide

Tobacco Surcharge FAQs

Free Tobacco Cessation Resources

Teladoc Member FAQs

Teladoc Talk to a Doc Anytime

Teladoc Pediatric FAQs

Teladoc Dependent Set Up

Understanding Core HDHP Infographic

Understanding Your Claims Statement

Uniform Glossary

Vitality Quick Guide

VSP Diabetic Eyecare Plus Program

Ways to Earn Vitality Points

Health Forms

BCBS Dental Claim Form

BCBS Medical Claim Form

HIPAA Release Information

Alliance RX Mail Order Form

Tobacco Free Affidavit

Vitality Check Biometrics Form


Flexible Spending Accounts (FSA)

FSA Documents

FSA Member Flyer

DCFSA Member Flyer

FSA Forms

HealthEquity DCFSA Reimbursement

HealthEquity Electronic Funds Transfer

HealthEquity FSA Reimbursement


Health Savings Accounts (HSA)

HSA Documents

HSA Member Brochure

HSA Forms

HSA Beneficiary Designation Form

HSA Reimbursement Form


Regions 401(k)

Regions 401(k) Documents

2021 401(k) Required Notices

2021 401(k) Auto Increase Notice

2020 Auto Escalate Notice

2020 401(k) Required Notices for Inactive Participants

401(k) Loan Policy

401(k) Plan Highlights for New Hires

401(k) SAR

Annual 2% Employer 401(K) Contribution FAQs

401(k) SPD 

401(k) Roth FAQs 

401(k) Roth Contributions Brochure 

Fee Disclosure

Regions 401(k) Enrollment Book 

Regions 401(k) Forms

Annual 2% Employer Contribution Appeals Form

401k Loans Payments While on LOA


Regions Retirement Plan

Retirement Plan Documents

Retirement Plan Annual Funding Notice

Retirement Plan for Associates Funding Notice


BlackArch LLC 401(k) (for BlackArch LLC Associates only)

BlackArch LLC 401(k) Documents

BlackArch LLC 401(k) QDIA Notice

BlackArch LLC 401(k) Participant Fee Disclosure

BlackArch LLC 401(k) SPD

BlackArch LLC 401(k) Loan Program

BlackArch LLC 401(k) Roth Contributions Brochure

BlackArch LLC 401(k) Roth FAQs

BlackArch LLC 401(k) Enrollment Book 

BlackArch LLC 401(k) SAR


Life and Disability

Life and Disability Documents

ARAG Legal at a Glance

ARAG Identity Theft Flyer

ARAG Legal Mobile App

How to Activate ARAG Identity Theft Monitoring

Cigna How to File a Disability Claim Brochure

Why Purchase Optional Life Insurance

Legal is Everywhere

Identity Theft Summary


Change in Status and Eligibility

Change in Status Documents

Change in Status Chart

Change in Status Documentation Requirements

Domestic Partner Benefits Requirements

Change in Status Forms

Affidavit for Domestic Partnership

Termination of Domestic Partnership


Workday at Regions

Workday Documents

Navigate Enrollment Job Aid

Editing Beneficiary Allocations Job Aid

Manage Your Benefits Job Aid

Requesting a Leave of Absence

Requesting Intermittent FMLA


Leave of Absence (LOA)

LOA Documents

401(k) Payments While on Leave

How to Report a Disability Claim

Benefits While on Leave

Payroll While on Leave

LOA Forms

401(k) Loan Payment Debit Authorization Form



Miscellaneous Documents 

2021 Associate Contributions

2021 Benefits Summary 

2021 Enrollment FAQs 

2021 Enrollment Guide

CDC Flu Vaccination Information Statement

Regions Discount Shopping Network

Exit Package

No More Excuses Flu Vaccine

Special Paid Time Off FAQs

Vacation Time

Vacation Purchase FAQs

Why Get a Flu Vaccine?

Miscellaneous Forms

2021 Open Enrollment Appeal Form

Change of Address for Former Regions Associates

Flu Shot Reimbursement