Documents and Forms
benefits-chapterFind all the documents and forms you need to manage your Regions benefits, all in in one place for your convenience.
Health (Medical, Dental, Vision, Wellness)
| Documents |
2019 Cost Worksheet 2019 Dental Plan Summary 2019 Medical SBC 2019 Summary of Benefits 2019 VSP Summary 90Day My Way Drug Tiers Explanation Generics Brochure Preventive Services SourceRX 1.0 Formulary SourceRX 1.0 Guide Tobacco Surcharge FAQs Free Tobacco Cessation Resources Nicotine Replacement Therapy Coverage Teladoc Member FAQs Teladoc Talk to a Doc Anytime Teladoc Pediatric FAQs Teladoc Dependent Set Up Uniform Glossary Vitality Quick Guide |
| Forms |
BCBS Dental Claim Form BCBS Medical Claim Form HIPAA Release Information PrimeMail Order Form Tobacco Free Affidavit Vitality Check Biometrics Form Ways to Earn Vitality Points |
Flexible Spending Accounts (FSA)
| Documents | 2019 Flex Plan Summary |
| Forms |
HealthEquity DCRA Reimbursement HealthEquity Electronic Funds Transfer HealthEquity FSA Reimbursement |
Health Savings Accounts
| Documents | N/A |
| Forms |
HSA Beneficiary Designation Form HSA Reimbursement Form |
Regions 401(k)
| Documents |
2019 401(k) Required Notices 2019 401(k) Auto Enrollment Notice 2019 401(k) Auto Increase Notice 401(k) Loan Policy 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 |
| Forms |
Annual 2% Employer Contribution Appeals Form 401k Loans Payments While on LOA |
Regions Retirement Plan
| Documents |
Retirement Plan Annual Funding Notice Retirement Plan for Associates Funding Notice |
| Forms | N/A |
BlackArch LLC 401(k) (for BlackArch LLC Associates only)
| 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 |
| Forms | N/A |
Life & Disability
| Documents |
Legal Insurance Overview ARAG Identity Theft Flyer How to Activate ARAG Identity Theft Monitoring Legal Issues as Children Grow Cigna How to File a Disability Claim Brochure Why Purchase Optional Life Insurance Legal Needs Life Cycle Medical vs Legal Identity Theft Summary |
| Forms | N/A |
Change in Status and Eligibility
| Documents |
Change in Status Chart Change in Status Documentation Requirements Change in Status Online Instructions Domestic Partner Benefits Policy (1/1/2019) |
| Forms |
Affidavit for Domestic Partnership (1/1/2019) Termination of Domestic Partnership |
Workday at Regions
| Documents |
Navigate Enrollment Job Aid Editing Beneficiary Allocations Job Aid Manage Your Benefits Job Aid Requesting a Leave of Absence Requesting Intermittent FMLA Change in Status Online Instructions |
| Forms | N/A |
Leave of Absence
| Documents |
401(k) Payments While on Leave How to Report a Disability Claim Benefits While on Leave Payroll While on Leave |
| Forms |
401(k) Loan Payment Debit Authorization Form Change in Status Online Instructions |
Miscellaneous
| Documents |
2019 Associate Contributions 2019 Benefits Summary 2019 Enrollment FAQs 2019 Enrollment Guide CDC Flu Vaccination Information Statement Exit Package Vacation Policy Vacation Purchase FAQs Why Get a Flu Vaccine? |
| Forms |
2019 Request for Appeal Change of Address for Former Regions Associates Flu Shot Reimbursement |
Related Information
Benefits Enrollment
Benefits Eligibility
Benefits Library
Benefits Sitemap
Documents and Forms
Summary Plan Descriptions
Where to Find Information
Health
Life & Disability
Retirement
Wellness
Additional Benefits
Need Help?
Contact the HR Connect Team at 1-877-562-8383