Documents and Forms

Find 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