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


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


Life & Disability



Additional Benefits

Need Help?

Contact the HR Connect Team at 1-877-562-8383