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FORMS & DOCS

Forms & Docs

Forms

Health

Supplemental Health

Accident Insurance Claim Form

Accident Wellness Bonus Claim Form

Critical Illness Insurance Claim Form

Critical Illness Wellness Bonus Claim Form

Hospital Indemnity Insurance Claim Form

Financial Security

HSA

HSA Rollover Form

FSA

Dependent Care FSA Change Form

Employee Stock Purchase Plan

ESPP Cancellation Form

Well-Being

Wellness Bonus Form

Documents

Lithia & Driveway

Lithia & Driveway Employee Handbook

2025 Total Rewards Guide

Dependent Statement of Eligibility

Updating Your Emergency Contacts

Internship Flyer

Health

Regence BCBS Medical

2025 Regence HSA Compatible Plan SBC

Regence HSA Compatible Plan SPD

2025 Regence PPO Plan SBC

Regence PPO Plan SPD

UPMC Medical

2025 UPMC PPO Plan SBC

Kaiser Medical

2025 Kaiser Northern California SBC

Northern CA Kaiser SPD

2025 Kaiser Southern California SBC

Southern CA Kaiser SPD

2025 Kaiser Hawaii HMO SBC

HI Kaiser HMO SPD

2025 Kaiser Hawaii Added Choice SBC

HI Kaiser Added Choice SPD

Supplemental Health

Accident Insurance Summary

Critical Illness Summary

Hospital Indemnity Insurance Summary

Dental

Guardian Dental Discount Program

Guardian Dental (Texas) SPD

2025 Guardian Texas Vision & Dental Classbook

Guardian Dental (Starbucks) SPD

2025 Guardian Starbucks Vision & Dental Classbook

Guardian Dental (All Other) SPD

Willamette Dental (ID, OR, WA) SPD

Hawaii Dental Service SPD

Vision

Guardian Vision (All Other) SPD

2025 Guardian All Other Vision Classbook

Guardian Vision (Texas) SPD

2025 Guardian Texas Vision & Dental Classbook

Guardian Vision (Starbucks) SPD

2025 Guardian Starbucks Vision & Dental Classbook

Financial Security

Disability

Guardian 2025 STD Summary

Guardian 2025 Voluntary LTD Summary

Life/AD&D

2025 Guardian Voluntary Life Summary

Hawaii AGMs and Above, Life, Disability and Supplemental Medical SPD

Hawaii All Other, Life, Disability and Supplemental Medical SPD

Starbucks, Life, Disability and Supplemental Medical SPD

All Other AGMs and Above, Life, Disability and Supplemental Medical SPD

All Other, Life, Disability and Supplemental Medical SPD

FSA

Employee Stock Purchase Plan

ESPP Information

ESPP E*TRADE Account Activation

Work/Life Balance

Time Off

Time Off Policy

Leaves of Absence

Benefits While on Leave

Legal Docs

Health

COBRA Continuation of Rights

Creditable Coverage Notice

HIPAA Notice of Privacy Practices

Marketplace Health Insurance Coverage Options Notice

Medicaid and the Children’s Health Insurance Program (CHIP)

Women’s Health and Cancer Act of 1998

Financial Security

401(k) Annual Fee Disclosure

Summary Annual Report

Qualified Default Investment Alternative Notice

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