Thursday, December 8, 2016
MERS Forms

Employer Forms

Whether you're enrolling a new employee, ready to sign adoption or participation agreements, updating contact information or much more, you'll find all our Employer Forms here. Click the links on the left to view the forms specific to your MERS program. To view a list of all our MERS forms, click here.

Form # Product Name Audience myMers Info
None GL&D Waiver of Premium Claim Packet Employer False more information

Waiver of Premium Claim Packet

Form #: None

Product: GL&D
Audience: Employer

MD-469 457 Uniform Resolution Employer False more information

Uniform Resolution

Form #: MD-469
Description:

test def.


Product: 457
Audience: Employer

MD-169 HCSP Uniform Resolution Employer False more information

Uniform Resolution

Form #: MD-169

Product: HCSP
Audience: Employer

RH-669 RHFV Uniform Resolution Employer False more information

Uniform Resolution

Form #: RH-669

Product: RHFV
Audience: Employer

DB-004 Defined Benefit Service Credit Purchase Request Form Employer False more information

Service Credit Purchase Request Form

Form #: DB-004

Product: Defined Benefit
Audience: Employer

None HCSP, RHFV Restated MERS Trust Agreement Employer False more information

Restated MERS Trust Agreement

Form #: None

Product: HCSP, RHFV
Audience: Employer

DB-001b DB Resolution Adopting The MERS Defined Benefit Plan Employer False more information

Resolution Adopting The MERS Defined Benefit Plan

Form #: DB-001b

Product: DB
Audience: Employer

None GL&D Request for Life Conversion Materials Employer False more information

Request for Life Conversion Materials

Form #: None

Product: GL&D
Audience: Employer

F-79 DB, DC, Hybrid Reciprocal Units (Act 88) - Resolution Employer False more information

Reciprocal Units (Act 88) - Resolution

Form #: F-79

Product: DB, DC, Hybrid
Audience: Employer

F-54 DB Psychiatric Medical Report Employer, Participant False more information

Psychiatric Medical Report

Form #: F-54

Product: DB
Audience: Employer, Participant

2160 GL&D Proposal Process & Data Checklist Employer False more information

Proposal Process & Data Checklist

Form #: 2160

Product: GL&D
Audience: Employer

DB-013b DB, DC, Hybrid Projection Study Employer False more information

Projection Study

Form #: DB-013b

Product: DB, DC, Hybrid
Audience: Employer

F-53 DB Physician's Statement of Disability Employer, Participant False more information

Physician's Statement of Disability

Form #: F-53

Product: DB
Audience: Employer, Participant

DB-002c DB Part-Time to Full-Time Service Credit Conversion Employer False more information

Part-Time to Full-Time Service Credit Conversion

Form #: DB-002c

Product: DB
Audience: Employer

MD-170 HCSP Participation Agreement Employer False more information

Participation Agreement

Form #: MD-170

Product: HCSP
Audience: Employer

MD-470 457 Participation Agreement Employer False more information

Participation Agreement

Form #: MD-470

Product: 457
Audience: Employer

MD-071 DC MERS Loan Addendum Employer False more information

MERS Loan Addendum

Form #: MD-071

Product: DC
Audience: Employer

F-05 DB Membership Application Employer, Participant False more information

Membership Application

Form #: F-05
Description:

test summary


Product: DB
Audience: Employer, Participant

None GL&D Medical History Statement Employer False more information

Medical History Statement

Form #: None

Product: GL&D
Audience: Employer

MD-010 DC Loan Application Participant False more information

Loan Application

Form #: MD-010

Product: DC
Audience: Participant

MD-371 Hybrid Loan Addendum Employer False more information

Loan Addendum

Form #: MD-371

Product: Hybrid
Audience: Employer

MD-471 457 Loan Addendum Employer False more information

Loan Addendum

Form #: MD-471

Product: 457
Audience: Employer

None GL&D Life Insurance Portability Employer False more information

Life Insurance Portability

Form #: None

Product: GL&D
Audience: Employer

None GL&D Life Insurance Enrollment / Change Employer False more information

Life Insurance Enrollment / Change

Form #: None

Product: GL&D
Audience: Employer

None GL&D Life Insurance Benefits Claim Packet Employer False more information

Life Insurance Benefits Claim Packet

Form #: None

Product: GL&D
Audience: Employer

MD-300 Hybrid Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-300

Product: Hybrid
Audience: Employer, Participant

MD-100 HCSP Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-100

Product: HCSP
Audience: Employer, Participant

MD-400 457 Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-400

Product: 457
Audience: Employer, Participant

MD-000 DC Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-000

Product: DC
Audience: Employer, Participant

F-94 DB, DC, Hybrid Employer Resolution Establishing Uniform Transfer Provision Employer False more information

Employer Resolution Establishing Uniform Transfer Provision

Form #: F-94

Product: DB, DC, Hybrid
Audience: Employer

MD-473 457 Employer Contribution Addendum Employer False more information

Employer Contribution Addendum

Form #: MD-473

Product: 457
Audience: Employer

F-17 DB Employee Census Employer False more information

Employee Census

Form #: F-17

Product: DB
Audience: Employer

MD-474 457 Eligible Automatic Contribution Arrangement (EACA) Addendum Employer False more information

Eligible Automatic Contribution Arrangement (EACA) Addendum

Form #: MD-474

Product: 457
Audience: Employer

MD-505 ISP Distribution Employer False more information

Distribution

Form #: MD-505

Product: ISP
Audience: Employer

None GL&D Disability Claim Packet Employer False more information

Disability Claim Packet

Form #: None

Product: GL&D
Audience: Employer

F-85 DB, DC, HCSP, 457 Customer Contact Employer False more information

Customer Contact

Form #: F-85

Product: DB, DC, HCSP, 457
Audience: Employer

MD-372 Hybrid Conversion Addendum Employer False more information

Conversion Addendum

Form #: MD-372

Product: Hybrid
Audience: Employer

MD-072 DC Conversion Addendum Employer False more information

Conversion Addendum

Form #: MD-072

Product: DC
Audience: Employer

DB-013a DB Benefit Change - Permanent or Temporary Employer False more information

Benefit Change - Permanent or Temporary

Form #: DB-013a

Product: DB
Audience: Employer

None GL&D Application for Group Insurance with Under 25 Employees Employer False more information

Application for Group Insurance with Under 25 Employees

Form #: None

Product: GL&D
Audience: Employer

None GL&D Application for Group Insurance Over 24 Employees Employer False more information

Application for Group Insurance Over 24 Employees

Form #: None

Product: GL&D
Audience: Employer

F-51 DB Application for Disability Retirement Employer, Participant False more information

Application for Disability Retirement

Form #: F-51

Product: DB
Audience: Employer, Participant

MD-369 Hybrid Adoption Resolution Employer False more information

Adoption Resolution

Form #: MD-369

Product: Hybrid
Audience: Employer

MD-069 DC Adoption Resolution Employer False more information

Adoption Resolution

Form #: MD-069

Product: DC
Audience: Employer

MD-070 DC Adoption Agreement Employer False more information

Adoption Agreement

Form #: MD-070

Product: DC
Audience: Employer

DB-002 DB Adoption Agreement Employer False more information

Adoption Agreement

Form #: DB-002

Product: DB
Audience: Employer

MD-370 Hybrid Adoption Agreement Employer False more information

Adoption Agreement

Form #: MD-370

Product: Hybrid
Audience: Employer

DB-001a DB Admin Order Adopting The MERS Defined Benefit Plan Employer False more information

Admin Order Adopting The MERS Defined Benefit Plan

Form #: DB-001a

Product: DB
Audience: Employer

MD-369b Hybrid Admin Order Adopting MERS Hybrid Employer False more information

Admin Order Adopting MERS Hybrid

Form #: MD-369b

Product: Hybrid
Audience: Employer

MD-069b DC Admin Order Adopting MERS Defined Contribution Plan Employer False more information

Admin Order Adopting MERS Defined Contribution Plan

Form #: MD-069b

Product: DC
Audience: Employer

FN-003 DC, Hybrid, HCSP, 457, RHFV, ISP ACH Debit Request - Automated Transfer Authorization Employer False more information

ACH Debit Request - Automated Transfer Authorization

Form #: FN-003
Description:

Employer Form: Banking information for employer to set up ACH transfer authorization for MERS DC, 457, HCSP, RHFV, and ISP.


Product: DC, Hybrid, HCSP, 457, RHFV, ISP
Audience: Employer

None GL&D Accidental Dismemberment Claim Packet Employer False more information

Accidental Dismemberment Claim Packet

Form #: None

Product: GL&D
Audience: Employer

None GL&D Accelerated Benefit Claim Packet Employer False more information

Accelerated Benefit Claim Packet

Form #: None

Product: GL&D
Audience: Employer

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Disclaimer
The information contained in this Web site is being made available as a public service. The information is not intended to constitute legal or investment advice, or to replace official versions of that information. Benefit Estimates or Service Credit Purchase estimates requested through this Web site are not official descriptions of any benefits, and do not represent a promise by MERS to provide any benefit(s) to any person(s). No one can detrimentally rely upon the information provided in, or requested through this Web site. MERS reserves the right to correct any errors, and presents this information without warranties, express or implied, regarding the information?s accuracy, timeliness or completeness. If you believe the information is inaccurate, out-of-date, or incomplete, or if you have problems accessing or reading the information, please call MERS at 800.767.MERS (6377).