Monday, February 18, 2019

MERS Forms


= Available on myMERS. Forms with a star may be completed Online by logging into your myMERS account. Click here to log in.
DB = Defined Benefit, DC = Defined Contribution, DC+ = Defined Contribution Plus, HCSP = Health Care Savings Program, RHFV = Retiree Health Funding Vehicle, ISP = Investment Services Program, Premier Adv = Premier Advantage, Annuity = Stable Income Annuity, GL&D = Group Life & Disability Insurance.

Health Care Savings Program

Form # Product Name Audience myMers Info
MD-169 HCSP Uniform Resolution Employer False more information

Uniform Resolution

Form #: MD-169

Product: HCSP
Audience: Employer

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

Restated MERS Trust Agreement

Form #: None

Product: HCSP, RHFV
Audience: Employer

MD-105 HCSP Reimbursement Claim Form Participant, Retiree False more information

Reimbursement Claim Form

Form #: MD-105

Product: HCSP
Audience: Participant, Retiree

MD-001 DB, DC, Hybrid, HCSP, 457 Personal Information Participant False more information

Personal Information

Form #: MD-001

Product: DB, DC, Hybrid, HCSP, 457
Audience: Participant

MD-170 HCSP Participation Agreement Employer False more information

Participation Agreement

Form #: MD-170

Product: HCSP
Audience: Employer

F-78 HCSP Model DRO Participant False more information

Model DRO

Form #: F-78

Product: HCSP
Audience: Participant

MD-102 HCSP Investment Change Participant True more information

Investment Change

Form #: MD-102

Product: HCSP
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

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

Enrollment Kit

Form #: MD-100

Product: HCSP
Audience: Employer, Participant

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

Customer Contact

Form #: F-85

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

MD-103 HCSP Beneficiary Designation Participant False more information

Beneficiary Designation

Form #: MD-103

Product: HCSP
Audience: Participant

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

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

MERS Social Media MERS Facebook MERS TwitterMERS LinkedInMERS Youtube

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).