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MERS Forms

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Abbreviations

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.

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Form #	Product	Name	Audience	myMers	Info
None Employer, Group Life & Disability Insurance, None	GL&D	Waiver of Premium Claim Packet	Employer	False	Waiver of Premium Claim Packet Form #: None Product: GL&D Audience: Employer
None Employer, Health Care Savings Program, Retiree Health Funding Vehicle, None	HCSP, RHFV	Restated MERS Trust Agreement	Employer	False	Restated MERS Trust Agreement Form #: None Product: HCSP, RHFV Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Request for Life Conversion Materials	Employer	False	Request for Life Conversion Materials Form #: None Product: GL&D Audience: Employer
2160 Employer, Group Life & Disability Insurance, None	GL&D	Proposal Process & Data Checklist	Employer	False	Proposal Process & Data Checklist Form #: 2160 Product: GL&D Audience: Employer
n/a Participant, Defined Benefit, 1-99, None, Domestic Relations Order (DRO)	DB	Model EDRO Qualification	Participant	False	Model EDRO Qualification Form #: n/a Description: EDRO Qualification, ELIGIBLE DOMESTIC RELATIONS ORDERS REVIEW AND QUALIFICATION (DEFINED BENEFIT PLAN) Product: DB Audience: Participant
None Employer, Group Life & Disability Insurance, None	GL&D	Life Insurance Portability	Employer	False	Life Insurance Portability Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Life Insurance Enrollment / Change	Employer	False	Life Insurance Enrollment / Change Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Life Insurance Benefits Claim Packet	Employer	False	Life Insurance Benefits Claim Packet Form #: None Product: GL&D Audience: Employer
MD-000 Participant, Employer, Defined Contribution, Enrollment Kits, None	DC	Enrollment Kit	Employer, Participant	False	Enrollment Kit Form #: MD-000 Product: DC Audience: Employer, Participant
MD-300 Participant, Employer, Enrollment Kits, Hybrid Plan, None	Hybrid	Enrollment Kit	Employer, Participant	False	Enrollment Kit Form #: MD-300 Product: Hybrid Audience: Employer, Participant
MD-100 Participant, Employer, Enrollment Kits, Health Care Savings Program, None	HCSP	Enrollment Kit	Employer, Participant	False	Enrollment Kit Form #: MD-100 Product: HCSP Audience: Employer, Participant
None Employer, Group Life & Disability Insurance, None	GL&D	Disability Claim Packet	Employer	False	Disability Claim Packet Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Application for Group Insurance with Under 25 Employees	Employer	False	Application for Group Insurance with Under 25 Employees Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Application for Group Insurance Over 24 Employees	Employer	False	Application for Group Insurance Over 24 Employees Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Accidental Dismemberment Claim Packet	Employer	False	Accidental Dismemberment Claim Packet Form #: None Product: GL&D Audience: Employer
None Employer, Group Life & Disability Insurance, None	GL&D	Accelerated Benefit Claim Packet	Employer	False	Accelerated Benefit Claim Packet Form #: None Product: GL&D Audience: Employer