Friday, December 14, 2018

MERS Forms

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= Available on myMERS. Forms with a star may be completed Online by logging into your myMERS account. Click here to log in.
 
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.

None

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

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

Restated MERS Trust Agreement

Form #: None

Product: HCSP, RHFV
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

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

Proposal Process & Data Checklist

Form #: 2160

Product: GL&D
Audience: Employer

n/a DB Model EDRO Qualification Participant False more information

Model EDRO Qualification

Form #: n/a
Description:

EDRO Qualification, ELIGIBLE DOMESTIC RELATIONS ORDERS
REVIEW AND QUALIFICATION
(DEFINED BENEFIT PLAN)


Product: DB
Audience: Participant

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-000 DC Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-000

Product: DC
Audience: Employer, Participant

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

None GL&D Disability Claim Packet Employer False more information

Disability Claim Packet

Form #: None

Product: GL&D
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

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).