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= Available on myMERS. Forms with a star may be completed Online by logging into your myMERS account.

Form #ProductNameAudiencemyMERS
MD-001
457 Program, Defined Benefit, Defined Contribution, Health Care Savings Program, Hybrid Plan
Personal Information
Participant
Yes
MD-102
Health Care Savings Program
Investment Change
Participant
Yes
MD-103
Health Care Savings Program
Beneficiary Designation
Participant
Yes
MD-100
Health Care Savings Program
Enrollment Kit
Employer, Participant
No
MD-169
Health Care Savings Program
Uniform Resolution
Employer
No
MD-170
Health Care Savings Program
Participation Agreement
Employer
No
FN-003
457 Program, Defined Contribution, Health Care Savings Program, Hybrid Plan, Investment Services Program, Retiree Health Funding Vehicle
ACH Debit Request - Automated Transfer Authorization
Employer
No
MD-105
Health Care Savings Program
Reimbursement Claim Form
Participant, Retiree
Yes
DB-001c
457 Program, Defined Benefit, Defined Contribution, Health Care Savings Program, Hybrid Plan, Investment Services Program, Retiree Health Funding Vehicle
Resolution Establishing Authorized Signatories for MERS Contracts and Service Credit Purchase Approvals
Employer
No