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

Form #ProductNameAudiencemyMERS
MD-073
Defined Contribution, Hybrid Plan
Contribution Addendum for MERS DC (and DC portion of Hybrid)
Employer
No
F-05
Defined Benefit
Enrollment Kit
Employer, Participant
No
DB-013a
Defined Benefit
Benefit Change - Permanent or Temporary
All, Employer
No
DB-013b
Defined Benefit, Defined Contribution, Hybrid Plan
Projection Study
Employer
No
F-17
Defined Benefit
Employee Census
Employer
No
MD-069
Defined Contribution
Adoption Resolution
Employer
No
MD-069b
Defined Contribution
Admin Order Adopting MERS Defined Contribution Plan
Employer
No
MD-070
Defined Contribution
Adoption Agreement
Employer
No
MD-071
Defined Contribution
MERS Loan Addendum
Employer
No
F-51
Defined Benefit
Application for Disability Retirement
Employer, Participant
No
F-53
Defined Benefit
Physician's Statement of Disability
Employer, Participant
No
F-54
Defined Benefit
Psychiatric Medical Report
Employer, Participant
No
F-79
Defined Benefit, Defined Contribution, Hybrid Plan
Reciprocal Units (Act 88) - Resolution
Employer
No
MD-000
Defined Contribution
Enrollment Kit
Employer, Participant
No
MD-369
Hybrid Plan
Adoption Resolution
Employer
No
MD-369b
Hybrid Plan
Admin Order Adopting MERS Hybrid
Employer
No
MD-370
Hybrid Plan
Adoption Agreement
Employer
No
MD-371
Hybrid Plan
Loan Addendum
Employer
No
MD-400
457 Program
Enrollment Kit
Employer, Participant
No
MD-469
457 Program
Uniform Resolution
Employer
No
MD-471
457 Program
Loan Addendum
Employer
No
MD-470
457 Program
Participation Agreement
Employer
No
MD-473
457 Program
Contribution Addendum for 457
Employer
No
MD-474
457 Program
Eligible Automatic Contribution Arrangement (EACA) Addendum
Employer
No
2160
Group Life & Disability Insurance
Proposal Process & Data Checklist
Employer
No
MD-300
Hybrid Plan
Enrollment Kit
Employer, Participant
No
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
RH-669
Retiree Health Funding Vehicle
Uniform Resolution
Employer
No
None
Group Life & Disability Insurance
Life Insurance Enrollment / Change
Employer
No
None
Group Life & Disability Insurance
Medical History Statement (Evidence of Insurability)
Employer
No
None
Group Life & Disability Insurance
Application for Group Insurance Over 25 Employees
Employer
No
None
Group Life & Disability Insurance
Application for Group Insurance with Under 25 Employees
Employer
No
None
Group Life & Disability Insurance
Life Insurance Benefits Claim Packet
Employer
No
None
Group Life & Disability Insurance
Accelerated Benefit Claim Packet
Employer
No
None
Group Life & Disability Insurance
Waiver of Premium Claim Packet
Employer
No
None
Group Life & Disability Insurance
Life Insurance Portability
Employer
No
None
Group Life & Disability Insurance
Request for Life Conversion Materials
Employer
No
None
Group Life & Disability Insurance
Disability Claim Packet
Employer
No
None
Group Life & Disability Insurance
Accidental Dismemberment Claim Packet
Employer
No
DB-001a
Defined Benefit
Admin Order Adopting The MERS Defined Benefit Plan
Employer
No
DB-001b
Defined Benefit
Resolution Adopting The MERS Defined Benefit Plan
Employer
No
DB-002
Defined Benefit
Adoption 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-505
Investment Services Program
Distribution
Employer
No
DB-004
Defined Benefit
Service Credit Purchase Opt-Out Form
Employer
No
DB-007
Defined Benefit
Defined Benefit Plan Surplus Division Adoption Addendum
Employer
No
DB-094
Defined Benefit
Employer Resolution Establishing Uniform Transfer Provision
Employer
No
MD-700
Defined Contribution Plus
Enrollment Kit
Employer, Participant
No
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
Defined Benefit
DB Plan Invoice Change Request
Employer
Yes