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Benefits Verification Concern Form
We would like to hear the questions and concerns that you have with the Benefits Verification Process.
We are collecting the many concerns that members and retirees have. We need your assistance to ensure that we are aware of all issues.
Name
*
First
Last
Which if the following best describes you.
Please select
Active Member
Pre-65 Retiree
Post-65 Retiree on Spending Account
Post-65 Retiree on former Municipality Plan
For concerns other than terminated dependents, please describe your issue as completely as possible.
Did you participate or attempt to participate in the Mercer Exercise
Please select
Yes
No
Has your spouse or other dependent(s) been terminated from your plan
Please select
None
spouse
dependent(s)
spouse and dependent(s)
If your spouse or dependant(s) has been terminated from your benefits plan, please describe your level of participation in the verification exercise. For example, did you submit forms, if so which ones? Where you late? Have only some of your family been cut off? Did you reach out to Mercer or the City for assistance? Anything you can provide us may help.
Please provide any relevant documents.
Email
*
