Request for MERP

This is to request Kistler Tiffany Benefit Human Resources Services established a MERP, Summary Plan Description and Corporate Resolution to adopt the Plan. Please forward the necessary forms to establish these legal documents.

MERP Information ( All fields are required)
KTB Broker Name
What is the name of the Employer?
Who is the contact person at the Employer?
Contact person’s email address?
What is the Employer’s address and telephone number?
Who is the Plan Administrator?
Note: This is not the third party administrator. It is usually the employer but it could be a committee.
What is the Plan Administrator’s address and telephone number, if different than above?
What is the Employer’s Tax ID number?
What is the Effective Date of the Plan?
State of Incorporation
Business Structures

What is the first day of the Plan Year?
What is the last day of the Plan year?
What are the Plan Eligibility Requirements?	For example, employee must work 30 or more hours per week and/or has completed 30 days of employment
What is the Plan Eligibility Date?	the first day of the month after the Eligibility Requirements have been satisfied on the date the eligibility requirements have been satisfied
Covered Expenses	For example, Deductibles, health care expenses not covered by insurance, dental and/or vision expenses, prescription & non-prescription drug expenses, etc.
Expense Limit	Maximum amount that can be submitted for reimbursement (can set limit for each employee or each participant to include dependents.)
Covered Carrier Name and Plan Type	For example: Aetna POS 1.3 Or United Healthcare Medical
Excluded Carrier Name and Plan Type (if participation in a specific plan excludes employees from participating in the MERP)	For example: Aetna POS 1.3 Or United Healthcare Medical
Does the plan allow participants to carry over into the following benefit year?	Yes No

Let Kistler Tiffany Benefits
give your group the edge in
employee benefits planning

As an employer, you are under considerable pressure to provide employee benefits at a reasonable cost. The task of shopping, designing, implementing, and administering benefit plans is complex. That's why you and your employees will benefit from the expertise of Kistler Tiffany Benefits consultants. We provide customized benefit solutions for your employee benefit needs as well as a wide rage of popular voluntary coverages.

Whether you wish to offer employer-paid, employee-paid, or shared contribution programs, Kistler Tiffany Benefits can develop winning strategies for you. Thanks to the volume of business we place and the number of carriers we have relationships with, we are able to provide bids from highly rated companies, many of which are well known to you and some that are new to the Philadelphia regional marketplace. We have direct contact with senior management at several well-known insurers, enabling us to directly negotiate for you. Some major insurers even have representatives dedicated to serving only our accounts.

Request for MERP

Let Kistler Tiffany Benefits give your group the edge in employee benefits planning

Let Kistler Tiffany Benefits
give your group the edge in
employee benefits planning