Individual & Family Plan Members
Forms + Resources
Individual & Family plan forms and resources
Thank you for choosing Quartz! We want to make it easy for you to use your health plan. To help you, we’ve gathered some helpful resources to walk you through important details.
How to keep your information updated
Need to make changes to your plan election, name, address, telephone number, or email address?
Members in Wisconsin
- Log in to your account at QuartzBenefits.com/Marketplace
- Call Quartz Customer Success at (800) 362-3310
Members in Minnesota
- Log in to your account at MNsure.org
- Contact MNsure at (651) 539-2099 or (855) 366-7873
Access the forms you need
Interactive tools & other resources
- Find a Doctor
- Healthwise
- Summary of Benefits and coverage lookup
- Transparency in coverage
- Wisconsin PricePoint Tool – Get basic, facility-specific information about health care services and charges
- HSA Bank’s calculator tool
- Pharmacy information and prior authorization
- Preventive services covered under the Affordable Care Act
- Contraceptive services covered under the Affordable Care Act
- Your rights and protections Against surprise medical bills
- Drug Formulary (choose your formulary, then download the document)
- Health Risk Assessment (HRA) on the Quartz Well portal
Quartz MyChart member resources
Get secure and convenient access to member forms and resources through Quartz MyChart.
- Send a secure message
- Change your primary care provider (PCP)
- Determination of benefits form
Use this form to help determine costs you may incur prior to receiving health care services. To complete the form, you will have to ask your provider for certain medical coding information including procedure codes, procedure modifiers, and unit codes for the services. - Order or print an ID card
- Order printed materials
- Other insurance questionnaire
Forms
- Appointment of representative for appeal Form (PDF)
- Determination of benefits worksheet (PDF)
- Authorization for Disclosure of Protected Health Information Form
- Member reimbursement form (PDF) (direct member reimbursement form for medications)
- Member claim form (PDF) (for health care other than medications)
- Recurring payment option (PDF)
- Health Risk Assessment (HRA) on the Quartz Well portal
Protected Health Information (PHI) Authorization
- You have the right to allow someone else to access your Protected Health Information (PHI). To do so, please complete and submit the Authorization for Disclosure of Protected Health Information form at QuartzBenefits.com/PHIForm or in Quartz MyChart.
- You may also print and mail the Authorization to Release Protected Health Information form and send it to Quartz.
Know your Quartz Team
Questions? We’re here to help
(800) 362-3310 (TTY: 711)
Mon. – Thurs., 7 a.m. – 6 p.m.
Fri., 7 a.m. – 5 p.m.
Quartz Care Management support
Our Care Management professionals are there to listen, understand your needs, and connect you with the right care and support.
Call us at (866) 884-4601
Understanding your plan
Take a moment to understand your health plan, including:
Digital tools
We keep you close to care with digital tools, such as Healthwise, our informational health topic database and virtual visit options.
Quartz Well programs
Explore tools, programs and personalized support to meet your health and wellness goals.
Contact us
We’re here to help you find the right plan option that works for you and your family. Please call Quartz Customer Success at (800) 362-3310, or if you have worked with an agent in the past, reach out to them with any questions on your Quartz plan options.