Group & Employer Plan Members

Forms + Resources

Access the Forms You Need

Get secure and convenient access to member forms and resources through MyChart.

Send a Secure Message

Change Your Address

Change Your Primary Care Physician (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.

Health Risk Assessment (HRA) on the Quartz Well Portal

Order or Print an ID Card

Order Printed Materials

Other Insurance Questionnaire

Printed Materials

If you would like printed materials, complete the Request Materials form in MyChart, or send a message.

You can also contact Quartz Customer Service at (800) 362-3310.

Printed materials you can request include:

  • Provider Directory
  • Member Guide
  • Certificate of Coverage
  • Prescription Drug Benefit Brochure
  • Preventive Services Covered Under the Affordable Care Act
  • Prescription Drug Formulary
  • Notice of Privacy Practices

Get an Answer Online — Right now!

Find a Doctor

Health Topics

Summary of Benefits and Coverage Lookup

Wisconsin PricePoint Tool – Get basic, facility-specific information about healthcare services and charges.

HSA Bank’s Calculator Tool

Downloadable Forms

Determination of Benefits Worksheet

Drug Formulary (choose your formulary, then download the document)

Authorization for Disclosure of Protected Health Information Form – English | Spanish

Appointment of Authorized Representative for Appeal Form

Health Plan Transition Form

Member Reimbursement Form (direct member Reimbursement Form for medications)

Member Claim Form

 (for health care other than medications)

Essential Information

Pharmacy Information and Prior Authorization

View the most recent issue of the Member Newsletter.

Appeals & Grievances

You or your authorized representative may request an initial decision or appeal. Your prescriber or treating provider may also request it for you.

Contact Us

Quartz is committed to providing superior customer service. That's one reason we offer so many ways to reach us.