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Access the Forms You Need

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

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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.

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
  • Federal Brochure
  • Prescription Drug Benefit Brochure
  • Preventive Services Covered Under the Affordable Care Act
  • Prescription Drug Formulary
  • Notice of Privacy Practices

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Health Topics

Summary of Benefits and Coverage Lookup

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

HSA Bank’s Calculator Tool

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