Individual & Family Plan Members
Forms + Resources
Thank you for choosing Quartz! We want to make it as easy as possible for you to use your health plan. To help you, we’ve created this member kit 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? Here’s how.
Members in Wisconsin and Illinois
- Log into your account at MarketplaceEnroll.QuartzBenefits.com
- Call Quartz Customer Success at (800) 362-3310
Members in Minnesota
- Log into your account at MNsure.org
- Contact MNsure at (651) 539-2099 or (855) 366-7873
Questions? We’re here to help. Call Customer Success at (800) 362-3310.
Access the forms you need.
Get secure and convenient access to member forms and resources through MyChart.
- Send a Secure Message
- 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
- Transparency in Coverage
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 health care services and charges
- HSA Bank’s Calculator Tool
Forms
- Appointment of Authorized Representative for Appeal Form (PDF)
- Determination of Benefits Worksheet (PDF)
- Drug Formulary (choose your formulary, then download the document)
- Authorization for Disclosure of Protected Health Information Form
- Health Plan Transition Form (PDF)
- Member Reimbursement Form (PDF) (direct member reimbursement form for medications)
- Member Claim Form (PDF) (for health care other than medications)
- Recurring Payment Authorization Form (PDF)
Essential Information and Resources
- Pharmacy Information and Prior Authorization
- Preventive services covered under the Affordable Care Act – Wisconsin | Illinois
- View the most recent issue of the Member Newsletter
- View Your Rights and Protections Against Surprise Medical Bills
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.