Select Your Plan
To access the Quartz Medicare Advantage enrollment application, please visit the enrollment page.
Plan Benefit Selection Form
To change plans, please complete the following form:
2023 Plan Benefit Selection Forms
Appointment of Representative Form (If you would like to appoint a representative to act on your behalf in requesting a coverage determination, appeal, or grievance, please refer to this form).
Member CashCard Reimbursement Form (fitness membership and medical ride transportation)
Completed forms can be mailed or faxed to:
Quartz Medicare Advantage (HMO)
2650 Novation Parkway
Fitchburg, WI 53713
Fax: (608) 881-8396