Medicare Advantage Members Forms & Resources

UW Health Quartz Medicare Advantage (HMO)



To access the Quartz Medicare Advantage enrollment application, please visit the enrollment page.

Plan benefit selection forms

To change plans, please complete the following form:

2024 Plan benefit selection forms

Standard print | Large print | Online plan benefit selection form tool​​​

Other forms

Submitting forms

Completed forms can be mailed or faxed to:

Quartz Medicare Advantage (HMO)
2650 Novation Parkway
Fitchburg, WI 53713

Fax: (608) 881-8396

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 or in Quartz MyChart.
  • You may also print and mail the Authorization to Disclosure of Protected Health Information form and send it to Quartz.

Appeals + Grievances

We provide quality service to our members. Our goal is to continuously improve the care and service members receive. You may have a concern at some point. As a member, you have the right to voice a complaint or appeal a decision made by Quartz Medicare Advantage.

We're here for you.

Thanks for choosing Quartz Medicare Advantage. If you have questions or need support, your local Quartz Champion is here for you.