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Medicare Advantage Members Forms & Resources: UW Health

Forms

Enrollment

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

2023 Plan benefit selection forms

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

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.