Individual Member Kit

Quartz MyChart

Quartz MyChart gives you access to your health insurance and UW Health medical information through one secure portal.

As a Quartz MyChart member you can –

• View your benefit information
• Pay your monthly premium
• Check claims status
• Check eligibility
• Review prior authorizations
• Receive electronic communications from Quartz
• Determine costs you may incur prior to receiving health care services
• Take a health risk assessment
• Request ID cards
• Change your Primary Care Provider
• Update your demographic information
• Renew your plan
• Ask customer service a question by sending a message within Quartz MyChart

Quartz MyChart members with a UW Health provider can –

• Receive test results
• Schedule, cancel and view appointments
• Send secure electronic messages to your UW Health care team
• View and print selected health issues, medications, allergies and immunizations
• Feel better, faster with a video or e-Visit for certain types of health problems

Quartz members with a Gundersen Health System (GHS) provider can –

Quartz members that use GHS MyCare can access their content through one login via MyChartCentral. Download instructions and then visit MyChartCentral to get started.

Member Pages

The member section of our website provides, videos, interactive tools and other resources to help you better understand the ins and out of your health plan.

Health Topics

• The Healthwise^® Knowledgebase is an online encyclopedia that allows you to research symptoms, diagnoses, treatments and obtain helpful tips on self-care.

Stay Connected

Curious about our latest news and programs? Want to discover new recipes or health tips? A complete Quartz experience awaits when you join our social community.

Review your ID card to make sure your information is correct. Keep it in your wallet and show it each time you receive care. You can print ID cards or request a new one through MyChart.

Your Schedule of Benefits (SOB) and Summary of Benefits and Coverage (SBC) contain a summary of your benefits. Your Certificate of Coverage contains information about your plan including limitations and exclusions. Visit MyChart to view these documents.

Your explanation of benefits informs you of what your plan has paid and what you might owe after receiving care. Learn more about your EOB and sign up to receive electronic EOBs in MyChart.

Our Find a Doctor tool provides search features for participating practitioners and providers. You can search by Primary Care Provider, Specialist, Location, Facility and more.

Quick Overview of How Insurance Works

Understanding Health Care Expenses

How and Where to Get Care

Out-of-Network Services

Out-of-network care typically isn't covered unless it is provided in the case of an emergency. If you utilize services out-of-network other than for emergency care, you may have financial liability for those claims and may be balance billed.

Medical Necessity and Prior Authorization

Some services and supplies covered by your insurance plan may require prior authorization or be reviewed for medical necessity. This means that you, your doctor or nurse must fill out a Prior Authorization Request Form before you can have the treatment to determine if it will be covered. Learn more about Prior Authorization.

Coordination of Benefits (COB)

Do you have more than one health insurance plan? If so, those plans need to work together to make sure you’re getting the most out of your coverage. One plan becomes your primary plan. It pays your claims first. Then the second plan pays toward the remaining cost. That process is called coordination of benefits.

1. Fill out the Member Claim Form.
2. Include a copy of the billing statement or claim form received from the doctor, clinic or other provider.

3. Include receipts and any proof of payment.
4. This claim must be mailed to Quartz within 90 days from the date of the service.

When can I add or remove someone from my plan?

You can remove someone from your plan at any time during the year but you are required to request the dependent be removed from your plan at least 14 days before the date you wish the change to take effect.

During the annual Open Enrollment period, you may choose to add or remove someone from your plan. You can also choose a new plan.

Outside of Open Enrollment, you may add someone to your policy only if you have certain life events that qualify you for a special enrollment period. See if you qualify.

If you purchased your health plan through the Health Insurance Marketplace (HIM), you will need to contact them at (800) 318-2596 or TTY: (855) 889-4325 or log into your account at healthcare.gov.

When can I select a different plan?

During Open Enrollment, you may choose a new plan. You can also add or remove someone from your plan. At any other time, you may choose a new plan only if you have certain life events that qualify you for a special enrollment period. See if you qualify.

When is the next Open Enrollment period? Open Enrollment runs from November 1 through December 15 of each year. Sign up to be notified when Open Enrollment begins.

Get the most out of your drug coverage –

• Review the Drug Formulary to see if your current medication is covered.
• Medications on the Formulary are assigned a Tier (Tier 1, Tier 2). See what Tier your medication falls under. Each Tier is listed on your Summary of Benefits next to the amount you contribute to payment for the medication. This is your cost-sharing.
• Check to see if your medications qualify for the Choice90 program.

Drug Exception Timeframe & Enrollee Responsibilities

• To access drugs not included in our formulary, the prescribing doctor can complete the Medication Coverage Request Form and submit the form online or via mail, phone or fax.
  • We will accept prior authorization request forms from members or their authorized representatives but recommend having your health care practitioner complete the form.
• Medical information is needed to make a decision on the exception request. Decisions will be made based on the medical necessity for the member to receive the requested medication, including the need to receive the requested medication instead of covered alternatives on the formulary.
• For urgent requests, a determination will be made within 24 hours of receiving the request. For non-urgent requests, a determination will be made within 72 hours of receiving the request and all necessary medical information.
• Quartz makes decisions on standard prior authorization requests in a timely manner. However, if additional information is necessary, it can take up to 15 calendar days.
• Requests will be processed and notification to member and provider will take place in a manner that provides members with appropriate and timely access to medical services. 
  • When a request is denied, members and providers will be made aware of the reason for the denial and their right to appeal denials of coverage.

When you have questions –

Dental Benefits

Momentum Insurance Plans, Inc. administers on their website or by calling toll-free (855) 729-6569 or locally (608) 729-6569.

Quartz Cares About Your Health

We offer a wide range of programs and resources to help you manage your health.

Health Management and Prevention programs – Our Health Management and Prevention programs provide rewards, reminders, health news, online information, support and classes  

Health Management Resources – Screenings, guidance and even healthy recipes to help you improve your health and wellness

Health Assessment Tools – Screening tools that can help you decide when to seek care

Wellness and Prevention – The best way to stay healthy is to prevent or find illness early - get some health guidance and even healthy recipes to help improve your health and fitness.

Health Topics – Browse health information, find decision tools for medical issues, or check your symptoms 

Quartz Well

Introducing Quartz Well*, a new, personalized digital wellness program that is simple, flexible and rewarding. It is designed to reward you for taking care of yourself — whatever your fitness level, wherever you are at.

• Simple – No paperwork to complete
• Flexible – Work out wherever and whenever you want
• Rewarding – Redeem and use your points online

Members age 18 and older can earn $100 for single plans and $100 each for the member and spouse (or domestic partner) on family plans.

Points can be redeemed and used for purchases on Amazon.com

Learn More.

Login to Quartz MyChart and sign on to Quartz Well to get started earning points! 

*

Subscribers age 18 and older can earn $100 for single plans. Family plans offer $100 for the subscriber and $100 for the subscriber's spouse (or domestic partner).

Monthly Premium

• Your monthly premium is due on the first of each month to the company underwriting your policy – Quartz Health Benefit Plans Insurance Corporation.
• To avoid having your coverage termed or canceled, and risk not having insurance until the next open enrollment period, be sure to pay the full premium amount on time each month.
• To avoid losing your insurance and having payment of a claim denied, make sure you pay the full premium payment before the end of your applicable grace period.
• If you apply for a new policy with Quartz, you may be required to pay any outstanding premiums you owe on this or other past due accounts before the new coverage can begin.
  

Retro-active Denials

Claims may be denied retro-actively if your policy is cancelled for non-payment. You will be responsible for paying all claims incurred after the termination date of your policy. In order to avoid your claims being retro-actively denied for payment, make sure to pay your premium on time each month.

We offer a variety of ways to pay your premium invoice.

Choose how to pay your premium

Grace Periods and Pending Claims

After you enroll in an Individual and Family plan, you must pay your first premium in order for your coverage to be active. If you don’t pay any premiums at all after you enroll in the plan, your policy will be cancelled.

Once your plan is active, you are eligible for a grace period for your monthly recurring premiums. A grace period is the amount of time you have to pay your Premium Invoice. The duration is dependent on whether you get subsidies or not. 

• If you are getting advanced premium tax credits (APTC), by law, you have a 90 day (or 3 month) grace period. Your coverage remains active during the grace period, but claims are treated differently depending on what month of the grace period they are incurred.
  • During the first month of your 90 day grace period, all medical and pharmacy claims will pay as usual.
  • During months 2 and 3 of grace, pharmacy claims will deny at the point of sale and medical claims will be pended. When claims are pended, they do not process for payment to the provider and are held until the grace period is resolved. If payment in full is received prior to the end of the third month of grace, all pended claims will be processed and paid.
  • If the grace period ends and payment is not made in full, only claims from the first month of grace will be paid. All claims incurred after the first month of grace, including pended claims, will be denied and become the responsibility of the member. Your coverage will be retro-terminated to the end of the first month of your 90 day grace period. You are still responsible for paying the premium for your first month of grace.
• If you do not get help paying your premium – You have 31 days to pay your Premium Invoice after the due date. Otherwise, Quartz will not pay claims and your policy will be terminated.

Your account will show a credit balance if you have overpaid your premium balance. This credit will be applied to future months’ coverage unless you request a refund. Please call Customer Service at (800) 362-3310 to request a refund of premium overpayment.

Access the forms you need –FAST!

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

• Send a Secure Message
• Change your Address
• 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

Not a MyChart member yet? Sign up now!

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
• Certificate of Coverage
• Prescription Drug Benefit Brochure
• Preventive Services Coverd Under the Affordable Care Act
• Prescription Drug Formulary
• Notice of Privacy Practices

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 healthcare services and charges
• HSA Bank's Calculator Tool

Downloadable Forms

• Appointment of Authorized Representative for Appeal Form
• Determination of Benefits Worksheet
• Drug Formulary (choose your formulary, then download the document)
• Authorization for Disclosure of Protected Health Information Form
• Health Care Transition Form
• Member Reimbursement Form (Direct member Reimbursement Form for medications)
• Member Claim Form (for health care other than medications)
• Individual Application
  • English
  • Spanish
• Recurring Payment Authorization Form

Essential Information and Free Screening Tools

• Pharmacy Information and Prior Authorization
• Screening Tools
• View the most recent issue of the Member newsletter