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Welcome to Quartz!

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.

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Questions?

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Online Tools

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 outs 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.

 

Understanding Your Health Plan

Accessing Care

Quartz wants you to receive the care you need when you need it. You may need different types of care depending on your situation. This video will help you decide what type of provider is right for your situation. Below is a summary of how to access care depending on your needs –

  Type of Care

 What To Do

Routine Care

Contact your Primary Care Provider's (PCP) clinic

Specialty CareContact your PCP clinic, they will tell you how to get appropriate care 
After-Hours CareContact your PCP clinic, they will tell you how to get appropriate care
Urgent CareGo to a participating Urgent Care Center if your injury is not life-threatening but you need prompt attention
Emergency CareGo to the nearest hospital or call 911
Care Away from HomeContact your PCP clinic, or if it's an emergency, go directly to the nearest hospital
Behavioral Health CareYou can call a provider directly to schedule an outpatient appointment. If you need assistance finding a provider or have questions about behavioral health services, including alcohol and drug treatment services, please call Behavioral Health Care Management at (608) 640-4450 or toll-free at (800) 683-2300.

If you are looking for a Primary Care Provider at a UW Health Clinic and need help selecting one, visit the UW Health Welcome Center, an individualized service available to help new members select primary care physicians, and transition their care to UW Health. Otherwise, use Find a Doctor to browse providers in your network.

Understanding Your Plan

Select any of the options below to learn more about the different features of your health plan.

GenericIDCard

ID Card

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.
EOB

Benefit Information

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.
SOB_SBC

Explanation of Benefits

Learn More
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.
Doc Choice

Find A Doctor

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.

Helpful Videos


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.

How to Submit a Medical Claim From an Out-of-Network Provider*

At times, you may receive services from a health care provider that is not in your plan's network. In that case, you must send claims to Quartz to assure payment. To do this –

  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.
  1. Include receipts and any proof of payment.
  2. This claim must be mailed to Quartz within 90 days from the date of the service.
Note: Quartz processes claims according to your plan's benefits. Some plans may not cover services outside of the plan's provider network.
Making Changes to Your Plan

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 the date you wish the change to take effect or prior to 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 Marketplace, you will need to contact the Marketplace at (800) 318-2596 or TTY: (855) 889-4325 or log into your account at HealthCare.gov (WI and IL residents) and (855) 366-7873 or visit MNsure.org (MN residents.).

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.

 
Pharmacy & Dental Benefits

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 –

You Want ToWhere to Find Information
Check the Formulary Status or Restriction Status of a DrugVisit the Prescription Drug Formulary
Find a PharmacyVisit Find a Pharmacy
Appeal a Prior Authorization DenialCall Customer Service at (800) 362-3310
Speak to a Clinical Pharmacist about why a Prior Authorization Request was deniedCall Quartz Pharmacy Program at (888) 450-4884
Find Criteria for Coverage of a MedicationCall Quartz at (800) 362-3310 or view the Medication Prior Authorization information to learn more about the process and timeline
Get Early Refills, Vacation Supplies, Emergency Supplies, Supplies for a New Member, or Reimbursement of Medications Purchased Out-of-PocketVisit Understanding Your Pharmacy Benefits

Dental Benefits

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

Managing Your Health & Rewards

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).
Due to overlap with the Well Wisconsin Program, the Quartz Well reward program is not available to State of Wisconsin Group Health Insurance Program members.
Paying Your Bill
  • Payments

    - Due on the 1st of every month

    - Payable to Quartz Health Benefit Plans Insurance Corporation (IL & WI) Quartz Health Plan MN Corporation (MN)

    Illinois & Wisconsin

    Quartz Health Benefits Plan Corporation

    PO Box 78730

    Milwaukee, WI 53278-0730

    Minnesota

    Quartz Health Plan MN Corporation

    PO Box 78368

    Milwaukee, WI 53278-8368

    - It’s important to pay your full premium each month. Failure to do so may result in your account entering your allowable grace period and possible termination.

  • Overpayments

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

  • Retro-active Denials

    Claims may be denied retro-actively if your policy is canceled/or terminated due to non-payment.

  • Grace Periods

    A grace period is the allowable time after your invoice is due to make your monthly premium payment. Depending on if you’re receiving advanced premium tax credits (APTC) or not will determine your allowable grace period.

     RECIEVING APTC  GRACE PERIOD
     Yes 90 Days from Due Date 
     No  31 Days from Due Date

  • 90-Day Grace

    During the 90-day (or 3 month) grace period your coverage remains active.  However, how claims are treated is different depending on what stage of the grace period you are in.   

    - Month 1-All medical and pharmacy claims will pay as usual

     - Months 2 & 3- pharmacy services will be denied at point of sale. While medical claims will be pended and not paid to the provider.

    If at any point during your 90-day grace you satisfy the balance owed in full, medical claims will be release and paid and any pharmacy services can be submitted for reimbursement. 

    If you fail to make full payment due within the 90-day grace period, your coverage will be retro-terminated to the end of the first month of the 90-day grace period.  Claims that were submitted during only the first month will be paid and claims received for service dates in months 2 and 3 will be denied and become your financial responsibility.  You will also be financially responsible to pay Quartz the premium due for the first month of your grace period.

  • 31-Day Grace

    During the 31-Day grace your coverage remains active.  If you fail to make payment in full by the end of your grace period, your coverage will be retro-terminated.  All claims after this date will be denied and will become your financial responsibility.

Forms & Resources

Access the forms you need –FAST!

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

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!

Downloadable Forms

Essential Information and Free Screening Tools

 


This Member Kit is for members who have purchased and Individual or Family plan. If you have insurance through an employer or the State of Wisconsin Group Insurance Program, please select the correct member kit for information about your plan.