Learn about private health insurance in Wisconsin.

Enrollment

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

Prescription (Part D) Forms

To request an initial Part D coverage determination or exception, please use this form:

To request a Part D redetermination, first-level appeal, please use this form:

Other forms

Completed forms can be mailed or faxed to:

Quartz Medicare Advantage (HMO)
840 Carolina Street
Sauk City, Wisconsin 53583

Fax: (608) 881-8396

 

 

This webpage was updated on January 12, 2021.