- Estimate your Costs: Determination of Benefits Worksheet (PDF)
- Authorization for Disclosure of Protected Health Information.
- Health Plan Transition Form (PDF)
- Member Claim Form (PDF)
- At-Home COVID Test Claim Form (PDF) (for at-home COVID-19 test)
UW Health Network
Essential Information and Resources
- View the most recent issue of the Member newsletter.
- View Your Rights and Protections Against Surprise Medical Bills