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Member Self-Help Forms

• Complex Case Management Form
• Determination of Benefits Worksheet
• Fitness First Change Form
• General Authorization Form 
• Member Claim Form
• Order Printed Materials
• Other Insurance Information Form
• Prescription Claim Form (Direct Member Reimbursement Form)
• Health Care Transition Form

What's New?

New to Unity & UW Health?  Learn About UW Health Welcome Center

• Looking for Insurance?
• Go Red for Women this February
• State of Wisconsin Employees
• New Member Kit
• Get Connected with MyChart
  

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