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.
Here are some steps to take to review and use your drug coverage –
To access drugs not included in our formulary, the prescribing doctor can complete the Medication Prior Authorization Request Form and submit 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. The prescriber will indicate on the form if they are requesting expedited review because of an exigent circumstance and the prescribing physician or other prescriber must provide a statement as to the basis of the exigency. Medical information is needed to make the determination for approval or denial of the 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 potential appropriate covered alternatives on the formulary. For exigent requests a determination will be made within 24 hours of receipt of 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, but if additional information is necessary it may take as long as 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. In the case 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.
Where to find information when you have questions –
Momentum Insurance Plans, Inc. administers dental benefits for members who have selected a policy with dental coverage. Find out if your dentist is in the Momentum network on their website or by calling toll-free 855.729.6569 or locally 608.729.6569.
This Member Kit is for members who have purchased an Individual or Family Plan.
If you have insurance through an employer or the State of Wisconsin
Group Health Insurance Program,
please select the correct member kit for information about your plan.
© 2017 Quartz Health Solutions, Inc. All rights reserved.
Quartz Health Solutions, Inc., Unity Health Plans Insurance Corporation, Gundersen Health Plan, Inc., Gundersen Health Plan Minnesota, Physicians Plus Insurance Corporation, Gundersen Health System, UnityPoint Health and UW Health are separate legal entities. Plans are underwritten by Unity Health Plans Insurance Corporation unless otherwise noted.