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.


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 determine what type of care you need. 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 Care Contact your PCP clinic, they will tell you how to get appropriate care 
After-Hours Care Contact your PCP clinic, they will tell you how to get appropriate care
Urgent Care Go to a participating urgent care center if your injury is not life-threatening but you need prompt attention 
Emergency Care Go to the nearest hospital or call 911 
Care Away From Home Contact your PCP clinic or if it's an emergency go directly to the nearest hospital
Behavioral Health Care  For assistance coordinating your behavioral health services, including alcohol and drug treatment services, please contact UW Health – Behavioral Health Care Management at 608.233.3575 or toll free at 800.683.2300.

If you are looking for a primary care physician 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. You'll find other important plan information in the How Insurance Works section of the website, including information on how to submit a claim for payment to a provider you received services from.

+ 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.MyChart link

+ Benefit Information

Your Schedule of Benefits and Summary of Benefits and Coverage 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.MyChart link

+ Explanation of Benefits (EOB)

Your Explanation of Benefits Statement informs you of what ​Quartz has paid and what you might owe after receiving care. Once a claim is received and processed, an EOB will be generated and delivered to you within two weeks.

Learn more about your EOB and sign up to receive electronic EOBs in MyChart.MyChart link

+ Find a Doctor

Our Find a Doctor tool provides search features for participating practitioners and providers. You can search by Primary Care P​rovider, Specialist, Location, Facility and more.

+ Helpful Videos
  • Understanding Health Care Expenses – Most benefit plans have fees that you need to pay depending on the care you receive. These payments are called “out-of-pocket expenses.” This video helps explain the different costs.
  • Understanding Your Summary of Benefits and Coverage – This video walks you through a typical benefit document.  It’s a quick and easy way to understand how to read your benefit documents.
  • How Health Insurance Works – Health insurance is a way to help reduce your cost of health care when it is needed. This video will help you learn more about how insurance really works.
+ Making Changes to Your Health 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 at least 14 days before 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.


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 15th of each year. Sign up to be notified when Open Enrollment begins

+ 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.

+ 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.

 

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.