• Members Home
• Using Your Plan
• Health & Wellness
• Using Your Pharmacy Benefits
• FAQs
• Self-Help Forms
• Newsletters

Member Self-Help Forms

• Complex Case Management Form
• Dependent Status 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)

What's New?

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

• Looking for Insurance?
• State of Wisconsin Employees
• New Member Kit
• Get Connected with MyChart
  

Quick Links