Plan Documents and Information
 

To find your member documents, select your plan below.

To request a hard copy mailed to you, send us a mesage through your acccount in the Member Portal or call Customer Services.

Use this form to notify UCare of your gender preference if it is different than the sex you were assigned at birth. This will help process your health care claims appropriately.

Get Engaged - Learn about our ambassador, advocacy and feedback programs for members.

Member Newsletters - Catch up on the latest information and tips to help you stay healthy.


Choose your coverage type, then plan:

We are going green! You can find complete information online about your benefits and coverage in the Evidence of Coverage (EOC), available providers and pharmacies in the Provider Directory, and prescription drugs in the Formulary. If you would like a hard copy mailed to you, send us a message through your account in the Member Portal or call Customer Services.

UCare Medicare Plans

Service Area Map (PDF)
Formulary

Member Release of Information Form (PDF)
Statement of Representative Form (PDF)

Automatic Payment Form (PDF)

Health care costs can vary depending on the area in which you live. Our UCare Medicare coverage area is divided into three regions based on counties: North, Metro and South. Find your county on the list below or view the map of Medicare regions to find out which region you are in.

North
Aitkin
Becker
Beltrami
Carlton
Cass
Clay
Clearwater
Cook
Crow Wing
Douglas
Grant
Hubbard
Itasca
Kanabec
Kittson
Koochiching
Lake
Lake of the Woods
Mahnomen
Marshall
Morrison
Norman
Otter Tail
Pennington
Pine
Polk
Red Lake
Roseau
St. Louis
Todd
Wadena
Wilkin

Metro
Anoka
Benton
Carver
Chisago
Dakota
Hennepin
Isanti
Mille Lacs
Ramsey
Scott
Sherburne
Stearns
Washington
Wright

South
Big Stone
Blue Earth
Brown
Chippewa
Cottonwood
Dodge
Faribault
Fillmore
Freeborn
Goodhue
Houston
Jackson
Kandiyohi
Lac qui Parle
Le Sueur
Lincoln
Lyon
Martin
McLeod
Meeker
Mower
Murray
Nicollet
Nobles
Olmsted
Pipestone
Pope
Redwood
Renville
Rice
Rock
Sibley
Steele
Stevens
Swift
Traverse
Wabasha
Waseca
Watonwan
Winona
Yellow Medicine

UCare Medicare Group Plans

Note: Summary of Benefits and Evidence of Coverage are determined per group.

Formulary
Provider and Pharmacy Directories (PDF)
Plan Rating Information (PDF)

Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Automatic Payment Form (PDF)

Minnesota Health Care Programs

Member Release of Information Form (PDF)
Prior Authorization Information (PDF)
Statement of Representative Form (PDF)

Provider and Pharmacy Directory (PDF)
Formulary (coming 1/1/2020)

Provider and Pharmacy Directory (PDF)
Formulary (coming 1/1/2020)

Provider and Pharmacy Directory (PDF)
Formulary (coming 1/1/2020)

Provider and Pharmacy Directory (PDF)
Formulary (coming 1/1/2020)

UCare Individual & Family Plans

New Member Guide (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)
Statement of Representative Form (PDF)

Formulary
Provider and Pharmacy Directory (PDF)
Service Area Map (PDF)

Automatic Payment Form (PDF)
Claim Reimbursement Form (PDF)
Prescription Drug Reimbursement Form (PDF)

A catastrophic plan available to people under 30 years of age or for those who obtain a hardship exemption.

Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Quick Reference Guide (PDF)

Additional Links and Documents

Prospective Member Information (PDF)

UCare Individual & Family Plans with M Health Fairview

New Member Guide (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)
Statement of Representative Form (PDF)

Formulary
Provider and Pharmacy Directories (PDF)
Service Area Map (PDF)

Automatic Payment Form (PDF)
Claim Reimbursement Form (PDF)
Prescription Drug Reimbursement Form (PDF)

Cost sharing reduction (CSR) plans

CSR plans help reduce your out-of-pocket costs by lowering your deductibles and coinsurance. You must meet certain income levels (determined by MNsure) to enroll in a CSR plan.

“A” plans have 100% cost sharing reductions; “B” plans have limited cost sharing variations; Silver “2” plans have 73% cost sharing reduction; Silver “3” plans have 87% cost sharing reduction; and Silver “4” plans have 94% cost sharing reduction. If you are unsure which plan you qualify for, please call us at 1-855-307-6985.


Choose your coverage type, then plan:

UCare Medicare is the new name for UCare for Seniors.

We are going green! You can find complete information online about your benefits and coverage in the Evidence of Coverage (EOC), available providers and pharmacies in the Provider Directory, and prescription drugs in the Formulary. If you would like a hard copy mailed to you, send us a message through your account in the Member Portal or call Customer Services.

UCare Medicare Plans

Service Area Map
New Member Welcome Booklet (PDF)
Member Extras Booklet (PDF)
Formulary

Member Release of Information Form (PDF)
Statement of Representative Form (PDF)

Automatic Payment Form (PDF)

Health care costs can vary depending on the area in which you live. Our UCare Medicare coverage area is divided into three regions based on counties: North, Metro and South. Find your county on the list below or view the map of Medicare regions to find out which region you are in.

North
Aitkin
Becker
Beltrami
Carlton
Cass
Clay
Clearwater
Cook
Crow Wing
Douglas
Grant
Hubbard
Itasca
Kanabec
Kittson
Koochiching
Lake
Lake of the Woods
Mahnomen
Marshall
Morrison
Norman
Otter Tail
Pennington
Pine
Polk
Red Lake
Roseau
St. Louis
Todd
Wadena
Wilkin

Metro
Anoka
Benton
Carver
Chisago
Dakota
Hennepin
Isanti
Mille Lacs
Ramsey
Scott
Sherburne
Stearns
Washington
Wright

South
Big Stone
Blue Earth
Brown
Chippewa
Cottonwood
Dodge
Faribault
Fillmore
Freeborn
Goodhue
Houston
Jackson
Kandiyohi
Lac qui Parle
Le Sueur
Lincoln
Lyon
Martin
McLeod
Meeker
Mower
Murray
Nicollet
Nobles
Olmsted
Pipestone
Pope
Redwood
Renville
Rice
Rock
Sibley
Steele
Stevens
Swift
Traverse
Wabasha
Waseca
Watonwan
Winona
Yellow Medicine

UCare Medicare Group Plans

Note: Summary of Benefits and Evidence of Coverage are determined per group.

Formulary
Provider and Pharmacy Directories (PDF)
Plan Rating Information (PDF)

Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Automatic Payment Form (PDF)

UCare Individual & Family Plans is the new name for UCare Choices and Fairview UCare Choices.

UCare Individual & Family Plans

New Member Booklet (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)

Formulary
Provider and Pharmacy Directory (PDF)
Service Area Map (PDF)

Automatic Payment Form (PDF)
Claim Reimbursement Form (PDF)
Prescription Drug Reimbursement Form (PDF)

UCare Individual & Family Plans with Fairview

New Member Booklet (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)

Formulary
Provider and Pharmacy Directories (PDF)
Service Area Map (PDF)

Automatic Payment Form (PDF)
Claim Reimbursement Form (PDF)
Prescription Drug Reimbursement Form (PDF)

Cost sharing reduction (CSR) plans

CSR plans help reduce your out-of-pocket costs by lowering your deductibles and coinsurance. You must meet certain income levels (determined by MNsure) to enroll in a CSR plan.

“A” plans have 100% cost sharing reductions; “B” plans have limited cost sharing variations; Silver “2” plans have 73% cost sharing reduction; Silver “3” plans have 87% cost sharing reduction; and Silver “4” plans have 94% cost sharing reduction. If you are unsure which plan you qualify for, please call us at 1-855-307-6985.