2024 UCare Medicare with M Health Fairview & North Memorial Plan Documents and Forms

UCare Medicare with M Health Fairview & North Memorial

Formulary (list of covered drugs)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)
Service area map (PDF)
Member Guide (PDF) 

TruHearing Hearing Aid Benefit (PDF)
Plan Rating Information (PDF)
Plan Rating Information - Spanish (PDF)

Prior Authorization List (PDF)
Prior Authorization List - Arabic (PDF)
Prior Authorization List - Hmong (PDF)
Prior Authorization List - Russian (PDF)
Prior Authorization List - Somali (PDF)
Prior Authorization List - Spanish (PDF)
Prior Authorization List - Vietnamese (PDF)

Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Automatic Payment Form (PDF)
Claim Reimbursement Form (PDF)
Online Automatic Payment Form
Advance Directives (PDF)

Enrollment Forms

Fillable PDFs
2024 Medicare Enrollment Form - Metro (PDF)
2024 Medicare Enrollment Form - Metro - Spanish (PDF)
2024 Medicare Enrollment Change Form (PDF)

Online Forms
2024 Medicare Enrollment Form - Metro