2024 UCare Your Choice Plan Documents and Forms
UCare Your Choice
Formulary (list of covered drugs)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)
Service area map (PDF)
Member Guide (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)
Online Automatic Payment Form
Claim Reimbursement Form (PDF)
Advance Directives (PDF)
Enrollment Forms
Fillable PDF
2024 Medicare Enrollment Form - Metro (PDF)
2024 Medicare Enrollment Form - South (PDF)
2024 Medicare Enrollment Form - North (PDF)
2024 Medicare Enrollment Form - Metro - Spanish (PDF)
2024 Medicare Enrollment Form - South - Spanish (PDF)
2024 Medicare Enrollment Form - North - Spanish (PDF)
2024 Your Choice Enrollment Change Form (PDF)
Online Form
2024 Medicare Enrollment Form - Metro
2024 Medicare Enrollment Form - North
2024 Medicare Enrollment Form - South
UCare Medicare Advantage Plans Overview (PDF)
UCare Medicare Advantage Plans Overview - Spanish (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
UCare Your Choice Summary of Benefits - Metro/North (PDF)
UCare Your Choice Summary of Benefits - Metro/North - Hmong (PDF)
UCare Your Choice Summary of Benefits - Metro/North - Spanish (PDF)
UCare Your Choice Summary of Benefits - South (PDF)
UCare Your Choice Summary of Benefits - South - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
Plan Comparison Chart - South (PDF)
UCare Medicare Advantage Plans Overview (PDF)
UCare Medicare Advantage Plans Overview - Spanish (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
UCare Your Choice Summary of Benefits - Metro/North (PDF)
UCare Your Choice Summary of Benefits - Metro/North - Hmong (PDF)
UCare Your Choice Summary of Benefits - Metro/North - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)