2025 UCare Your Choice Plan Documents and Forms

UCare Your Choice

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

Plan Rating Information (PDF)
Plan Rating Information - Spanish (PDF) 

Medicare Coverage Updates

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
2025 Medicare Enrollment Form - Metro (PDF)
2025 Medicare Enrollment Form - North (PDF)
2025 Medicare Enrollment Form - South (PDF)

2025 Medicare Enrollment Form - Metro - Spanish (PDF)
2025 Medicare Enrollment Form - South - Spanish (PDF)
2025 Medicare Enrollment Form - North - Spanish (PDF)

2025 Your Choice Enrollment Change Form (PDF)

Online Form
2025 Medicare Enrollment Form - Metro
2025 Medicare Enrollment Form - North
2025 Medicare Enrollment Form - South