2022 Plan Documents and Information

To find your member documents, select your plan below.

To request a hard copy mailed to you, send us a message through your account in the Member Account or call Customer Service.

Use this form to notify UCare of your gender 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.

Jump to your 2022 plans:

UCare Medicare

EssentiaCare

UCare Medicare with M Health Fairview & North Memorial

UCare Advocate ISNP

UCare Medicare Group

UCare Medicare Supplement

Medicaid + Medicare

Minnesota Health Care Programs

UCare Individual & Family Plans

UCare Individual & Family Plans with M Health Fairview

UCare Medicare

Provider and Pharmacy Directory (PDF)
Formulary
Service Area Map (PDF)
Welcome Booklet (PDF)
Travel Benefit (PDF)
TruHearing Hearing Aid Benefit
UCare Dental Overview (PDF)
Dental Enrollment Form (PDF)
Plan Rating Information (PDF)
Prior Authorization Information (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)

Enrollment Forms

2022 Medicare Enrollment Form - Metro (PDF)
2022 Medicare Enrollment Form - South (PDF)
2022 Medicare Enrollment Form - North (PDF)
2022 Dental Enrollment Form (external link)
2022 UCare Medicare Enrollment Change Form (external link)

EssentiaCare

Provider and Pharmacy Directory (PDF)
Formulary
Service Area Map (PDF)
Welcome Booklet (PDF)
Travel Benefit (PDF)
Plan Rating Information (PDF)
Prior Authorization Information (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)

Enrollment Forms

2022 EssentiaCare Enrollment Form (PDF)
2022 EssentiaCare Enrollment Change Form (external link)

UCare Medicare with M Health Fairview & North Memorial

Provider and Pharmacy Directory (PDF)
Formulary
Service Area Map (PDF)
Travel Benefit (PDF)
TruHearing Hearing Aid Benefit
Care Wise & Care Core Member Programs (PDF)
Plan Rating Information (PDF)
Prior Authorization Information (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)

Enrollment Forms

2022 Medicare Enrollment Form - Metro (PDF)
2022 Medicare Enrollment Change Form (external link)

UCare Advocate Plans

Provider and Pharmacy Directory (PDF)
Formulary
Service Area Map (PDF)
Welcome Book (PDF)
Prior Authorization Information (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)

Enrollment Forms

2022 Medicare Enrollment Form (PDF)
2022 Medicare Online Enrollment Form (external link)

UCare Medicare Group Plans

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

Provider and Pharmacy Directory (PDF)
Formulary
TruHearing Hearing Aid Benefit Information
Plan Rating Information (PDF)
Prior Authorization Information (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)

UCare Medicare Supplement

Enrollment Form (PDF)

Medicaid + Medicare

Member Release of Information Form (PDF)
Member Release of Information Form - Arabic (PDF)
Member Release of Information Form - Hmong (PDF)
Member Release of Information Form - Russian (PDF)
Member Release of Information Form - Somali (PDF)
Member Release of Information Form - Spanish (PDF)
Member Release of Information Form - Vietnamese (PDF)

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

Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)

Statement of Representative Form (PDF)
Statement of Representative Form - Arabic (PDF)
Statement of Representative Form - Hmong (PDF)
Statement of Representative Form - Russian (PDF)
Statement of Representative Form - Somali (PDF)
Statement of Representative Form - Spanish (PDF)
Statement of Representative Form - Vietnamese (PDF)

Medicare Coverage Updates

Minnesota Health Care Programs

Formulary
Member Release of Information Form (PDF)
Member Release of Information Form - Arabic (PDF)
Member Release of Information Form - Hmong (PDF)
Member Release of Information Form - Russian (PDF)
Member Release of Information Form - Somali (PDF)
Member Release of Information Form - Spanish (PDF)
Member Release of Information Form - Vietnamese (PDF)

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

Statement of Representative Form (PDF)
Statement of Representative Form - Arabic (PDF)
Statement of Representative Form - Hmong (PDF)
Statement of Representative Form - Russian (PDF)
Statement of Representative Form - Somali (PDF)
Statement of Representative Form - Spanish (PDF)
Statement of Representative Form - Vietnamese (PDF)

Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Advance Directives Info (PDF)

UCare Individual & Family Plans

New Member Guide (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)
Prior Authorization Data
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Member Contract Amendment Letter (PDF)

Formulary
Provider and Pharmacy Directory (PDF)
Network Adequacy Waiver (PDF)
Service Area Map (PDF)

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

UCare Individual & Family Plans with M Health Fairview

New Member Guide (PDF)
Member Release of Information Form (PDF)
Prior Authorization Information (PDF)
Prior Authorization Data
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Member Contract Amendment Letter (PDF)

Formulary
Provider and Pharmacy Directories (PDF)
Network Adequacy Waiver (PDF)
Service Area Map (PDF)

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