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2025 UCare Medicare Plan Documents and Forms

UCare Medicare

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

UCare Dental Overview (PDF)

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