2026 UCare Individual & Family Plan — Easy Compare Plans Documents and Forms
UCare Individual & Family Plans — Easy Compare Plans
Formulary (list of covered drugs)
Provider and Pharmacy Directory (PDF)
Coverage 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)
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)
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Automatic Payment: Log on to your online member account to set up your automatic withdrawal.
Claim Reimbursement Form (PDF)
Prescription Drug Claim Form (PDF)
Easy Compare Bronze
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Summary of Benefits and Coverage - Off-Exchange (PDF)
Easy Compare Bronze A
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Bronze B
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Silver and Rx Copay
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Summary of Benefits and Coverage - Off-Exchange (PDF)
Easy Compare Silver and Rx Copay A
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Silver and Rx Copay B
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Silver and Rx Copay 2
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Silver and Rx Copay 3
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Silver and Rx Copay 4
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Gold and Rx Copay
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Summary of Benefits and Coverage - Off-Exchange (PDF)
Easy Compare Gold and Rx Copay A
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)
Easy Compare Gold and Rx Copay B
Member Contract (PDF)
Summary of Benefits and Coverage (PDF)