Plan Documents and Information
Welcome to Aspirus Health Plan. We’re committed to serving central Wisconsin, and we’re always here to support you.
2025 Plans
Pharmacy resources
Formulary (list of covered drugs)
Part D prescription drug coverage
Search Pharmacy Network
Medicare Prescription Payment Plan
Dental and hearing resources
Dental Overview (PDF)
Explore new dental benefits
TruHearing Hearing Aid Benefit (PDF)
Health and wellness resources
Health and Wellness Program
Rewards and incentives
Healthy Benefits+ card
Mental Health and Substance Use Disorder
Medication Therapy Management (MTM) for plans with a Part D component
Member resources
Member Guide (PDF)
Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Power of Attorney Short Form (Fillable PDF, external link)
Member Reimbursement Form (PDF)
Automatic Payment Form (PDF)
Instructions for Appointing a Representative (PDF)
Advanced Directive (PDF)
Enrollment Forms
Enrollment Form (Fillable PDF)
Enrollment Form - Spanish (Fillable PDF)
Enrollment Change Form (PDF)
Dental Enrollment Form (PDF)
Quality Improvement Program
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits (PDF)
Choice Dental Certificate (PDF)
Plan Comparison Chart (PDF)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits (PDF)
Choice Dental Certificate (PDF)
Plan Comparison Chart (PDF)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)