Plan Documents and Information
Welcome to Aspirus Health Plan. We’re committed to serving central Wisconsin, and we’re always here to support you.
2024 Plans
Pharmacy resources
Formulary (list of covered drugs)
Search Preferred Pharmacy Network
Dental and hearing resources
Dental Overview (PDF)
TruHearing Hearing Aid Benefit (PDF)
Health and wellness resources
Health and Wellness Program
Mental Health and Substance Use Disorder
Medication Therapy Management (MTM) for plans with a Part D component
Member forms
Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Power of Attorney Short Form (PDF, external link)
Member Reimbursement Form (PDF)
Automatic Payment Form (PDF)
Instructions for Appointing a Representative (PDF)
Enrollment Forms
Enrollment Form (PDF)
Enrollment Form - Spanish (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)
Summary of Benefits - Spanish (PDF)
Choice Dental Certificate (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)
Summary of Benefits - Spanish (PDF)
Choice Dental Certificate (PDF)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)