On this page you will find links to the forms that Gundersen Lutheran Health Plan members need most often. These forms are sometimes required to verify information such as other coverage, student status or designated representatives.
Thank you for taking the time to complete the questionnaire(s). If you would like to speak to a customer service representative, please call (608) 775-8007 or (800) 897-1923. For those with hearing impairment, call TTY (800) 947-3529. Our office hours are Monday through Friday from 8 a.m. to 5 p.m.
Accident Questionnaires
Other Coverage Questionnaires
Designated Representative Authorization Questionnaires
Other
Completed forms can be mailed or faxed to:
Gundersen Lutheran Health Plan
1836 South Avenue, Mail Stop: NCA2-01
La Crosse, WI 54601
Fax: (608) 775-8091