Documents & Forms
Access your health plan coverage documents, forms needed to manage your claims, and more.
Plan Documents
Select a Plan to See a List of Available Documents.
Prescription/Drug Forms
Medication Therapy Management
Drug and/or Utilization Management Information (for plans offering Part D)
Prescription Drug Transition Policy
Humana Pharmacy® Registration and Prescription Order Forms
Concurrent DUR Quality Assurance
Retrospective DUR Quality Assurance
Grievance/Appeal Forms
Notice of Nondiscrimination
Access our form
Disenrollment Forms
Other Forms
Health Benefits Claims Form
Access our form with a link
Appointment of Representative Form
You also can get the Appointment of Representative form on the Centers for Medicare & Medicaid Services Website.
Centers for Medicare & Medicaid Services Website
Multi-language Translator Service
Access our form
Multi-language Interpreter Services
Member Blocking Request
Disable the secure member website for yourself or a family member.
Website Blocking Request
Vision Services Claim Form
Submit vision-related out of pocket expenses for reimbursement.
Note:
Our forms are in Portable Document Format (PDF) and require Adobe Reader for viewing and printing. To get the plug-in, visit Adobe's Website to Download Adobe Reader, opens new tab