Individual Privacy Rights
Privacy laws, rules, and regulations provide our members with various options, which are called individual rights. Individual rights may be exercised by the member or, if appropriate documentation is provided, authorized personal representatives.
- California Residents
- All California residents should review Humana's No Cost Language Services notice.
- (1.0 MB) Download PDF
- English
Individual Rights Forms
The following is a brief description of the various individual rights and the appropriate form to invoke one of these rights.
- Consent for Release of Protected Health Information
- This form grants Humana permission to share your information to a trusted individual(s) that you choose. The form below allows you to choose the level of information to share with the trusted individual. You can specify any and all information, information specific to a treatment or injury, or something different. This form was last updated in April 2009
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- English | Spanish
- For our Medicare members only, we have created a version of this form to use when you would like to allow the disclosure of any and all of your information to a trusted individual. This form was last updated in May 2009.
- (150 KB) Download PDF
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- For our CompBenefits members only, we have created a version of this form to use when you would like to grant CompBenefits permission to share your information to a trusted individual(s) that you choose. The form below allows you to choose the level of information to share with the trusted individual. You can specify any and all information, information specific to a treatment, or something different. This form was last updated in July 2009
- (250 KB) Download PDF
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- Revocation of Consent for Release of Protected Health Information
- This form terminates previously granted permission for Humana to release or disclose a member's protected health information to other individuals named on the form. This form was last updated in April 2008.
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- Request for Accounting of Disclosures
- This form requests a list of disclosures Humana made of a member's protected health information. Disclosures made for payment and health plan operations are excluded from this process. The form was last updated in April 2008.
- (108 KB) Download PDF
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- Request for Restriction of Protected Health Information
- This form requests limitation or restriction of disclosures of a member's protected health information to others such as a family member, friend, spouse, doctor, or any other party. This form was last updated in April 2008.
- (108 KB) Download PDF
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- Request for Alternate Communications
- This form requests that Humana communicate with a member about protected health information in a different way during life-threatening situations. Examples of alternate means could include telephone, mail, e-mail, or different address. The form was last updated in April 2009.
- (108 KB) Download PDF
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