Get enrollment forms, continuation forms, eligibility certification forms, and privacy documents. Contact your Humana Market Office for large quantities.
Application Builder allows for a customized application which corresponds to any Humana products selected for enrollment – medical, dental, life, vision, disability and voluntary products. The tool now includes both employer and employee applications for the following states:
Small Business* (2-99 group size):
Employer: AK, AL, AR, CO, CT, DC, DE, GA, IA, ID, IN, LA, MD, ME, MI, MN, MS, ND, NM, NV, OK, PA, RI, SC, SD, TN, UT, VA, WV & WY
Employee: CO, CT, IA, PA, SD & WV
Large Business* (100+ group size):
Employer: AL, AR, CO, DC, DE, GA, IA, ID, IN, LA, MD, ME, MI, MN, ND, NM, NV, OK, PA, RI, SC, SD, TN, UT, VA, WI, WV & WY
*Additional state applications – employer & employee - continue to be added. Application Builder