Member Forms

Forms made easy

Find all the forms you need listed right here.

Medical Forms

Health Benefits Claim Form (200 Kb)

Pharmacy Forms

Prescription Drug Claim Form (694 Kb)

General form used to submit pharmacy benefits claims.

Grievance and Appeals Request Forms
Individual & Family Plan Members

You also can get the Appointment of Representative form on CMS's website (link opens in new window) .

Provider Reconsideration Waiver (71.73 Kb)

UMB Health Savings Account Forms

RightSource Mail Order Pharmacy Forms

Michelle's Law

Federal HR 2851 "Michelle's Law" (32 Kb)

Process for continued coverage for full time students who are on medical leave of absence.

Financial Protection Products (FPP) Claim Forms

Financial Protection Products (FPP) Service Forms

Other

Website Blocking (53 Kb)

Disable the secure member Website for yourself or a family member.

Privacy

View Humana's privacy rights and download forms, including:

  • Consent for Release of Protected Health Information
  • Revocation of Consent for Release of Protected Health Information
  • Individual Privacy Rights Page

View all medical forms