Medical forms Forms made easy

Find all the forms you need listed right here.

Financial Protection Products Form (FPP)
Accident Claim Form
(294 KB) Download PDF
English

Supplemental Health, Hospital Indemnity, and Healthcare Plus Claim form
Form 6783 – GNHH5M5HH
(405 KB) Download PDF
English

Medical Forms
Health Benefits Claim Form
(200 KB) Download PDF
English

Pharmacy Forms
Prescription Drug Claim Form
General form used to submit pharmacy benefits claims.
(694 KB) Download PDF
English

Grievance and Appeals Request Forms
Individual & Family Plan Members
Grievance/Appeal Request Form
(135 KB) Download PDF
English

Appointment of Representative Form
(9 KB) Download PDF
English

You also can get the Appointment of Representative form on CMS's website.

Provider Reconsideration Waiver
(71.73 KB) Download PDF
English

UMB Health Savings Account Forms
HSA Beneficiary Designation
(52 KB) Download PDF
English

HSA Account Closure
(38 KB) Download PDF
English

RightSource Mail Order Pharmacy Forms
Registration & Prescription Order Form
(620 KB) Download PDF
English| Spanish

Physician Fax Form
(76 KB) Download PDF
English| Spanish

Life & Supplemental Products Forms
Individual Life Claim Form
Form 6784 - GCA09JHHH
(377.07 KB) Download PDF
English

Cash Cancer Claim Form
Form 6740 - GNHH5LTHH
(413 KB) Download PDF
English

Critical Illness Claim Form
Form 6781 - GNHH5M2HH
(424 KB) Download PDF
English

Michelle's Law
Federal HR 2851 "Michelle's Law"
Process for continued coverage for full time students who are on medical leave of absence.
(32 KB) Download PDF
English

Kanawha Insurance Company, Service Forms

Cancelation Request

(36 KB) Download PDF

English

Bank Draft and Credit Card Authorization

(71 KB) Download PDF

English

Termination of Payroll Deduction Authority

(36 KB) Download PDF

English

Other
Website Blocking
Disable the secure member Website for yourself or a family member.
(53 KB) Download PDF
English

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