Member Forms

Forms made easy

Find all the forms you need listed right here.

Medical Forms

Health Benefits Claim Form (200 Kb) (PDF opens in new window)

Pharmacy Forms

Medicare Prescription Drug Claim Form (324 Kb) (PDF opens in new window)

Prescription Drug Claim Form (200 Kb) (PDF opens in new window)

LINET Prescription Drug Claim Form - English (135 Kb) (PDF opens in new window)

Medicare Prescription Drug Claim Form - Spanish (317 Kb) (PDF opens in new window)

Prescription Drug Claim Form - Spanish (322 Kb) (PDF opens in new window)

LINET Prescription Drug Claim Form - Spanish (288 Kb) (PDF opens in new window)

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 (42 Kb) (PDF opens in new window)

UMB Health Savings Account Forms

Humana Mail Order Pharmacy Forms

Michelle's Law

Federal HR 2851 "Michelle's Law" (32 Kb) (PDF opens in new window)

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

Financial Protection Products (FPP) Claim Forms

Workplace Voluntary Benefits and Financial Protection Products have moved to and is serviced by Manhattan Life. Please call 855-448-6982 for assistance

Financial Protection Products (FPP) Service Forms

Other

Website Blocking (53 Kb) (PDF opens in new window)

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

Privacy

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

View all medical forms

Life Forms

Life Authorization Form (48 KB) (pdf opens in new window)