Note: Our forms are in Portable Document Format (PDF) and require Adobe Reader for viewing and printing. To get the plug-in, visit Adobe's Website to Download Adobe Reader (link opens in new window)  .
General form used to submit pharmacy benefits claims.Medicare Part D Coverage Determination and Redetermination forms
Find out about drug coverage determinations and redeterminations and access our forms.
Applies ONLY to members who received a letter from Humana directing them to this Humana Contraceptive Benefits Plan SPD link. If you are not sure whether this applies to you, please call the customer service phone number on the back of your Humana ID card.
You also can get the Appointment of Representative form on CMS's website (link opens in new window) .
Form 6786 – GCA09JQHH
Process for continued coverage for full time students who are on medical leave of absence.
Disable the secure member website for yourself or a family member.
View Humana's privacy rights and download forms, including:
For new members; apply current-year expenses to Humana deductible.