Members form

Member forms

This page links you to the forms Humana members need most often — including medical, dental, life, spending account, and pharmacy documents.

Printable forms

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)  .

Pharmacy forms

Prescription Drug Claim form - English (62 KB)

General form used to submit pharmacy benefits claims.

Limited Income NET Pharmacy Claim form - English (650 KB)

Medicare Part D Coverage Determination and Redetermination forms

Find out about drug coverage determinations and redeterminations and access our forms.

Contraceptive Benefits Plan form

Contraceptive-only SPD - English (510 KB)

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.

Michelle's Law

Federal HR 2851 "Michelle's Law" - English (32 KB)

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


Website blocking - English (53 KB)

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


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

Prior Carrier Deductible Credit form - English (28 KB)

For new members; apply current-year expenses to Humana deductible.