Documents and forms
Find the documents and forms you need to get the most out of your Humana Dual Integrated enrollment.
Humana Dual Integrated Special Needs Plans (D-SNP) in Florida
Summary of Benefits
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) Broward, Miami-Dade, and Palm Beach counties – English
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) Broward, Miami-Dade, and Palm Beach counties – Spanish
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) Greater Tampa Bay – English
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) Greater Tampa Bay – Spanish
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) Flagler and Volusia counties – English
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) Flagler and Volusia counties – Spanish
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) Jacksonville Metro area – English
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) Jacksonville Metro area – Spanish
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) Orlando Counties: Lake, Marion, Orange, Osceola, Seminole, Sumter – English
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) Orlando Counties: Lake, Marion, Orange, Osceola, Seminole, Sumter – Spanish
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) Emerald Coast – English
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) Emerald Coast – Spanish
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) Treasure Coast – English
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) Treasure Coast – Spanish
Humana Fully Integrated H1036-280 (HMO D-SNP) Select central and south Florida Counties – English
Humana Fully Integrated H1036-280 (HMO D-SNP) Select central and south Florida Counties – Spanish
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) Gulf Coast – English
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) Gulf Coast – Spanish
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) Broward, Miami Dade, and Palm Beach Counties – English
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) Broward, Miami Dade, and Palm Beach Counties – Spanish
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) Central and North Florida – English
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) Central and North Florida – Spanish
Humana Gold Plus SNP-DE H1036-339 (HMO D-SNP) – English
Humana Gold Plus SNP-DE H1036-339 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-340 (HMO D-SNP) – English
Humana Gold Plus SNP-DE H1036-340 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-341 (HMO D-SNP) – English
Humana Gold Plus SNP-DE H1036-341 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE (HMO D-SNP)
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) Central and North Florida – English
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) Central and North Florida – Spanish
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) Southeast Florida – English
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) Southeast Florida – Spanish
HumanaChoice Florida SNP-DE H7284-113 (PPO D-SNP) – English
HumanaChoice Florida SNP-DE H7284-113 (PPO D-SNP) – Spanish
Annual Notice of Change (ANOC)
Humana Gold Plus DNP-DE (HMO D-SNP)
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) Broward, Miami-Dade, and Palm Beach counties
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) Greater Tampa Bay
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) Flagler and Volusia counties
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) Jacksonville Metro area
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) Orlando Counties: LAK, MRN, ORA, OSC, SEM, SUM
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) Emerald Coast
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) Treasure Coast
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) – Spanish
Humana Fully Integrated H1036-280 (HMO D-SNP) Select central and south Florida Counties
Humana Fully Integrated H1036-280 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) Gulf Coast
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) Broward, Miami Dade, and Palm Beach Counties
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) Central and North Florida
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) – Spanish
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) Central and North Florida
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) – Spanish
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) Southeast Florida
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) – Spanish
Evidence of Coverage (EOC)
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) Broward, Miami-Dade, and Palm Beach counties
Humana Gold Plus SNP-DE H1036-077A (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) Greater Tampa Bay
Humana Gold Plus SNP-DE H1036-102 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) Flagler and Volusia counties
Humana Gold Plus SNP-DE H1036-209 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) Jacksonville Metro area
Humana Gold Plus SNP-DE H1036-210 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) Orlando Counties: LAK, MRN, ORA, OSC, SEM, SUM
Humana Gold Plus SNP-DE H1036-213 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) Emerald Coast
Humana Gold Plus SNP-DE H1036-214 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) Treasure Coast
Humana Gold Plus SNP-DE H1036-226 (HMO D-SNP) – Spanish
Humana Fully Integrated H1036-280 (HMO D-SNP) Select central and south Florida Counties
Humana Fully Integrated H1036-280 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) Gulf Coast
Humana Gold Plus SNP-DE H1036-285 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) Broward, Miami Dade, and Palm Beach Counties
Humana Gold Plus SNP-DE H1036-304 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) Central and North Florida
Humana Gold Plus SNP-DE H1036-314 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-339 (HMO D-SNP)
Humana Gold Plus SNP-DE H1036-339 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-340 (HMO D-SNP)
Humana Gold Plus SNP-DE H1036-340 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE H1036-341 (HMO D-SNP)
Humana Gold Plus SNP-DE H1036-341 (HMO D-SNP) – Spanish
Humana Gold Plus SNP-DE (HMO D-SNP)
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) Central and North Florida
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) Central and North Florida – Spanish
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) Southeast Florida
HumanaChoice Florida SNP-DE H7284-010 (PPO D-SNP) – Spanish
HumanaChoice Florida SNP-DE H7284-113 (PPO D-SNP)
HumanaChoice Florida SNP-DE H7284-113 (PPO D-SNP) – Spanish
Legal and privacy notices
These notices provide information about how Humana uses, and when we might share, your personal information. They also outline the various privacy rights available to you.
Rights and responsibilities – English
Rights and responsibilities – Spanish
HIPAA privacy notice – English
HIPAA privacy notice – Spanish
Pharmacy resources
Over-the-counter order forms
Your pharmacy benefit lets you order certain over-the-counter (OTC) items through the mail. Use this catalog to look up OTC items you want to order each month. Fill out the form and mail, fax or phone your order to CenterWell Pharmacy.
Over-the-counter order form – English
Over-the-counter order form – Spanish
Pharmacy direct member reimbursement form
We hope you don’t have to pay for any medicine out of pocket. If ithappens, let us know by filling out a reimbursement claim form, and we will try to pay you back. Fill out this form to send in a reimbursement claim if you paid out of pocket for a prescription.
Pharmacy direct member reimbursement form – English
Pharmacy direct member reimbursement form – Spansh
Formularies
Understanding your medicine coverage is important. Check the lists below to see the medicines your plan covers.
2026 Prescription Drug Guide (PDG) – English
2026 Prescription Drug Guide (PDG) – Spanish
2026 Prior Authorization Criteria
Step therapy criteria
DSNP Transition Policy
Visit our pharmacy webpage for more information about your pharmacy benefits
Prior authorization forms
Provider directories
Humana Healthy Horizons in Florida
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Documents and forms
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