Documents and forms
Stay organized and find all of the documents and forms you need in one place for your Humana Healthy Horizons® in Florida plan.
Humana Healthy Horizons in Florida
Consent for release of protected health information
If you want your caregiver to have access to your health information, you need to fill out the protected health information (PHI) consent form. Download and complete the forms and return the completed forms to us.
Consent for release of protected health information – English
Consent for release of protected health information – Spanish
Carelon Behavioral health consent for release of PHI
Grievances and appeals
We want you to be happy with the care you get from Humana Healthy Horizons in Florida. We hope you get the best care possible
If you are not happy with any part of your healthcare plan, Customer Care, your doctor, or a facility, you can send in a grievance. You also can appeal a claim or a denied service using this form
If you are sending an appeal or grievance for another covered member, be sure to fill out an Appointment of Representative form
Grievance/Appeal request form – English
Grievance/Appeal request form – Spanish
Appointment of representative form – English and Spanish
Your healthcare is our priority. We know your private duty nursing (PDN) services are important. Your relationship with the agency providing the services is important, too.
To make sure you get the high-quality care you need and deserve, we put in place a new way to report your issues and concerns in real time. Issues and concerns may include problems like:
- Nurses missing shifts
- Nurse no-shows
- No nurse available
Learn more about our real-time reporting requirements and process
Health Risk Assessment
You can complete your Health Risk Assessment (HRA) by:
- Filling out the HRA and sending it back to us in the postage-paid envelope you received in your Welcome Kit, OR
- Calling us at 800-611-1467 (TTY: 711), OR
- Completing it in your MyHumana account online or in the app.
Health Risk Assessment – English
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
Living will
A living will is an important document every adult should complete. A living will lets you clarify in writing what you want family or other healthcare proxy to do if you’re not in a position to make healthcare decisions for yourself
Long-term care
Long-term care (LTC)
LTC consent to share health facts – English
LTC consent to share health facts – Spanish
LTC consent for release of information – English
LTC request for alternative communications – English
Member Handbook
Do you have any questions about your plan? Check out the Member Handbook to find full details of your plan and benefits. You can find information about the Humana medical plan, Humana long-term care plan, and Humana comprehensive plan.
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
Preferred Drug List
Understanding your medicine coverage is important. Check the lists below to see the medicines your plan covers.
View the AHCA Preferred Drug List
Cystic Fibrosis Supplemental Drug Lists – English
Cystic Fibrosis Supplemental Drug Lists – Spanish
Recent Changes to Florida Medicaid Drug List – English
Recent Changes to Florida Medicaid Drug List – Spanish
Prescription drug reimbursement claim form
We hope you don’t have to pay for any medicine out of pocket. If it happens, 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.
Prescription drug reimbursement claim form – English
Prescription drug reimbursement claim form – Spanish
Provider directories
Region A
Bay, Calhoun, Escambia, Franklin, Gadsen, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, and Washington
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region B
Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, Putnam, St. Johns, Sumter, Suwanee, Union, and Volusia
Provider directory – All provider types (Part 1 of 2) – English and Spanish
Provider directory – All provider types (Part 2 of 2) – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – behavioral health – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health (Part 1 of 2) – English and Spanish
Provider directory – All provider types except behavioral health (Part 2 of 2) – English and Spanish
Provider directory – All provider types except behavioral health (Part 2 of 2) – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region C
Pasco and Pinellas
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region D
Hardee, Highlands, Hillsborough, Manatee, and Polk
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region E
Brevard, Orange, Osceola, and Seminole
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region F
Charlotte, Collier, Desoto, Glades, Hendry, Lee, and Sarasota
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region G
Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – Behavioral health and specialists – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region H
Broward
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – English and Spanish
Provider directory – Behavioral health and specialists – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Region I
Miami-Dade and Monroe
Provider directory – All provider types except behavioral health – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – All provider types except behavioral health and specialists – English and Spanish
Provider directory – Behavioral health – English and Spanish
Provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Long-term care provider directory – English and Spanish
Reimbursement form for expanded benefits and overnights
We hope you don’t have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in Florida member. If you do, let us know by filling out a reimbursement claim form, and you may get a refund. Fill out one of the forms below to send a reimbursement claim.
Expanded benefits reimbursement form – English
Expanded benefits reimbursement form – Spanish
Medicaid overnight reimbursement form – English
Medicaid overnight reimbursement form – Spanish
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