To make the most of your health plan, find the documents and forms you need, including:
Adobe Reader is needed to view PDFs.
Get Adobe Reader
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
- Nurses no-shows
- No nurse available
Learn more about our real-time reporting requirements and process, PDF
Member materials
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.
To find a doctor or other healthcare provider or facilities:
- Use our Find a doctor service
- Use the below directories to see a list of in-network providers and facilities in your area
Region 1
Counties: Escambia, Okaloosa, Santa Rosa and Walton
Provider Directory – English and Spanish (FL counties: Bay, Escambia, Holmes, Okaloosa, Santa Rosa, Walton, and Washington; AL counties: Baldwin, Covington, Escambia, Geneva, Houston, and Mobile; GA counties: Cook, Dekalb, Glynn and Lowndes), PDF
Long-Term Care Provider Directory – English and Spanish (Escambia, Okaloosa, Santa Rosa, Walton, Bay, Holmes, and Washington counties), PDF
Region 2
Counties: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington
Provider Directory – English and Spanish (Bay, Calhoun, Dixie, Franklin, Gadsden, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Suwanee, Taylor, Wakulla, Walton, and Washington counties), PDF
Long-Term Care Provider Directory – English and Spanish (Bay, Calhoun, Franklin, Gadsden, Gulf, Hamilton Holmes, Jackson, Jefferson, Leon, Lafayette, Liberty, Madison, Taylor, Wakulla, Washington, Dixie, Suwanee, and Walton counties), PDF
Region 3
Counties: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union
Provider Directory – English and Spanish (Alachua, Bradford, Citrus, Columbia, Dixie, Lake and Volusia counties), PDF
Provider Directory – English and Spanish (Baker, Clay, Flagler, Levy, Marion, Pasco, Putnam, Sumter, Suwanee, and Union counties), PDF
Provider Directory – English and Spanish (Polk, Seminole, St. Johns, and Taylor counties), PDF
Provider Directory – English and Spanish (Gilchrist, Hamilton, Hernando, Hillsborough, and Lafayette counties), PDF
Provider Directory – English and Spanish (Madison, Orange, and Osceola counties), PDF
Long-Term Care Provider Directory – English and Spanish (Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwanee, and Union counties), PDF
Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Flagler, Hillsborough, Madison, and Orange counties), PDF
Long-Term Care Provider Directory – English and Spanish (Osceola, Pasco, Polk, Seminole, St. Johns, Taylor, and Volusia counties), PDF
Region 4
Counties: Baker, Clay, Flagler, Nassau, and Volusia
Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties), PDF
Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, Lake, Marion, and Union counties), PDF
Provider Directory – English and Spanish (Orange, Putnam, and Seminole counties), PDF
Provider Directory – English and Spanish (Duval and St. Johns counties), PDF
Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties), PDF
Long-Term Care Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, Lake, Marion, Orange, Putnam, Seminole, and Union counties), PDF
Region 5
Counties: Pasco and Pinellas
Provider Directory – English and Spanish (Lake, Pasco, Polk, and Sumter counties), PDF
Provider Directory – English and Spanish (Citrus, Hernando, and Hillsborough counties), PDF
Provider Directory – English and Spanish (Pinellas county), PDF
Long-Term Care Provider Directory – English and Spanish (Citrus, Hernando, Hillsborough, Lake, Pasco, Pinellas, Polk, and Sumter counties)PDF
Region 6
Counties: Hardee, Highlands, Hillsborough, Manatee and Polk
Provider Directory – English and Spanish (Hillsborough and Manatee counties), PDF
Provider Directory – English and Spanish (Desoto, Glades, Hernando, Lake, Okeechobee, Polk, Sarasota, and Sumter counties), PDF
Provider Directory – English and Spanish (Hardee, Highlands, Osceola, and Pinellas counties), PDF
Provider Directory – English and Spanish (Charlotte, Orange, and Pasco counties), PDF
Long-Term Care Provider Directory – English and Spanish (Hardee, Highlands, Hillsborough, Manatee, and Polk counties), PDF
Long-Term Care Provider Directory – English and Spanish (Charlotte, DeSoto, Glades, Hernando, Lake, Okeechobee, Orange, Osceola, Pasco, Pinellas, Sarasota, and Sumter counties), PDF
Region 7
Counties: Brevard, Orange, Osceola, and Seminole
Provider Directory – English and Spanish (Highlands, Indian River, and Lake counties), PDF
Provider Directory – English and Spanish (Polk, St. Lucie, and Volusia counties), PDF
Provider Directory – English and Spanish (Okeechobee, Orange, and Osceola counties), PDF
Long-Term Care Provider Directory – English and Spanish (Highlands, Indian River, Osceola, St. Lucie and Seminole counties), PDF
Long-Term Care Provider Directory – English and Spanish (Brevard, Lake, Okeechobee, Orange, Polk, and Volusia counties), PDF
Region 8
Counties: Charlotte, Collier, Desoto, Glades, Hendry, Lee, and Sarasota
Provider Directory – English and Spanish (Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Highlands, Lee, and Sarasota counties), PDF
Provider Directory – English and Spanish (Hillsborough and Manatee counties), PDF
Provider Directory – English and Spanish (Monroe county), PDF
Provider Directory – English and Spanish (Okeechobee and Palm Beach counties), PDF
Long-Term Care Provider Directory – English and Spanish (Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota counties), PDF
Long-Term Care Provider Directory – English and Spanish (Broward, Hardee, Highlands, Hillsborough, and Manatee counties), PDF
Long-Term Care Provider Directory – English and Spanish (Okeechobee and Palm Beach counties) , PDF
Long-Term Care Provider Directory – English and Spanish (Miami-Dade and Monroe counties), PDF
Region 9
Counties: Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
Provider Directory – English and Spanish (Brevard, Glades, Indian River, Martin, Okeechobee, and St. Lucie counties), PDF
Provider Directory – English and Spanish (Palm Beach county), PDF
Provider Directory – English and Spanish (Hendry, Highlands, Osceola, and Polk counties), PDF
Long-Term Care Provider Directory – English and Spanish (Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie counties), PDF
Long-Term Care Provider Directory – English and Spanish (Brevard, Broward, Glades, Hendry, Highlands, Osceola, and Polk counties), PDF
Region 10
Counties: Broward
Provider Directory – English and Spanish (Broward county) – Behavioral Health Services, Durable Medical Equipment, Hospitals, Laboratory Services, Pharmacies, Primary Care Providers, Urgent Care Centers, and Vision Providers, PDF
Provider Directory – English and Spanish (Broward county) – Other Healthcare Providers and Specialists, PDF
Provider Directory – English and Spanish (Collier and Palm Beach counties), PDF
Provider Directory – English and Spanish (Hendry county), PDF
Long-Term Care Provider Directory – English and Spanish (Broward, Collier, and Palm Beach counties), PDF
Long-Term Care Provider Directory – English and Spanish (Hendry and Miami-Dade counties), PDF
Region 11
Counties: Miami-Dade and Monroe
Provider Directory – English and Spanish (Miami-Dade county), PDF
Provider Directory – English and Spanish (Collier, Monroe and Palm Beach counties), PDF
Provider Directory – Specialists – English and Spanish (Miami-Dade county), PDF
Long-Term Care Provider Directory – English and Spanish (Miami-Dade and Monroe counties), PDF
Long-Term Care Provider Directory – English and Spanish (Broward, Collier, and Palm Beach counties), PDF
Participant Direction Option
Find more information about another option for your long-term care plan—the Participant Direction Option (PDO). The PDO allows you to self-direct your services.
Learn more about PDO
Pharmacy resources
We know understanding your medicine coverage is important. Check the lists below to see the medicines your plan covers.
Preferred Drug List (English, PDF and SpanishPDF)
Cystic Fibrosis Supplemental Drug List – English (1.15 MB), PDF
Cystic Fibrosis Supplemental Drug List – Spanish (1.09 KB), PDF
Recent changes to Florida Medicaid Drug List
Over-the-counter (OTC) 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™.
Contact us
Combined Humana Medical and Long-Term Care (LTC) OTC form
Over-the-Counter Order Form—English (1.19 MB), PDF
Over-the-Counter Order Form—English/Spanish (838 KB), PDF
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 the form below to send in a reimbursement claim if you paid out of pocket for a prescription.
Prescription drug reimbursement claim form (611 KB), PDF
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.
Individual privacy rights—English and Spanish
Rights and responsibilities—English
Rights and responsibilities—Spanish
HIPAA privacy notice—English (119 KB), PDF
HIPAA Privacy Notice – Spanish (111 KB), PDF
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.
Living will – English and Spanish, PDF
Detecting, Preventing, and Reporting Healthcare Fraud
Detecting, Preventing, and Reporting Healthcare Fraud, PDF
Grievance 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.
Download and return to us the completed forms:
Grievance/Appeal request form—English (157 KB), PDF
Grievance/Appeal request form—Spanish (157 KB), PDF
Appointment of Representative form—English/Spanish (157 KB), PDF
Your appeal rights, as listed in the Member Handbook (154 KB), PDF
Caregiver forms
If you want your caregiver to have access to your health information, you need to fill out the protected health consent form.
Download and complete the forms and return the completed forms to us.
Medical
Consent for Release of Protected Health Information (2.6 MB) English, PDF
Consent for Release of Protected Health Information (2.6 MB) Spanish, PDF
Access Behavioral Health Consent for Release of PHI (Regions 1 & 2) PDF (195 KB) English, PDF
Carelon Behavioral Health Consent for Release of PHI (Regions 3–11) PDF (152 KB) English , PDF
Long-Term Care (LTC)
LTC Consent to Share Health Facts (38 KB) English, PDF
LTC Consent to Share Health Facts (38 KB) Spanish, PDF
LTC Consent for Release of Information (965 KB) English, PDF
LTC Request for Alternative Communications (396 KB) English, PDF
Performance measurement surveys
Let us know how we are doing. We want to make sure we are giving you the best care and services to manage your health. Download performance measurement reports and take our member satisfaction survey.
Guide to HEDIS® measurements
State of Health Care Quality Report (NCQA website)
Health Risk Assessment (HRA)
You can complete your HRA by:
- Filling out the HRA in your Welcome Kit and sending it back to us in the postage-paid envelope (also in your Welcome Kit), or
- Calling us at 800-611-1467 (TTY: 711), or
- Registering for a MyHumana
If you have a care coordinator or care manager, he or she may ask you to print and complete the below HRA:
Take our health risk assessment (877 KB) English, PDF
Take our health risk assessment (872 KB) Spanish, PDF
Smartphone benefit information
Humana and SafeLink wireless will provide Humana Healthy Horizons in Florida members with free cellphone service and a smartphone to call your family, friends, and doctors. Plus, you’ll get even more extra services as a member.
Download this fact sheet to learn all the details and how to sign up.
Download SafeLink mobile phone flyer [719 Kb]—English and Spanish, PDF
Expanded Benefits and Overnight Reimbursement Form
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, PDF
Expanded Benefits Reimbursement Form – Spanish, PDF
Medicaid Overnight Reimbursement Form – English, PDF
Medicaid Overnight Reimbursement Form – Spanish, PDF
