Find the forms you need quickly
Find your member handbook, provider directories and other Medicaid documents and forms to manage your plan.
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Have questions about your plan? Check out the member handbook to find full details of your plan and benefits. Information on Humana Medical Plan, Humana Long-Term Care Plan and Humana Comprehensive Plan can all be found in the member handbook.
If you're looking for a doctor, you can use these directories to see a list of providers you can choose from in your area to get health services.
You can also search for doctors, pharmacies and other healthcare facilities online using our Find a doctor tool.
Counties: Escambia, Okaloosa, Santa Rosa and Walton
Counties: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington
Counties: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union
Counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia
Counties: Pasco and Pinellas
Counties: Hardee, Highlands, Hillsborough, Manatee and Polk
Counties: Brevard, Orange, Osceola and Seminole
Counties: Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota
Counties: Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
Counties: Miami-Dade and Monroe
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.
We know it’s important for you to understand which of your medicines are covered. Check the lists below to see which medicines your plan covers.
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 PrescribeIT Rx:
10749 Marks Way
Miramar, FL 33025
1-800-526-1490 (TTY: 711)
Monday – Friday, 8 a.m. – 6 p.m., Eastern time
Combined Medicaid medical and Long-term care (LTC) OTC form
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.
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.
Grievance and appeals
We want you to be happy with the care you get from Humana Florida Medicaid. We hope you are getting 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 can also 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, complete and send the forms to:
Humana Medical Plan Florida Medicaid Humana Medical Plan, Inc.
P.O. Box 14546
Lexington, KY 40512-4546
Attn: Grievance & Appeal Department
If you want your caregiver to have access to your health information, you need to fill out the protected health consent form.
You can also find the power of attorney form.
Download below and return the completed forms to:
Humana Insurance Company
P.O. Box 14168
Lexington, KY 40512-4168
Long term care
Download and complete your living will, fill out an advanced directive or complete an organ donation form.
Performance measurement surveys
Let us know how we're 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.
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Care coordination guidelines
If you have a care coordinator or a case manager, you might want to read the care management guidelines to learn more about these services. You can also take our health risk assessment.
Smartphone benefit information
Humana and SafeLink wireless will provide Medicaid medical members with a free cellphone service and 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.