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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.

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Find the forms you need quickly

To make the most of your health plan, find the documents and forms you need, including:

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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 opens new window

Member materials

Do you have any questions about your plan? Check out the Member Handbook, PDF opens new window 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 opens new window

Long-Term Care Provider Directory – English and Spanish (Escambia, Okaloosa, Santa Rosa, Walton, Bay, Holmes, and Washington counties) , PDF opens new window

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 opens new window

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 opens new window

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, and Dixie counties) , PDF opens new window

Provider Directory – English and Spanish (Baker, Clay, Flagler, Levy, Marion, Putnam, Sumter, Suwanee, and Union counties) , PDF opens new window

Provider Directory – English and Spanish (Polk, Seminole, St. Johns, Taylor, and Volusia counties) , PDF opens new window

Provider Directory – English and Spanish (Gilchrist, Hamilton, Hernando, Hillsborough, and Lafayette counties) , PDF opens new window

Provider Directory – English and Spanish (Lake, Madison, Orange, Osceola, and Pasco counties) , PDF opens new window

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 opens new window

Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Flagler, Hillsborough, Madison, and Orange counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Osceola, Pasco, Polk, Seminole, St. Johns, Taylor, and Volusia counties) , PDF opens new window

Region 4

Counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia

Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties) , PDF opens new window

Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, and Lake counties) , PDF opens new window

Provider Directory – English and Spanish (Marion, Orange, Putnam, Seminole, and Union counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Alachua, Bradford, Brevard, Columbia, Lake, Marion, Orange, Putnam, Seminole, and Union counties) , PDF opens new window

Region 5

Counties: Pasco and Pinellas

Provider Directory – English and Spanish (Lake, Pasco, Pinellas, Polk, and Sumter counties) , PDF opens new window

Provider Directory – English and Spanish (Citrus, Hernando, and Hillsborough counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Citrus, Hernando, Hillsborough, Lake, Pasco, Pinellas, Polk, and Sumter counties) , PDF opens new window

Region 6

Counties: Hardee, Highlands, Hillsborough, Manatee and Polk

Provider Directory – English and Spanish (Hardee, Highlands, Hillsborough, and Manatee counties) , PDF opens new window

Provider Directory – English and Spanish (Charlotte, Desoto, Glades, Hernando, Lake, Okeechobee, Polk, Sarasota, and Sumter counties) , PDF opens new window

Provider Directory – English and Spanish (Osceola and Pinellas counties) , PDF opens new window

Provider Directory – English and Spanish (Orange and Pasco counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Hardee, Highlands, Hillsborough, Manatee, and Polk counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Charlotte, DeSoto, Glades, Hernando, Lake, Okeechobee, Orange, Osceola, Pasco, Pinellas, Sarasota, and Sumter counties) , PDF opens new window

Region 7

Counties: Brevard, Orange, Osceola, and Seminole

Provider Directory – English and Spanish (Brevard, Orange, Osceola, and Seminole counties) , PDF opens new window

Provider Directory – English and Spanish (Highlands, Indian River, Lake, Okeechobee, Polk, St. Lucie, and Volusia counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Brevard, Orange, Osceola, Seminole, Highlands, Indian River, Lake, Okeechobee, Polk, St. Lucie, and Volusia counties) , PDF opens new window

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 opens new window

Provider Directory – English and Spanish (Hillsborough and Manatee counties) , PDF opens new window

Provider Directory – English and Spanish (Monroe county) , PDF opens new window

Provider Directory – English and Spanish (Okeechobee and Palm Beach counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Broward, Hardee, Highlands, Hillsborough, and Manatee counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Miami-Dade, Monroe, Okeechobee, and Palm Beach counties) , PDF opens new window

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 opens new window

Provider Directory – English and Spanish (Palm Beach county) , PDF opens new window

Provider Directory – English and Spanish (Hendry, Highlands, Osceola, and Polk counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Brevard, Broward, Glades, Hendry, Highlands, Osceola, and Polk counties) , PDF opens new window

Region 10

Counties: Broward

Provider Directory – English and Spanish (Broward county) , PDF opens new window

Provider Directory – English and Spanish (Collier and Palm Beach counties) , PDF opens new window

Provider Directory – English and Spanish (Hendry county) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Broward county) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Hendry, Collier, Miami-Dade, and Palm Beach counties) , PDF opens new window

Region 11

Counties: Miami-Dade and Monroe

Provider Directory – English and Spanish (Miami-Dade county) , PDF opens new window

Provider Directory – English and Spanish (Collier, Monroe and Palm Beach counties) , PDF opens new window

Provider Directory – Specialists – English and Spanish (Miami-Dade county) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Miami-Dade and Monroe counties) , PDF opens new window

Long-Term Care Provider Directory – English and Spanish (Broward, Collier, and Palm Beach counties) , PDF opens new window

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.

Agency for Health Care Administration (AHCA) PDO Template , opens new window

Agency for Health Care Administration (AHCA) PDO Manual , opens new window

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 opens new window and Spanish, PDF opens new window)

Cystic Fibrosis Supplemental Drug List – English (1.15 MB) , PDF opens new window

Cystic Fibrosis Supplemental Drug List – Spanish (1.09 KB) , PDF opens new window

Recent changes to Florida Medicaid Drug List , opens new window

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 PrescribeIT Rx.

Contact us

Combined Humana Medical and Long-Term Care (LTC) OTC form

Over-the-Counter Order Form—English (1.19 MB) , PDF opens new window

Over-the-Counter Order Form—Spanish (838 KB) , PDF opens new window

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 opens new window

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 opens new window

HIPAA Privacy Notice – Spanish (111 KB) , PDF opens new window

Detecting, Preventing, and Reporting Healthcare Fraud

Detecting, Preventing, and Reporting Healthcare Fraud , PDF opens new window

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 opens new window

Grievance/Appeal request form—Spanish (157 KB) , PDF opens new window

Appointment of Representative form—English/Spanish (157 KB) , PDF opens new window

Your appeal rights, as listed in the Member Handbook (154 KB) , PDF opens new window

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 Medical Information (English and Spanish) , PDF opens new window

Consent for Release of Protected Health Information (2.6 MB) English , PDF opens new window

Access Behavioral Health Consent for Release of PHI (Regions 1 & 2) PDF (195 KB) English , PDF opens new window

Beacon Consent for Release of PHI (Regions 3–11) PDF (152 KB) English , PDF opens new window

Long-Term Care (LTC)

LTC Consent to Share Health Facts (38 KB) English , PDF opens new window

LTC Consent to Share Health Facts (38 KB) Spanish , PDF opens new window

LTC Consent for Release of Information (965 KB) English , PDF opens new window

LTC Request for Alternative Communications (396 KB) English , PDF opens new window

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 , opens new window

State of Health Care Quality Report , opens new window (NCQA website)

Health Risk Assessment (HRA)

You can complete your HRA by:

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 opens new window

Take our health risk assessment (872 KB) Spanish, PDF opens new window

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 opens new window

Looking for help?

Contact Us

If you have questions, find the number you need to get help and support.

Find a doctor

Find a doctor, hospital or pharmacy.

Documents & forms

Find the documents and forms you need, including your member handbook.