Below, you’ll find key plan documents and forms for the 2021 plan year. You can open and/or download each form as needed. These documents are effective through December 31, 2021.
2021 Member Handbook – English, PDF
2021 Member Handbook – Spanish, PDF
2021 Prescription Drug Guide – English, PDF
2021 Prescription Drug Guide – Spanish, PDF
2021 Summary of Benefits – English, PDF
2021 Summary of Benefits – Spanish, PDF
2021 Annual Notice of Changes – English, PDF
2021 Annual Notice of Changes – Spanish, PDF
Learn how you can get a free cellphone and cell services.
SafeLink® information, PDF
Learn how Humana uses and protects your health information.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Notice – English, PDF
HIPAA – Aviso de Prácticas de privacidad, PDF
If you want someone to act on your behalf with us, he or she needs to complete and return to us an Appointment of Representative Form.
Appointment of Representative Form, PDF
Learn more about how we can help you in a language other than English.
Multilanguage Interpreter Services, PDF