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

Pharmacy forms

Learn more about our process for reviewing and giving prior authorization and our step-therapy criteria.

2021 Illinois Prior Authorization Criteria, PDF

2021 Illinois Step-Therapy Criteria, PDF

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.