Below, you’ll find key plan documents and forms for the 2022 plan year. You can open and/or download each form as needed. These documents are effective from January 1, 2022 through December 31, 2022.

2022 Member Handbook – English, PDF

2022 Member Handbook – Spanish, PDF

2022 Prescription Drug Guide – English, PDF

2022 Prescription Drug Guide – Spanish, PDF

2022 Summary of Benefits – English, PDF

2022 Summary of Benefits – Spanish, PDF

2022 Annual Notice of Changes – English, PDF

2022 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.

2022 Illinois Prior Authorization Criteria, PDF

2022 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.