Member reading notes from paper

2024 documents and forms

Below, you’ll find key plan documents and forms for the 2024 plan year. You can open and/or download each form as needed. These documents are effective from January 1, 2024 through December 31, 2024.

2024 Member Handbook – English, PDF − Last updated October 1, 2023

2024 Member Handbook – Spanish, PDF − Last updated October 1, 2023

2024 Prescription Drug Guide – English, PDF − Last updated October 1, 2023

2024 Prescription Drug Guide – Spanish, PDF − Last updated October 1, 2023

2024 Summary of Benefits – English, PDF − Last updated October 1, 2023

2024 Summary of Benefits – Spanish, PDF − Last updated October 1, 2023

2024 Annual Notice of Changes – English, PDF

2024 Annual Notice of Changes – Spanish, PDF

You may qualify for discounts on your broadband Internet service and the purchase of eligible computers and tablets. Also, enrollment in a Medicaid plan, like Humana Gold Plus Integrated, qualifies you for a free phone, talk, text, data, and more through Safelink Wireless.

Learn more about these available federal programs, 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

Notice of Non-Discrimination

Humana Inc. and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate or exclude people because of their race, color, religion, gender, gender identity, sex, sexual orientation, age, disability, national origin, military status, veteran status, genetic information, ancestry, ethnicity, marital status, language, health status, or need for health services.

Non-Discrimination Notice – English 

Non-Discrimination Notice – Spanish 

Notice of Availability of Language Assistance Services and Auxiliary Aids and Services

Humana Inc. and its subsidiaries comply with Section 1557 by providing free auxiliary aids and services to people with disabilities when auxiliary aids and services are necessary to ensure an equal opportunity to participate.

Auxiliary Aids and Services Notice – English 

Auxiliary Aids and Services Notice – Spanish 

Pharmacy forms

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

2024 Illinois Prior Authorization Criteria, PDF

2024 Illinois Step-Therapy Criteria, PDF

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