Humana PathWays Dual Care Plan

Documents and Forms

Find the documents and forms you need to get the most out of your Humana D-SNP enrollment.

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Evidence of coverage

Your 2026 Evidence of Coverage - Humana Pathways Dual Care Special Needs Plan H4939-001 (HMO-POS D-SNP) pdf opens in new window

Su Evidencia de Cobertura 2026 - Humana Pathways Dual Care Special Needs Plan H4939-001 (HMO-POS D-SNP) pdf opens in new window

Summary of Benefits - Humana PathWays Dual Care (HMO-POS D-SNP) pdf opens in new window

Resumen de beneficios - Humana PathWays Dual Care (HMO-POS D-SNP) pdf opens in new window

Annual Notice of Changes (ANOC) - Humana PathWays Dual Care (HMO-POS D-SNP) pdf opens in new window

Notificación Anual de Cambios - Humana PathWays Dual Care (HMO-POS D-SNP) pdf opens in new window

Pharmacy documents

Pharmacy Direct Member Reimbursement Form pdf opens in new window

2026 Humana Drug List (HMO-POS D-SNP) - English pdf opens in new window

2026 Humana Drug List (HMO-POS D-SNP) - Spanish 2026 pdf opens in new window

Prior Authorization Criteria pdf opens in new window

DSNP Transition Policy pdf opens in new window

2026 Step Therapy Criteria pdf opens in new window

Prior authorization forms

Medical and pharmacy authorizations pdf opens in new window

Provider and pharmacy directory

You can search for a provider near you using our Find Care opens in new window tool.

Humana Healthy Horizons in Indiana

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. We also provide free language interpreter services. See our full accessibility rights information opens in new window , non-discrimination disclosure opens in new window , and language options opens in new window .

If you are requesting membership in a Dual Eligible Special Needs Plan (D-SNP), the following statement applies: I understand this plan is for individuals with both Medicaid and Medicare. My ability to enroll is based on verification that I am entitled to both Medicare and medical assistance under Medicaid.

Medicare beneficiaries may also enroll in Humana Medicare plans through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov opens in new window

Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, refer to the plan document or call or write your Humana insurance agent or the company. In the event of any disagreement between this communication and the plan document, the plan document will control.

Other pharmacies may be available in our network. You can locate network pharmacies by visiting Humana.com/finder/pharmacy opens in new window . CenterWell Pharmacy is the preferred cost-sharing mail-order pharmacy under many Humana MAPD and PDP plans. There are other pharmacies, including preferred cost-sharing retail pharmacies, are available in our network. Members can choose any network pharmacy for their prescriptions.

Humana is a Dual Eligible Special Needs plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in any Humana plan depends on contract renewal.

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Last Updated: 10/15/2025