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Documents and forms

Stay organized and find in one place all of the documents and forms you need for Humana Healthy Horizons™ in Kentucky.

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Find the forms you need

Find your Enrollee Handbook, provider directories, and other Medicaid documents and forms to manage your plan.

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Enrollee materials

Have questions about your plan?

Please read your Enrollee Handbook when you become a Humana Healthy Horizons in Kentucky enrollee and then at least once at the start of each plan year. We include below links to English and Spanish-language versions of our current Enrollee Handbooks:

2021 Humana Healthy Horizons in Kentucky Enrollee Handbook – English, PDF opens in new window

2021 Humana Healthy Horizons in Kentucky Enrollee Handbook – Spanish, opens in new window

Looking for a doctor or healthcare facility in your area?

Pharmacy resources

Pharmacy program changes

As of July 1, 2021, MedImpact administers pharmacy benefits for all Medicaid enrollees in Kentucky, including Humana Healthy Horizons in Kentucky enrollees. All of your previous pharmacy benefits will remain the same and you do not have to do anything. Connect with MedImpact to learn more about your pharmacy benefits, opens in new window.

All of our covered households received a letter about this change. Below, you’ll also find a link to the letter we sent enrollees.

Pharmacy program changes effective July 1, 2021, PDF opens in new window

If you use medicine that did not need a prior authorization prior to July 1, 2021 and needs a prior authorization after July 1, 2021, you will have 90 days to transition to a preferred alternative or have your doctor submit a prior authorization request to MedImpact. If you take medicine, talk to the doctor who prescribed the medicine to you to learn more about how you are affected, if at all.

Grievances and appeals

If you have a grievance or appeal related to Humana Healthy Horizons in Kentucky or any aspect of your care, we want to hear about it and see how we can help. To file a grievance or appeal, you can submit a grievance or appeal form to tell us what happened. Please provide as much information as you can so we can help resolve your issue.

Grievance/Appeal Request Form – English, PDF opens in new window

Grievance/Appeal Request Form – Spanish, PDF opens in new window

If you are filing a grievance or appeal on behalf of a Humana Healthy Horizons in Kentucky enrollee, you must submit a completed Appointment of Representative (AOR) Form, or other type of representative form (e.g., power of attorney), along with the other information listed above.

Appointment of Representative Form – English, PDF opens in new window

Appointment of Representative Form – Spanish, PDF opens in new window

You can send a completed Grievance/Appeal Request Form, and/or the AOR Form to us by:

Fax: 800-949-2961

Mail:

Humana Inc.

P.O. Box 14546

Lexington, KY 40512-4546

Attn: Grievance & Appeal Department

Learn more about your options for submitting a grievance or appeal (including our online submission process)

Help accessing groceries and essentials

Incarceration status correction

Per the Commonwealth of Kentucky Cabinet for Health and Family Services Department for Medicaid Services, enrollees who are incarcerated must report to the state their beginning and end dates of incarceration.

Incarceration Status Correction Form, PDF opens in new window

Medical

We can provide better care when we know more about you. You can help by filling out a:

  • Health Risk Assessment: Tell us about your health history and how we can best help you. You should fill out and return this to us as soon as possible after becoming a new member.

Health Risk Assessment (HRA) – English, PDF opens in new window

Health Risk Assessment (HRA) – Spanish, PDF opens in new window

  • Consent for release of medical records: If you change doctors, this form will allow us to send your medical records to your new doctor.

Consent for Release of Protected Health Information (PHI) – English, PDF opens in new window

Consent for Release of Protected Health Information (PHI) – Spanish, PDF opens in new window

Performance measurement surveys

Let us know how we’re doing. We want to make sure we give you the best care and services to manage your health. Download performance measurement reports and take our member satisfaction survey.

Guide to Health Effectiveness Data and Information Set measurements, opens in new window

State of Health Care Quality Report, opens in new window

Smartphone benefit information

Humana and SafeLink Wireless®, PDF opens in new window will provide Humana Healthy Horizons medical plan enrollees with free cellphone service and a smartphone to call your family, friends, and doctors. Plus, you’ll get even more extra services as a member.

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 Enrollee Handbook.