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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. Your Enrollee Handbook also includes key information about the benefits, services, and rewards you get.

We include below links to English and Spanish-language versions of our current Enrollee Handbook:

2023

2023 Humana Healthy Horizons in Kentucky Enrollee Handbook – English, PDF

2023 Humana Healthy Horizons in Kentucky Enrollee Handbook – Spanish, PDF

2023 Welcome Kit – English, PDF

2023 Welcome Kit – Spanish, PDF

Notice of Privacy Practices

Learn how medical information about you may be used and disclosed and how you can access to this information.

Humana Healthy Horizons in Kentucky Notice of Privacy Practices – English, PDF

Humana Healthy Horizons in Kentucky Notice of Privacy Practices – Spanish, PDF

2022

2022 Humana Healthy Horizons in Kentucky Enrollee Handbook – English, PDF

2022 Humana Healthy Horizons in Kentucky Enrollee Handbook – Spanish, PDF

2022 Welcome Kit – English , PDF

2022 Welcome Kit – Spanish, PDF

2021

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

2021 Humana Healthy Horizons in Kentucky Enrollee Handbook – Spanish, PDF

Looking for a doctor or healthcare facility in your area?

Use our Find a Doctor service to find doctors, pharmacies, and other healthcare facilities in your area. You also can refer to the Provider Directory for the area where you live.

Provider directories

Region 1 – The Lakes

Counties: Ballard, Caldwell, Calloway, Carlisle, Christian, Crittenden, Fulton, Graves, Hickman, Hopkins, Livingston, Lyon, Marshall, McCracken, Muhlenberg, Trigg, Todd


Region 2 – Two Rivers

Counties: Allen, Barren, Butler, Daviess, Edmonson, Hancock, Hart, Henderson, Logan, McLean, Metcalfe, Monroe, Ohio, Simpson, Union, Warren, Webster


Region 3 – Salt River Trail

Counties: Anderson, Breckinridge, Bullitt, Franklin, Grayson, Hardin, Henry, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble, Washington, Woodford


Region 4 – Cumberland

Counties: Adair, Bell, Casey, Clay, Clinton, Cumberland, Green, Harlan, Jackson, Knox, Laurel, McCreary, Pulaski, Rockcastle, Russell, Taylor, Wayne, Whitley


Region 5 – Southern Bluegrass

Counties: Boyle, Clark, Estill, Fayette, Garrard, Jessamine, Lincoln, Madison, Mercer, Powell


Region 6 – Northern Bluegrass

Counties: Boone, Bourbon, Campbell, Carroll, Gallatin, Grant, Harrison, Kenton, Nicholas, Owen, Pendleton, Scott


Region 7 – Northeastern

Counties: Bath, Bracken, Boyd, Carter, Elliott, Fleming, Greenup, Lawrence, Lewis, Mason, Menifee, Montgomery, Morgan, Robertson, Rowan


Region 8 – Eastern Mountain

Counties: Breathitt, Floyd, Johnson, Knott, Lee, Leslie, Letcher, Magoffin, Martin, Owsley, Perry, Pike, Wolfe


Region 9 – Jefferson

County: Jefferson

Pharmacy resources

MedImpact administers pharmacy benefits for all Medicaid enrollees in Kentucky, including Humana Healthy Horizons in Kentucky enrollees. Connect with MedImpact to learn more about your pharmacy benefits.

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

Grievance/Appeal Request Form – Spanish, PDF

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

Appointment of Representative Form – Spanish, PDF

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)

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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

Health Risk Assessment (HRA) – Spanish, PDF

  • 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

Consent for Release of Protected Health Information (PHI) – Spanish, PDF

After printing and completing one or more of the above forms, please send them to:

Humana Healthy Horizons in Kentucky
P.O. Box 14823
Lexington, KY 40512-4823

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

State of Health Care Quality Report

Smartphone benefit information

Humana and SafeLink Wireless®, PDF 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.

Expanded Benefits Reimbursement Form

We hope you don’t have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in Kentucky enrollee. If you do, let us know by filling out a reimbursement claim form, and you may get a refund.

Fill out the form below to send a reimbursement claim.

Expanded Benefits Reimbursement Form – English , PDF

Expanded Benefits Reimbursement Form – Spanish , 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 Enrollee Handbook.