Documents and forms

Stay organized and find all of the documents and forms you need in one place for your Kentucky Medicaid plan.

A woman flips through papers on a clipboard with two adults.

Find the forms you need quickly

Find your member handbook, provider directories and other Medicaid documents and forms to manage your plan.

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Member materials

Have questions about your plan? Check out the member handbook to find full details of your plan and benefits. Information on Humana Health Plan can be found in the member handbook.

If you’re looking for a doctor, you can use these directories to see a list of providers you can choose from in your area to get health services.

You can also search for doctors, pharmacies and other healthcare facilities online using our find a doctor tool.

Member Handbook – English, PDF opens new window

Member Handbook – Spanish, PDF opens new window

Provider Directory – Region 1, PDF opens new window

Provider Directory – Region 2, PDF opens new window

Provider Directory – Region 3, PDF opens new window

Provider Directory – Region 4, PDF opens new window

Provider Directory – Region 5, PDF opens new window

Provider Directory – Region 6, PDF opens new window

Provider Directory – Region 7, PDF opens new window

Provider Directory – Region 8, PDF opens new window

Provider Directory – Region 9, PDF opens new window

Provider Directory – Region 9 part 2, PDF opens new window

Provider Directory – Region 9 part 3, PDF opens new window

Pharmacy resources

We know it’s important for you to understand which of your medicines are covered. Check the lists below to see which medicines your plan covers.

Preferred Drug List – English, PDF opens new window

Preferred Drug List – Spanish, PDF opens new window

Preferred Drug List (Machine Readble File) – English

Prescription drug reimbursement claim form

We hope you don’t have to pay for any medicine out of pocket. If it happens, let us know by filling out a reimbursement claim form, and we will try to pay you back.

Fill out the form below to send in a reimbursement claim if you paid out of pocket for a prescription.

Prescription drug reimbursement claim form – English, PDF opens new window

Prescription drug reimbursement claim form – Spanish, PDF opens new window

Grievances and appeals

We want you to be happy with the care you get from Humana Kentucky Medicaid, and we hope you are getting the best care possible.

If you are not happy with any part of your healthcare plan, Customer Care, your doctor or a facility, you can send in a grievance. You can also appeal a claim or a denied service using this form.

If you are sending an appeal or grievance for another covered member, be sure to fill out an Appointment of Representative (AOR) Form.

Download, complete and send the forms to:

Fax:

1-800-949-2961

Mail:

Humana Health Plan, Inc.

P.O. Box 14546

Lexington, KY 40512-4546

Attn: Grievance & Appeal Department

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

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

Appointment of Representative Form – English, PDF opens new window

Appointment of Representative Form – Spanish, PDF opens new window

Medical

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

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

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

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

Performance measurement surveys

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

Guide to HEDIS® measurements, opens new window

State of Health Care Quality Report, opens new window

Smartphone benefit information

Humana and SafeLink wireless will provide Medicaid medical members 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 and forms

Find the documents and forms you need to manage your Kentucky Medicaid plan, including your enrollee handbook.