Documents and forms

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

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Have questions about your plan?

Please read your member handbook when you become a Humana Healthy Horizons in Kentucky member and then at least once at the start of each plan year. Your member 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 member handbook:

Caregiver Toolkit

Caregiver’s Toolkit – English pdf opens in new window

Caregiver’s Toolkit – Spanish pdf opens in new window

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 opens in new window

Humana Healthy Horizons in Kentucky Notice of Privacy Practices – Spanish
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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 pdf opens in new window

Non-Discrimination Notice – Spanish pdf opens in new window

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 pdf opens in new window

Auxiliary Aids and Services Notice – Spanish pdf opens in new window

Looking for a doctor or healthcare facility in your area?

Use our Find Care opens in new window  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.

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

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 member, 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 Healthy Horizons in Kentucky
Attn: Grievance & Appeal Department
P.O. Box 14546
Lexington, KY 40512-4546

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

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

• Health Risk Assessment (HRA): 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

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

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

We hope you don’t have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in Kentucky member. 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 opens in new window

Expanded Benefits Reimbursement Form – Spanish pdf opens in new window