Documents and forms for Humana Healthy Horizons in Louisiana Members
Find the documents and forms you need to get the most from your health plan.
Key plan documents
Change of address form
If your home or mailing address changes, you have to let the Louisiana Department of Health (LDH) know. If you don’t, you may lose your coverage or miss out on key health plan information and reminders. After completing the form, you can return it by email or fax.
Or, to update your information through us, call us at 1-800-448-3810 (TTY: 711), Monday – Friday, from 7 a.m. – 7 p.m.
Welcome Kit/Quick Start Guide
All new members get a Welcome Kit/Quick Start Guide in the mail. You also can view it below. Your Welcome Kit/Quick Start Guide includes the information you need at the start of your enrollment in Humana Healthy Horizons® in Louisiana
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Health Needs Assessment (HNA)
The HNA is a set of health questions for you to answer. Your answers will help us make sure you get the care you need. Your Welcome Kit/Quick Start Guide includes an HNA and a postage-paid envelope in which to return it.
Earn $30 in rewards through Go365 for Humana Healthy Horizons® if you complete your HNA during the first 90 days of enrollment in Humana Healthy Horizons® in Louisiana
Member Handbook
Refer to your Member Handbook for information your plan, benefits, and covered services
Provider directories
To find information about in-network doctors, specialists, and healthcare facilities near you:
- Refer to the provider directory in the region where you live, or
Use our Find a Doctor service
Watch a short video about using our Find a Doctor service
To use our online Find a Doctor tool go to Humana.com/FindaDoctor.
Enter your ZIP code, select Medicaid as your coverage type, and select Network from the drop-down menu.
You can then search by the name of the doctor or facility, specialty, such as cardiology, or a condition such as ear infection.
You also can choose All and type any text into the search.
Then click Search.
Click Update my search to search for something else.
If you need help finding and choosing a doctor, call the number on the back of your enrollee ID card to speak with an Enrollee Services representative.
Region 1 - Metropolitan: Jefferson, Orleans, Plaquemines, and St. Bernard parishes
Provider Directory – English and Spanish,Region 1 - Metropolitan: Jefferson, Orleans, Plaquemines, and St. Bernard parishes, PDF Provider Directory – English and Spanish,Region 1 - Metropolitan: Jefferson, Orleans, Plaquemines, and St. Bernard parishes, PDF
Region 2 – Capital Area: Ascension, East Baton Rouge, East Feliciana, Iberville, Pointe Coupee, West Baton Rouge, and West Feliciana parishes
Region 3 – South Central: Assumption, Lafourche, St. Charles, St. John the Baptist, St. James, St. Mary, and Terrebonne parishes
Region 4 – Acadiana Area: Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin, and Vermillion parishes
Region 5 – Imperial Calcasieu: Allen, Beauregard, Calcasieu, Cameron, and Jefferson Davis parishes
Region 6 – Central: Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon, and Winn parishes
Region 7 – Northwest: Bienville, Bossier, Caddo, Claiborne, Desoto, Natchitoches, Red River, Sabine, and Webster parishes
Region 8 – Northeast Delta: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, and West Carroll parishes
Region 9 – Florida Parishes: Livingston, St. Helena, St. Tammany, Tangipahoa, and Washington parishes
Primary care provider change request form
To change your primary care provider (PCP), use our online PCP change request service in your MyHumana account (desktop version only) or complete and submit the PCP Change Request Form.
Advance directive/Living will
An advance directive, also known as a "living will," is a written legal document that instructs healthcare providers who should make medical decisions on your behalf if you cannot do so. We include below more information about advance directives/living wills:
Pharmacy information and resources
Preferred Drug List (PDL)
The Louisiana Department of Health (LDH) PDL:
The LDH Single PDL is a list of medicine Louisiana Medicaid recipients can use if prescribed. A Pharmacy and Therapeutics (P&T) Committee recommends medicine to include on or remove from the PDL. Medicine on the PDL is identified as preferred or nonpreferred and includes information about prior authorization requirements.
Please note: The LDH Single PDL is not all-inclusive. Many medications listed on the single PDL are covered.
Over-the-counter (OTC) catalog and order form
Humana Healthy Horizons in Louisiana members:
- Have a $25/month allowance to spend on OTC health and wellness items through the mail
- Can use Humana’s mail-order pharmacy, CenterWell Pharmacy™, which will send medicine to your home
To get started:
- Look up available OTC items in the Humana Health and Wellness Catalog
- Follow directions on the form to submit your order to us
Health benefits claim form
To request reimbursement of out-of-pocket expenses tied to a Humana Healthy Horizons in Louisiana covered benefit, please complete and return a Health Benefits Claim Form.
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 Louisiana 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.
Grievances and appeals forms
We want you to be happy with the care you get. We hope you get the best care possible.
If you are not happy with any part of your healthcare plan, Member Services, your doctor, or a facility, you can send in a grievance.
You also can appeal a claim or a denied service using the grievances and appeals forms.
To have someone send an appeal or grievance for a covered member, we must have a completed
Legal and privacy notices
The legal and privacy notices below provide information about:
- How Humana uses, and when we might share, your personal information
- Your privacy rights
To give us permission to share your medical information with someone, you must complete and send back to us a Consent for Release of Medical Information and a Consent for Release of Protected Health Information
Detecting, preventing, and reporting healthcare fraud
As part of our efforts to improve the healthcare system, we are committed to:
- Detecting, correcting, and preventing healthcare fraud
- Educating our members about how to detect and/or prevent fraud
Performance measurement
Refer to the below information to see:
How we’re measured as a health plan and
How we’re doing