Documents and forms for Humana Healthy Horizons in Ohio members
Find the documents and forms you need to get the most from your health plan.
Key plan documents
Welcome Kit
All new members get a Quick Start Guide in the mail. You also can view it below. Your Quick Start Guide includes the information you need at the start of your enrollment in Humana Healthy Horizons® in Ohio.
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Health Risk Assessment (HRA)
The HRA is a set of health questions for you to answer. Your answers will help us make sure you get the care you need. Your Quick Start Guide includes an HRA and a postage-paid envelope in which to return it. You also can download an HRA below.
Earn $25 in rewards through Go365 for Humana Healthy Horizons® if you complete your HRA during the first 90 days of enrollment in Humana Healthy Horizons in Ohio. This reward is available to all members.
Member Handbook
Have questions about your plan, benefits, and covered services? Check out your Member Handbook. Your handbook also has information about our medical necessity criteria. To request we send you a handbook or a copy of this criteria, call 877-856-5702 (TTY: 711), Monday – Friday, from 7 a.m. – 8 p.m., Eastern time.
If you need to change your address
To make sure you don’t lose your Medicaid coverage, be sure to keep your information current with the Ohio Department of Medicaid (ODM). If you need to change your address:
- Call the Ohio Medicaid Consumer Hotline at 800-324-8680, Monday – Friday, 7 a.m. – 8 p.m., and Saturday, 8 a.m. – 5 p.m.
- Contact a case worker through your local department of job and family services
- Use your Ohio Benefits Self-Service account, if you have one, to report the change through the online portal
Get a free phone
Through the federal Safelink program, you can get a free phone and talk time to use every month.
Provider directories
Refer to the provider directory in the region where you live to find information about in-network providers, specialists, healthcare facilities, and more. You also can use our
Region 1 – West
Ohio Counties
Adams, Brown, Clermont, Clinton, and Highland
Allen and Crawford
Auglaize, Fulton, Henry, Mercer, Ottowa, Paulding, Sandusky, Van Wert, and Williams
Butler and Warren
Hospitals, Urgent Care Centers, Primary Care Providers, Other Health Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health – Part 1 of 2, PDF Behavioral Health – Part 2 of 2, PDF Specialists, PDF
Champaign, Darke, Logan, Miami, Preble, and Shelby
Clark
Defiance, Seneca, and Wood
Greene
Hamilton
Hospitals, Urgent Care Centers, Primary Care Providers, Other Health Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health - Part 1 of 3, PDF Behavioral Health - Part 2 of 3, PDF Behavioral Health – Part 3 of 3, PDF Specialists - Part 1 of 2, PDF Specialists - Part 2 of 2, PDF
Hancock, Hardin, Marion, Putnam, and Wyandot
Lucas
Hospitals, Urgent Care Centers, Primary Care Providers, Other Health Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health - Part 1 of 2, PDF Behavioral Health - Part 2 of 2, PDF Specialists, PDF
Montgomery
Hospitals, Urgent Care Centers, Primary Care Providers, Other Health Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health - Part 1 of 2, PDF Behavioral Health - Part 2 of 2, PDF Specialists - Part 1 of 2, PDF Specialists - Part 2 of 2, PDF
Indiana, Kentucky, and Michigan border counties
IN counties: Delaware, Fayette, Henry, Randolph, Union, and Wayne
IN counties: Adams, Allen, Blackford, De Kalb, Jay, Lagrange, Noble, Steuben, Wells and Whitley. MI counties: Hillsdale, Jackson, Lenawee, Monroe, Washtenaw, and Wayne
IN counties: Dearborn, Franklin, and Ohio. KY counties: Boone, Bracken, Campbell, Kenton, Lewis, Mason, and Pendleton
Region 2 – Northeast
Ohio Counties
Ashland, Coshocton, Erie, Holmes, Huron, Knox, Richland, and Wayne
Hospitals, Urgent Care Centers, Primary Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health – Part 1 of 2, PDF Behavioral Health – Part 2 of 2, Specialists and Other Health Care Providers, PDF All Provider Types – Part 1 of 2, PDF All Provider Types – Part 2 of 2, PDF
Ashtabula, Columbiana, Harrison, and Jefferson
Carrol and Trumbull
Cuyahoga
Hospitals, Urgent Care Centers, Primary Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers, PDF Behavioral Health – Part 1 of 4, PDF Behavioral Health – Part 2 of 4, PDF Behavioral Health – Part 3 of 4, PDF Behavioral Health – Part 4 of 4, PDF Other Health Care Providers, PDF Specialists – Part 1 of 3, PDF Specialists – Part 2 of 3, PDF Specialists – Part 3 of 3, PDF
Geauga and Lorain
Lake
Mahoning
Medina and Portage
Stark and Tuscarawas
Summit
Hospitals, Urgent Care Centers, Primary Care Providers, Other Health Care Providers, Durable Medical Equipment, Dental Services, Vision Providers, PDF Behavioral Health - Part 1 of 2, PDF Behavioral Health - Part 2 of 2, PDF Specialists , PDF
Pennsylvania and W. Virginia border counties
PA county: Allegheny. WV counties: Brooke and Hancock
PA counties: Beaver, Butler, Crawford, Erie, Lawrence, Mercer, Venango, and Washington
Region 3 – Central/Southeast
Ohio Counties
Athens, Belmont, Guernsey, Meigs, Monroe, Morgan, Muskingum, Noble, and Washington
Delaware, Fairfield, and Union
Fayette, Hocking, Licking, Madison, Morrow, Perry, and Pickaway
Franklin
Hospitals, Urgent Care Centers, Primary Care Providers, Durable Medical Equipment, Lab Services, Dental Services, Vision Providers , PDF Behavioral Health – Part 1 of 4, PDF Behavioral Health – Part 2 of 4, PDF Behavioral Health – Part 3 of 4, PDF Behavioral Health – Part 4 of 4, PDF Other Health Care Providers, PDF Specialists – Part 1 of 4, PDF Specialists – Part 2 of 4, PDF Specialists – Part 3 of 4, PDF Specialists – Part 4 of 4, PDF
Gallia, Pike, Scioto, and Vinton
Jackson, Lawrence, and Ross
Kentucky and W. Virginia border counties
KY counties: Boyd, Carter, Greenup, Lewis. WV counties: Cabell, Jackson, Lincoln, Marshall, Mason, Ohio, Pleasants, Putnam, Ritchie, Tyler, Wayne, Wetzel, Wirt, Wood
Pharmacy information
Preferred Drug List
The Ohio Department of Medicaid (ODM) Unified Preferred Drug List (PDL) is a list of drugs and medicines covered for Ohio residents who receive Medicaid benefits. Gainwell Technologies administers pharmacy benefits for all Ohio Medicaid recipients. Your provider can prescribe you drugs and medicines on this list if needed. If your provider wants to prescribe you medicine that requires prior authorization, he or she will send Gainwell Technologies a prior authorization request.
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 provider, 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.
Change PCP form
Your doctor can use the Change PCP form to let us know that they will be your primary care physician (PCP).
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 also how we’re doing.
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 Ohio member. If you do, let us know by filling out an Expanded Benefits Reimbursement claim form, and you may get a refund.
Fill out the form below to send a reimbursement claim.
Member Reimbursement Form
We hope you don’t have to pay out of pocket services you get as a Humana Healthy Horizons in Ohio member. If you do, let us know by filling out a Member Reimbursement claim form, and you may get a refund.
Fill out the form below to send a reimbursement claim.