Oklahoma SoonerSelect: Documents and Forms
Key plan documents
Welcome Kit
All new members get a Welcome Kit in the mail. You also can view it below. Your Welcome Kit includes the information you need at the start of your enrollment in Humana Healthy Horizons® in Oklahoma.
Welcome Kit – English
Welcome Kit – Spanish
Health Risk Screening
The answers you give us on your Health Risk Screening (HRS) help us make sure you get the care you need. Your Welcome Kit includes an HRS form and postage-paid envelope in which to return your completed HRS. You also can download the HRS below.
Health Risk Screening (HRS) – English
Health Risk Screening (HRS) – Spanish
Your Welcome Kit includes information about the many ways you can return your completed HRS to us.
Member Handbook
Have questions about your plan, benefits and covered services? Check out your Member Handbook.
Pharmacy forms
Over-the-Counter Catalog and Order Form
Your pharmacy benefit lets you order certain over-the-counter (OTC) items through the mail. To get started:
- Look up available OTC items in the Humana Health and Wellness Catalog and Order Form
- Write down your order on the order form
- Submit your order:
- By mail:
CenterWell Pharmacy
P.O. Box 1197
Cincinnati, OH 45201-1197
- By phone: Call CenterWell Pharmacy at 855-211-8370 (TTY: 711). Customer Care Representatives are available Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. – 6:30 p.m., Central time.
- By fax: 800-379-7617
- By mail:
Call the number on the back of your ID card if you have questions about your benefit.
Humana Health and Wellness Catalog and Order Form – English
Humana Health and Wellness Catalog and Order Form – Spanish
Prescription Drug Reimbursement Claim Form
We hope you don’t have to pay for any medicine out of pocket. If it happens, please fill out the form below to send in a reimbursement claim if you paid out of pocket for a prescription. We will try to pay you back.
Prescription Drug Claim Form for Member Reimbursement – English
Prescription Drug Claim Form for Member Reimbursement – Spanish
Oklahoma Health Care Authority (OHCA) Drug Utilization Review (DUR) Board
Preferred Drug List
The Preferred Drug List (PDL) is a list of drugs and medicine your plan covers. Your doctor can prescribe you drugs and medicine on this list if needed. We update our PDL periodically during the year. If we update the PDL, we will notify you and we will make the new version available below.
Preferred Drug List – English
Preferred Drug List – Spanish
Preferred Drug List Change Log – English
Preferred Drug List Change Log – Spanish
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
Individual privacy rights – English
Individual privacy rights – Spanish
Rights and responsibilities – English
Rights and responsibilities – Spanish
HIPAA privacy notice – English
HIPAA privacy notice – Spanish
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
Sensitive protected health information (PHI) provider consent – English
Sensitive protected health information (PHI) provider consent – Spanish
Consent for Release of Protected Health Information – English
Consent for Release of Protected Health Information – Spanish
Detecting, Preventing, and Reporting Healthcare Fraud
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
Non-Discrimination Notice – Spanish
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
Auxiliary Aids and Services Notice – Spanish
Performance measurement
Refer to the below information to see how we’re measured as a health plan, and also how we’re doing.
Guide to HEDIS® measurements
State of Health Care Quality Report (NCQA)
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 Oklahoma 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
Expanded Benefits Reimbursement Form – Spanish
Advance directives
Click on the link below for tools and information when making advance directives.
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Documents and forms
Find the documents and forms you need, including your Member Handbook.