South Carolina Dual Integrated Special Needs Plan

Documents and Forms

Find the documents and forms you need to get the most out of your Humana D-SNP enrollment.

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Evidence of coverage

Your 2025 Evidence of Coverage - Humana Dual Integrated Special Needs Plan (HMO-POS D-SNP)

Su Evidencia de Cobertura 2025 - Humana Dual Integrated Special Needs Plan (HMO-POS D-SNP)

Pharmacy documents

Over-the-Counter Order Form - English

Over-the-Counter Order Form - Spanish

Pharmacy Direct Member Reimbursement Form

2026 Humana Drug List (HMO-POS D-SNP) - English

2026 Humana Drug List (HMO-POS D-SNP) - Spanish 2026

2026 Step Therapy Criteria

DSNP Transition Policy

Prior authorization forms

Medical and pharmacy authorizations

Provider and pharmacy directory

You can search for a provider near you using our Find Care tool.

Humana Healthy Horizons in South Carolina

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If you are requesting membership in a Dual Eligible Special Needs Plan (D-SNP), the following statement applies: I understand this plan is for individuals with both Medicaid and Medicare. My ability to enroll is based on verification that I am entitled to both Medicare and medical assistance under Medicaid.

Medicare beneficiaries may also enroll in Humana Medicare plans through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov.

Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, refer to the plan document or call or write your Humana insurance agent or the company. In the event of any disagreement between this communication and the plan document, the plan document will control.

Other pharmacies may be available in our network. You can locate network pharmacies by visiting Humana.com/finder/pharmacy. CenterWell Pharmacy is the preferred cost-sharing mail-order pharmacy under many Humana MAPD and PDP plans. There are other pharmacies, including preferred cost-sharing retail pharmacies, are available in our network. Members can choose any network pharmacy for their prescriptions.

Humana is a Dual Eligible Special Needs plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in any Humana plan depends on contract renewal.

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Last Updated: 8/21/2025