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Documents and forms for Humana Healthy Horizons in South Carolina members

Find the documents and forms you need to get the most from your health plan.
Young pregnant Medicaid member on the telephone

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 South Carolina.

Welcome Kit (English), PDF

Welcome Kit (Spanish), PDF

Health Risk Assessment (HRA)

The answers you give us on your HRA help us make sure you get the care you need. Your Welcome Kit includes a HRA form and postage-paid envelope in which to return your completed HRA. You also can download a HRA below.

Health Risk Assessment (English), PDF

Health Risk Assessment (Spanish), PDF

Your Welcome Kit includes information about the many ways you can return your completed HRA to us.

Member Handbook

Have questions about your plan, benefits, and covered services? Check out your Member Handbook.

Member Handbook (English), PDF

Member Handbook (Spanish), PDF

Handbook Change Log, PDF

Preferred Drug List

The Preferred Drug List 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 Preferred Drug List periodically during the year. If we update the Preferred Drug List, we will notify you and we will make the new version available below.

2021 Preferred Drug List (English), PDF

2021 Preferred Drug List (Spanish), PDF

2022 Preferred Drug List (English), PDF

2022 Preferred Drug List (Spanish), PDF

Preferred Drug List changes (English), PDF

Preferred Drug List changes (Spanish), PDF

Preferred Drug List – Machine Readable File, PDF

Provider Directories

Refer to the Provider Directory in the region where you live to find information about in-network doctors, specialists, healthcare facilities, and more. You also can use our Find a Doctor service.

Region 1 – Abbeville, Anderson, Cherokee, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee, Pickens, Saluda, and Spartanburg

Region 2 – Aiken, Allendale, Bamberg, Barnwell, Calhoun, Chester, Clarendon, Fairfield, Kershaw, Lancaster, Lee, Lexington, Newberry, Orangeburg, Richland, Sumter, Union, and York

Region 3 – Beaufort, Berkeley, Charleston, Chesterfield, Colleton, Darlington, Dillon, Dorchester, Florence, Georgetown, Hampton, Horry, Jasper, Marion, Marlboro, and Williamsburg

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Pharmacy forms

Over-the-counter (OTC) catalog and order form

As a Humana Healthy Horizons in South Carolina member, you can use Humana’s mail-order pharmacy, CenterWell Pharmacy™, which will send medicine to your home.

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
  • Write down your order on the Order Form
  • Submit your order:
    • Online at CenterWellPharmacy.com (you will need a MyHumana account)
    • By mail: CenterWell Pharmacy, P.O. Box 745099, Cincinnati, OH, 45274-5099
    • By phone: Call 800-379-0092 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. to 6:30 p.m., Eastern time

Humana Health and Wellness Catalog and Order Form (English), PDF

Humana Health and Wellness Catalog and Order Form (Spanish), PDF

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 reimbursement claim form, PDF

Grievance 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, PDF

You also can appeal a claim or a denied service using this form, PDF

If you are sending an appeal or grievance for another covered member, be sure to fill out an Appointment of Representative form, PDF

Learn more about Grievance and Appeals

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 and Spanish)

Rights and responsibilities (English), PDF

Rights and responsibilities (Spanish), PDF

HIPAA privacy notice (English), PDF

HIPAA privacy notice (Spanish), PDF

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.

Consent for Release of Medical Information (English and Spanish), PDF

Consent for Release of Protected Health Information (English), PDF

Consent for Release of Protected Health Information (Spanish), PDF

Detecting, Preventing, and Reporting Healthcare Fraud, PDF

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)

Looking for help?

Contact Us

If you have questions, find the number you need to get help and support.

Find a doctor

Find a doctor, hospital, or pharmacy.

Documents & forms

Find the documents & forms you need, including your Member Handbook.