Documents and forms for Humana Healthy Horizons in South Carolina members

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 opens new window

Welcome Kit (Spanish) , PDF opens new window

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 opens new window

Health Risk Assessment (Spanish) , PDF opens new window

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 opens new window

Member Handbook (Spanish) , PDF opens new window

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 opens new window

2021 Preferred Drug List (Spanish) , PDF opens new window

2022 Preferred Drug List (English) , PDF opens new window

2022 Preferred Drug List (Spanish) , PDF opens new window

Preferred Drug List changes (English) , PDF opens new window

Preferred Drug List changes (Spanish) , PDF opens new window

Preferred Drug List – Machine Readable File , PDF opens new window

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) , PDF opens new window
• Region 2 (Aiken, Allendale, Bamberg, Barnwell, Calhoun, Chester, Clarendon, Fairfield, Kershaw, Lancaster, Lee, Lexington, Newberry, Orangeburn, Richland, Sumter, Union, and York) , PDF opens new window
• Region 3 (Beaufort, Berkeley, Charleston, Chesterfield, Colleton, Darlington, Dillon, Dorchester, Florence, Georgetown, Hampton, Horry, Jasper, Marion, Marlboro, and Williamsburg) , PDF opens new window

Adobe Reader is needed to view PDFs. If you do not have Adobe Reader, download it, opens new window today.

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, Humana 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 HumanaPharmacy.com (you will need a MyHumana account)
  • By mail: Humana Pharmacy, P.O. Box 745099, Cincinnati, OH, 45274-5099
  • By phone: Call 1-800-379-0092 (TTY: 711) 24 hours a day, seven days a week

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

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

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 opens new window

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 opens new window

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

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

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 opens new window

Rights and responsibilities (Spanish) , PDF opens new window

HIPAA privacy notice (English) , PDF opens new window

HIPAA privacy notice (Spanish) , PDF opens new window

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 opens new window

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

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

Detecting, Preventing, and Reporting Healthcare Fraud , PDF opens new window

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 , opens new window

State of Health Care Quality Report (NCQA) , opens new window