Documents and forms
Find the documents and forms you need to get the most out of your Humana Fully Integrated D-SNP enrollment.
Humana Fully Integrated D-SNP
Evidence of coverage
Your 2025 Evidence of Coverage - Humana Dual Fully Integrated H2875-001 (HMO-POS D-SNP)
Su Evidencia de Cobertura 2025 - Humana Dual Fully Integrated H2875-001 (HMO-POS D-SNP)
Your 2025 Evidence of Coverage - Humana Dual Fully Integrated H2875-003 (HMO D-SNP)
Su Evidencia de Cobertura 2025 - Humana Dual Fully Integrated H2875-003 (HMO D-SNP)
Your 2025 Evidence of Coverage - Humana Gold Plus SNP-DE H2875-002 (HMO D-SNP)
Su Evidencia de Cobertura 2025 - Humana Gold Plus SNP-DE H2875-002 (HMO D-SNP)
Your 2025 Evidence of Coverage - Humana Gold Plus SNP-DE H2875-004 (HMO D-SNP)
Su Evidencia de Cobertura 2025 - Humana Gold Plus SNP-DE H2875-004 (HMO D-SNP)
Pharmacy documents
Over-the-Counter Order Form – English
Over-the-Counter Order Form - Spanish
Pharmacy Direct Member Reimbursement Form
2025 Prescription Drug Guide (HMO D-SNP) - English
2025 Prescription Drug Guide (HMO D-SNP) - Spanish
2025 Prescription Drug Guide (HMO-POS D-SNP) - English
2025 Prescription Drug Guide (HMO-POS D-SNP) - Spanish
2025 Prior Authorization Criteria
2025 Strep Therapy Criteria
2025 DSNP Transition Policy
2026 DSNP Transition Policy
Prior authorization forms
Provider directory
You can search for a provider near you using our Find Care tool
View a printable PDF of your provider directory
Humana Healthy Horizons in Virginia
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