Humana Healthy Horizons in Virginia

Cardinal Care
Documents and Forms

An adult and a child looking at a laptop computer

Find the documents and forms Virginia Cardinal Care Members need to get the most from their enrollment.

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 Virginia.

Welcome Kit (English)

Welcome Kit (Spanish)

Health Needs assessment Screening (HNA)

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

Health Needs Assessment (English)

Health Needs Assessment (Spanish)

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

Member Handbook

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

Member Handbook (English)

Member Handbook (Spanish)

Preferred Drug List (PDL)

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.

Preferred Drug List (English)

Preferred Drug List (Spanish)

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

Call the number on the back of your ID card if you have questions about your benefit.

Humana Health and Wellness Order Form (English)

Humana Health and Wellness 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

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)

Medical information consent forms

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 Protected Health Information (English)

Consent for Release of Protected Health Information (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)