Member Guidelines

Understand your plan, get the care you deserve

Signing up for a Humana plan means having certain rights. Get to know what medical services you’re entitled to. Find out what’s covered, from emergency room visits to prescription drugs. That knowledge can lead to better care — and more chances to stay on top of your game.

Member information

Knowing how to use your plan can save you in the long run. Learn the terms, what’s covered, how to find a doctor, and more. If English isn’t your native language, you can find help here too

Member rights

Besides the right to privacy, there’s so much more you’re entitled to. And all those rights translate into a better relationship with your doctor.

Medical authorizations

Sometimes a medical procedure needs to be okayed ahead of time. Otherwise, it might not be covered. Knowing when you need permission can save you cash.

Pharmacy authorizations

Not all the drugs your doctor prescribes may be covered. Find out which are off-limits, and what to do about it. Your wallet will thank you.

Medical organization determination

You have the right to ask Humana to pay for items or services you think should be covered. This is called an “organization determination” (also called a coverage decision).

Exceptions and appeals

If your prescription drugs aren’t covered, or you’re paying too much for them,speak up. You have the right. All you need to do is call.

Low income subsidy

You may be eligible for extra help with your prescription drug plan, deductible and copayments.

Lower your chances of getting a severe flu

Schedule your appointment to get your flu shot early! The Centers for Disease Control and Prevention suggest a flu shot for people 65 years and older with a long-term health condition like diabetes, heart and lung disease.

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