Translated forms and documents

Available materials

The 2021 Enrollment Application and other plan documents are available in Spanish, Chinese and Korean for certain plans.

Spanish documents Chinese documents Korean documents

Applications

Full application – Spanish, PDF opens new window

D-SNP application – Spanish, PDF opens new window

Applications

Full application – Chinese, PDF opens new window

D-SNP application – Chinese, PDF opens new window

Plan documents

Humana Gold Plus HMO H3533-033

Summary of benefits – Chinese, PDF opens new window

Evidence of coverage – Chinese, PDF opens new window

CMS Star Plan Ratings, PDF opens new window

Low Income Premium Subsidy , PDF opens new window

Provider and Pharmacy Directories

H3533NYHS01ACCH21, PDF opens new window

H3533NYHS01BCCH21, PDF opens new window

H3533NYHS01CCCH21, PDF opens new window

H3533NYHS01DCCH21, PDF opens new window

Prescription Drug Guides

Chinese Comprehensive, PDF opens new window

Applications

Full application – Korean, PDF opens new window

D-SNP application – Korean, PDF opens new window