Translated forms and documents

The 2025 and 2026 Enrollment Application and other plan documents are available in Chinese , Korean and Spanish for certain plans.

Chinese documents

Applications

Full application – Chinese – 2025 pdf opens in new window

Full application – Chinese – 2026 pdf opens in new window

D-SNP application – Chinese – 2025 pdf opens in new window

D-SNP application – Chinese – 2026 pdf opens in new window

Plan documents

2025 Medicare Transition Policy – Chinese pdf opens in new window

2026 Medicare Transition Policy – Chinese pdf opens in new window

2026 Medicare Transition Policy – Korean pdf opens in new window

Humana Gold Plus^® H3533-033 (HMO)

Summary of benefits – Chinese Brooklyn and Queens, NY - 2025 pdf opens in new window

Summary of benefits – Chinese Brooklyn and Queens, NY - 2026 pdf opens in new window

Evidence of coverage – Chinese – Brooklyn & Queens, NY — 2025 pdf opens in new window

Evidence of coverage – Chinese – Brooklyn & Queens, NY — 2026 pdf opens in new window

Annual Notice of Change – H3533-033 – Chinese – Brooklyn & Queens, NY - 2025 pdf opens in new window

Annual Notice of Change – H3533-033 – Chinese – Brooklyn & Queens, NY - 2026 pdf opens in new window

CMS 3533 Plan Star Ratings – 2025 pdf opens in new window

Prescription Drug Guides – Abbreviated 20250020PDGCH2545625 – 2025

Prescription Drug Guides – Comprehensive 20250020PDGCH2545625C – 2025 pdf opens in new window

Humana Gold Plus H3533-034-001 (D-SNP)

HumanaChoice^® H5525-055 (PPO)

Summary of benefits – Chinese – San Francisco and Marin County, CA – 2025 pdf opens in new window

Evidence of coverage – Chinese – San Francisco & Marin Counties, CA – 2025 pdf opens in new window

Annual Notice of Change – Chinese – H5525-055 — San Francisco, Marin Counties, CA —2025 pdf opens in new window

CMS 5525 Plan Star Ratings – 2025 pdf opens in new window

Prescription Drug Guides – Comprehensive 20250012PDGCH2545625C– 2025 pdf opens in new window

Prescription Drug Guides - Abbreviated 20250012PDGCH2545625– 2025 pdf opens in new window

HumanaChoice H5525-087 (PPO) 

Evidence of coverage – Chinese – San Francisco & Marin Counties, CA – 2026 pdf opens in new window

Provider and Pharmacy Directories – 2025

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Hudson Valley pdf opens in new window

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP New Jersey pdf opens in new window

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Brooklyn pdf opens in new window

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Connecticut pdf opens in new window

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Queens pdf opens in new window

H5525 – Chinese - Humana Choice PPO San Francisco and Marin Counties, CA pdf opens in new window

Korean documents

Applications

Plan documents

2025 Medicare Transition Policy – Korean pdf opens in new window

Annual Notice of Changes – Korean –2025

Humana Dual Select H5619-165 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Annual Notice of Changes – Korean – 2026

Humana Dual Select H5619-165 (HMO D-SNP)6 pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Evidence of Coverage – Korean – 2025

Humana Dual Select H5619-165 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) - Korean, King and Snohomish Counties, WA—2025 pdf opens in new window

Evidence of Coverage – Korean – 2026

Humana Dual Select H5619-165 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) - Korean, Washington: Select Counties—2026 pdf opens in new window

Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) - Korean, Washinton: King and Snohomish Counties—2026 pdf opens in new window

Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) - Korean, Select Counties, WA—2026 pdf opens in new window

Summary of Benefits—Korean—2025

Humana Dual Select H5619-155 (HMO D-SNP) pdf opens in new window

Humana Dual Select H5619-165 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) pdf opens in new window

Summary of Benefits—Korean—2026

Humana Dual Select H5619-165 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP)  pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP)  pdf opens in new window

Humana Gold Plus SNP-DE H1036-324 (HMO D-SNP) - Korean, Washington: Select Counties pdf opens in new window

Humana Gold Plus SNP-DE H1036-325 (HMO D-SNP) - Korean, Washinton: King and Snohomish Counties, WA pdf opens in new window

Humana Gold Plus SNP-DE H1036-326 (HMO D-SNP) - Korean, Select Counties, WA pdf opens in new window

Prescription Drug Guide—Korean—2025

Humana Dual Select H5619-165 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) pdf opens in new window

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) pdf opens in new window

Prescription Drug Guide — Korean — 2026

H5619, H1036 – Korean pdf opens in new window

Annual Notice of Changes – Korean –2025

Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)

Evidence of coverage – Korean – Clark County, WA – 2025 pdf opens in new window

Evidence of coverage – Korean – Snohomish County, WA – 2025 pdf opens in new window

Evidence of coverage – Korean – Whatcom & Skagit Counties, WA – 2025 pdf opens in new window

Evidence of coverage – Korean – Washington state – 2025 pdf opens in new window

Humana Gold Plus SNP-DE H5619-155 (HMO D-SNP)

Evidence of coverage – Korean – King & Snohomish Counties, WA – 2025 pdf opens in new window

Summary of benefits – Korean – King and Snohomish Counties, WA – 2025 pdf opens in new window

Provider and Pharmacy Directories - 2025

H5619 – Korean - Humana Gold Plus HMO D-SNP Snohomish County pdf opens in new window

H5619 – Korean - Humana Gold Plus HMO D-SNP Washington pdf opens in new window

H5619 - Korean - Humana Gold Plus HMO D-SNP King and Pierce Counties pdf opens in new window

Application forms—2025

Full/Korean Application Form–2025 pdf opens in new window

Full/Korean Application Form – 2026 pdf opens in new window

D-SNP/Korean Application Form– 2025 pdf opens in new window

D-SNP/Korean Application Form – 2026 pdf opens in new window

Spanish documents

Application Forms – 2025

Full Spanish Application Form - 2025 pdf opens in new window

Full Spanish Application Form – 2026 pdf opens in new window

DSNP Spanish Application Form - 2025 pdf opens in new window

DSNP Spanish Application Form – 2026 pdf opens in new window