Humana members
Whether you're a Humana Medicare member, have an individual or family plan, or get insurance from your employer, you have easy access to documents and forms. Choose the category that best describes your coverage.
Medicare Advantage and Prescription Drug Plan Disenrollment Instructions and Form
Medicare Prescription Drug Claim Form
Declaration of Prior Prescription Drug Coverage Form
Limited income NET pharmacy claim form
Medicare Part D drug coverage determination
There may be times when it is necessary to get approval from Humana before getting a prescription filled. This is called “prior authorization” or Part D coverage determination.
Downloadable request forms for Part D prior authorization
Learn more about the Part D drug prior authorization process
Grievance, appeal and coverage redetermination
If you have a complaint related to your Humana Part C/Medicare Advantage plan, Part D drug coverage or any aspect of a member's care, we want to hear about it and see how we can help.
You can use this form to:
- File an appeal for a denied medical service, a medical device or a denied prescription medication.
- Submit a grievance about your complaint and tell us how you are dissatisfied with your experience.
Please provide complete information, so we can get your issue to the associate who can help you best.
Downloadable request forms for grievance, appeal and coverage redetermination
Learn more about the Medicare drug (Part D) coverage redetermination process
Learn more about the Medicare Advantage (Part C) reconsideration process
Appointment of representative form for appeals and grievances
If you are filing an appeal or grievance on behalf of a member, you need an Appointment of Representative (AOR) form or other appropriate legal documentation on file with Humana so that you are authorized to work with Humana on his or her behalf.
You also can get the Appointment of Representative form on the , opens new window.
Report an injury or get information about an injury investigation
Use the , PDF opens new window to:
- Report accidents
- Confirm if Humana provided benefits for an accident-related injury or illness
- Request final payment information needed to settle claims made against other insurance carriers and individuals
Once you have completed the request, please email a saved copy to SubrogationReferrals@Humana.com, or mail to:
Humana Subrogation and Other payer Liability
004/48110
P.O. Box 2257
Louisville, KY 40201-2257
If you have additional questions or need to supply additional information, please contact us.
Notice of nondiscrimination
Please visit our accessibility page for information on filing a discrimination complaint
Multi-language translator service
Multi-language interpreter services contact information
Member blocking request
Disable access to your secure member website for yourself or a family member
State-specific documents
View state-specific documents related to Humana’s offerings in your state.
Medical forms
Pharmacy forms
Grievance and Appeals Request Form
Appointment of representative form for appeals and grievances
If you are filing an appeal or grievance on behalf of a member, you need an Appointment of Representative (AOR) form or other appropriate legal documentation on file with Humana so that you are authorized to work with Humana on his or her behalf.
UMB health savings account forms
Humana mail order pharmacy forms
Michelle's Law
Process for continued coverage for full-time students who are on medical leave.
Financial protection products (FPP) claim forms
Financial protection products (FPP) service forms
Member blocking request
Disable the secure member website for yourself or a family member.
Life forms
Privacy
View Humana's privacy rights and download forms. You can also learn more about your rights on the Rights and responsibilities page.
Multi-language translator service
Multi-language interpreter services contact information
Medical forms
Pharmacy forms
Both forms below must be completed, signed and returned to Humana for processing.
Contraceptive Benefits Plan Form
Applies ONLY to members who received a letter from Humana directing them to this Humana Contraceptive Benefits Plan SPD link. If you are not sure whether this applies to you, please call the customer service phone number on the back of your Humana ID card.
Behavioral Health Care Services
The
Florida residents can view the
Grievance and Appeals Request Form
Appointment of representative form for appeals and grievances
If you are filing an appeal or grievance on behalf of a member, you need an Appointment of Representative (AOR) form or other appropriate legal documentation on file with Humana so that you are authorized to work with Humana on his or her behalf.
Spending account forms
Humana Pharmacy® mail delivery
Dental forms
Life claim forms
Group disability claim forms
Prior carrier deductible credit form
For new members apply current year expenses to Humana deductible.
Michelle's Law
Process for continued coverage for full-time students who are on medical leave.
Member blocking request
Disable the secure member website for yourself or a family member.
Privacy
View Humana's privacy rights and download forms. You can also learn more about your rights on the Individual Privacy Rights page.
Multi-language translator service
Multi-language interpreter services contact information
State-Specific Documents
View state-specific documents related to Humana’s offerings in your state.
Pre-enrollment disclosure forms
Review a description of plan provisions which may exclude, limit, reduce, modify or terminate your group health insurance coverage.
Medical Pre-Enrollment Disclosure Forms
Note: Our forms are in Portable Document Format (PDF) and require Adobe Reader for viewing and printing. To get the plug-in, visit Adobe's Website to , opens new window