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Submit Power of Attorney documentation for a Humana member

Use this form to submit legal documentation that appoints you or another person as healthcare Power of Attorney (POA) for one of our Humana members.

Fields marked with an asterisk * are required.

Enter the Humana member’s information

Remember, the following information is for the Humana member. The Power of Attorney will act on this person's behalf.
Member name
Member info
Member contact info

Enter the appointee’s information

Remember, the following information is for the person or organization appointed as Power of Attorney for a Humana member.
Individual
Organization

Upload Power of Attorney form

Please upload your legal documents appointing you as Power of Attorney for one of our members.