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 ID can be found on the Member ID card
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.