Health Insurance Associates, Inc

19525 Janacek Ct STE 101

Brookfield, WI 53045

Phone (262) 786-6666

Fax (262) 786-6731

© 2019 Health Insurance Associates, Inc

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Health Insurance Associates, Inc
Below you will find a list of commonly used forms for groups with Humana available for download.  While we do the best we can to keep everything up to date, sometimes carrier websites change without our knowledge, which may mean step by step instructions may be out of date.  If you notice anything doesn't work as intended, please bring it to our attention and we will correct it.  
 
Please submit all completed forms to Julie Palmer:
 
Email:     Julie.Palmer@hia-wi.com
Fax:        262-786-6731
Mail:  Health Insurance Associates, Inc
           Attn:  Julie Palmer
           19525 Janacek Ct STE 101
           Brookfield, WI 53045
Type
Description
Form

Employee Enrollment Form

Can be used by any existing Humana group to enroll new members

Employee Change/Term Form

Can be used by any existing Humana group to make changes to an employees information or terminate an employee or dependents.

MyHumana Registration & Printing Temp ID Cards

Instructions for how to register for MyHumana and print temporary ID cards

Humana COBRA Coverage Rights

General notice of COBRA continuation coverage rights.  For use by single-employer group health plans that fall under COBRA guidelines.

Continuation Coverage Election Notice

Model COBRA continuation coverage election notice.  For use by single-employer group health plans that fall under COBRA guidelines.

How to choose a primary care physician (PCP)

Use this form to choose a primary care physician (PCP) for groups going with the WI Value network.

Dental ID Card Online

How to view a copy of a member dental identification (ID) card on MyHumana.com.

Underwriting Census Form

In most cases, all we need to get final underwritten rates for Humana Level Funded plans is this census form filled out completely.  

Medical Provider Search Instructions

Instructions for how to lookup in network doctors, clinics, and hospitals for the HPN and WI Value Network.

Dental Provider Search Instructions (No Graphics)

Instructions for how to look up in network dentists.  This is the same document as above, but with no screen shots.

Dental Provider Search Instructions

Instructions for how to lookup in network dentists, including screen shots.

Pharmacy Search (HPN Network)

Locate which pharmacies are in network.  Most groups are with the HPN network, but double check if you are unsure. 

Pharmacy Search (Select Rx Network)

Locate which pharmacies are in network.  Will most often include only CVS, Target, Walmart, Sam's Club, and Humana's mail order prescription program.  Few groups are on this network, so please double check if you are unsure.

Doctor On Demand

Immediately talk with a doctor 24 hours a day, 7 days a week via your phone or computer.  If you are on a copay plan, this is free of charge. If you are not on a copay plan, or have an HSA plan, the charge is only $49.  It’s a fraction of the cost of an office visit, it’s immediate, and it’s incredibly more convenient.

Employee Assistance Program (EAP) #1

An Employee Assistance Program (EAP) offers short-term counseling over the telephone to help you and members of your household manage everyday life issues. Professional counselors are available to assist you with issues such as family, relationship, and workplace concerns, weight control, loss of a loved one, and will even help with event planning, college planning, travel needs, pet care, and many many more.  

Employee Assistance Program (EAP) #2

Same program as above, but highlights some different areas.

Employee Assistance Program Mobile App

Everything the Humana EAP program has to offer, at your fingertips through a mobile app.

Humana Employer Portal Guide

Your complete guide to Humana's online employer portal.