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up to date, sometimes carrier websites change without our knowledge, which may mean step by step instructions may be out of date.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:
Fax: 262-786-6731
​
Mail: Health Insurance Associates, Inc
Attn: Julie Palmer
19525 Janacek Ct STE 101
Brookfield, WI 53045
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Type
Description
Form
Employee Enrollment Form - Fully Insured
Can be used by any existing fully insured Humana group to enroll new members
Employee Enrollment Form - Level Funded
Can be used by any existing level funded 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.