Humana

Humana’s diverse lines of business work and serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Our team uses innovation to deliver results to our consumers.

 Provider Finder Dental

Form Name Effective Date Download Form
New Group Submission
Humana New Group Enrollment Checklist
01/01/2020 Download
Employer Application-all lines except DHMO
01/01/2020 Download
Employer Application-DHMO
01/01/2020 Download
ACH Authorization Form
01/01/2020 Download
In Force Group Forms
Group Level Change Form
01/01/2020 Download
Administration
Online Benefits Administration Guide
01/01/2020 Download
Employer Guide - Dental (up to 99 employees)
01/01/2020 Download
Employer Guide - Vision (up to 99 employees)
01/01/2020 Download
Employer Guide - Life (up to 99 employees)
01/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Application-all lines except DHMO
01/01/2020 Download
Employee Application Small Group-DHMO
01/01/2020 Download
Employee Application Large Group 101+-all lines except DHMO
01/01/2020 Download
Employee Application Large Group 101+-DHMO
01/01/2020 Download
Employee Change Form
01/01/2020 Download
Employee Evidence of Health (for life coverage over guarantee issue amount)
01/01/2020 Download
Life Authorization Form (for life coverage over guarantee issue amount)
01/01/2020 Download
Claim Forms
HIPAA Form
01/01/2020 Download
Dental Claim Form
01/01/2020 Download
Vision Claim Form (for out of network reimbursement)
01/01/2020 Download
Life Claim Form
01/01/2020 Download
Form Name Effective Date Download Form
Dental PPO, Vision and Life plan summaries are generated specific for each group and available to download from the Humana quote. Contact your RBG Team with questions.
Steps to Find Benefit Summaries in Your Humana Quote
01/01/2020 Summary
Dental HMO Benefit Summaries
LS100 Plan Summary
01/01/2020 Summary
LS200 Plan Summary
01/01/2020 Summary
LS300 Plan Summary
01/01/2020 Summary
Form Name Effective Date Download Form
General Information
2020 Specialty Producer Guide - Groups 1 to 100
01/01/2020 Download
2020 Producer Partnership Plan
01/01/2020 Download
2020 Standalone Go365 Rate Card - Groups of 100 to 999
01/01/2020 Download
Humana Plans Brochure
01/01/2020 Download
Bundling Discount Flyer
01/01/2020 Download
Lifestyle Discount Program Value Adds for Members
01/01/2020 Download
Dental
Dental Enhanced Preventive Care
01/01/2020 Download
Dental Extended Annual Maximum
01/01/2020 Download
Dental Unlimited Annual Maximum
01/01/2020 Download
Dental PPO Network Flyer
01/01/2020 Download
Provider Search Instructions Dental HMO or Dental PPO
01/01/2020 Download
Provider Search Instructions Dental PPO
01/01/2020 Download
Vision
Vision Coverage Flyer
01/01/2020 Download
Vision Provider Search Instructions
01/01/2020 Download
Form Name Effective Date Download Form
Humana Welcome Letter Contact Sheet Dental
Download
Humana Welcome Letter Contact Sheet Vision
Download