Humana 2-50


Humana Inc., is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. The company’s strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country.

New Business Submission forms:

Employer Forms-

Small Business Enrollment Checklist

2015 Group Application-Medical Only

2015 Group Application- Medical and Ancillary

ACH Authorization Form

Attestation Form

HSA Election Form

HSA Contribution


Employee Forms-

2015 Utah Universal Application

Employee Application- Ancillary


Please note most of these forms can be completed online and the submission process will be faster. Please click on the Small Business Enrollment Checklist for the links.


Servicing Forms:

Employee changes-

Change of address, change of name, dependent add or removal, and employee terminations.

Employee Change or Termination form


New Hire-

2015 Utah Universal Application

Employee Application- Ancillary


For quote and rate information for Humana please contact our staff.


Provider Search:

Please click the below link for an up-to-date provider search.

The forms posted on this page are for 2017. If you are interested in any forms for previous years or any pre-ACA plan forms please contact our staff.

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