Welcome University of Texas     
 
Home
Enrollment Materials
Your HumanaHMO Benefits
Customer Service
Physician and Hospital Information
Forms
Continuation of Benefits
Certificate of Coverage
Additional Services
Online Member Services
www.humana.com
UT System Employee Group Insurance

Forms

Need to select or change your primary care physician, or would you like to receive prescriptions-by-mail? Use the following forms:

PCP Selection Form: Use this form to register your choice for Primary Care Physician. Complete and mail it to:

Humana Inc.
Automated Enrollment
PO Box 740022
Louisville, KY 40201-7422

Claims Reimbursement Form: Submit this form if you have received emergency care or out-of-area care at a non-network facility and have incurred out-of-pocket expenses. Complete and submit to:

Humana Claims Office
PO Box 14603
Lexington, KY 40512-4603

Prescriptions-by-Mail: Enjoy the convenience of Prescriptions-by-Mail.


  Download Adobe Reader

 

 

Copyright © 2008 Humana Inc.