If you or a family member have coverage through South Carolina Healthy Connections Medicaid, you may receive a review form soon. Learn how to keep your benefits on our
Documents and forms
Find the documents and forms Humana Healthy Horizons® in South Carolina members need to get the most from their enrollment.
Key plan documents
Welcome Kit
All new members get a Welcome Kit in the mail. You also can view it below. Your Welcome Kit includes the information you need at the start of your enrollment in Humana Healthy Horizons® in South Carolina.
Health Risk Assessment (HRA)
The answers you give us on your HRA help us make sure you get the care you need. Your Welcome Kit includes a HRA form and postage-paid envelope in which to return your completed HRA. You also can download a HRA below.
Your Welcome Kit includes information about the many ways you can return your completed HRA to us.
Member Handbook
Have questions about your plan, benefits, and covered services? Check out your Member Handbook.
Comprehensive Drug List
The Comprehensive Drug List is a list of drugs and medicine your plan covers. Your doctor can prescribe you drugs and medicine on this list if needed. We update our Comprehensive Drug List periodically during the year. If we update the Comprehensive Drug List, we will notify you and we will make the new version available below.
Provider Directories
Refer to the Provider Directory in the region where you live to find information about in-network doctors, specialists, healthcare facilities, and more. You also can use our
Region 1 – Abbeville, Anderson, Cherokee, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee, Pickens, Saluda, and Spartanburg
Provider Directory – English and Spanish (Part 1 of 3) Provider Directory – English and Spanish (Part 2 of 3) Provider Directory – English and Spanish (Part 3 of 3)
Region 2 – Aiken, Allendale, Bamberg, Barnwell, Calhoun, Chester, Clarendon, Fairfield, Kershaw, Lancaster, Lee, Lexington, Newberry, Orangeburg, Richland, Sumter, Union, and York
Provider Directory – English and Spanish (Part 1 of 3) Provider Directory- English and Spanish (Part 2 of 3) Provider Directory- English and Spanish (Part 3 of 3)
Region 3 – Beaufort, Berkeley, Charleston, Chesterfield, Colleton, Darlington, Dillon, Dorchester, Florence, Georgetown, Hampton, Horry, Jasper, Marion, Marlboro, and Williamsburg
Provider Directory – English and Spanish (Part 1 of 3) Provider Directory – English and Spanish (Part 2 of 3) Provider Directory – English and Spanish (Part 3 of 3)
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Pharmacy forms
Over-the-counter (OTC) catalog and order form
As a Humana Healthy Horizons in South Carolina member, you can use Humana’s mail-order pharmacy, CenterWell Pharmacy™, which will send medicine to your home.
Your pharmacy benefit lets you order certain over-the-counter (OTC) items through the mail. To get started:
- Look up available OTC items in the Humana Health and Wellness Catalog
- Write down your order on the Order Form
- Submit your order:
- By mail: CenterWell Pharmacy, P.O. Box 745099, Cincinnati, OH, 45274-5099
- By phone: Call 800-379-0092 (TTY: 711), Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. to 6:30 p.m., Eastern time
Prescription drug reimbursement claim form
We hope you don’t have to pay for any medicine out of pocket. If it happens, please fill out the form below to send in a reimbursement claim if you paid out of pocket for a prescription. We will try to pay you back.
Grievance and appeals forms
We want you to be happy with the care you get. We hope you get the best care possible.
If you are not happy with any part of your healthcare plan, Member Services, your doctor, or a facility, you can send in a
You also can appeal a claim or a denied service using
If you are sending an appeal or grievance for another covered member, be sure to fill out an
Legal and privacy notices
The legal and privacy notices below provide information about:
- How Humana uses, and when we might share, your personal information
- Your privacy rights
Individual privacy rights (English and Spanish)
To give us permission to share your medical information with someone, you must complete and send back to us a Consent for Release of Medical Information and a Consent for Release of Protected Health Information.
Performance measurement
Refer to the below information to see how we’re measured as a health plan and also how we’re doing.
Expanded Benefits Reimbursement Form
We hope you don’t have to pay out of pocket for the benefits you get as a Humana Healthy Horizons in South Carolina member. If you do, let us know by filling out a reimbursement claim form, and you may get a refund.
Fill out the form below to send a reimbursement claim.
Humana Healthy Horizons in South Carolina
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