Download and print enrollment forms
Small Business 2-50 Enrollment Checklist PDF Document (67 KB) Download PDF
Small Business 51-99 Enrollment Checklist PDF Document (66 KB) Download PDF
Specialty Benefits 2-99 Enrollment Checklist PDF Document (64 KB) Download PDF
Enrollment change forms
ACH Form
Attestation Form

Small Business and Large Group Forms

Application & Enrollment Forms

Get employer applications, employee applications, and other supplemental enrollment forms.

Please log in to the agent secure section to order larger quantities or contact your Humana Market Office.

List Enrollment

Submit employee enrollment through our list enrollment spreadsheets. Using list enrollment allows for cases to be enrolled faster, reduces missing information, and provides employers and employees plan information sooner!

List Enrollment — Use for employer Medical and Specialty benefit plans (Dental, Vision, Life, Disability and Workplace Voluntary products).

List Enrollment User Guide — Provides an overview of when the List Enrollment can be used and the information that is needed when the list enrollment is used.

Level Funding Plans

Level Funding Premium Plans – Brochure