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Humana Supply Request Form – Job Aid

Humana Supply Request Form is used to reorder Humana products and brochures specific to your state. The Supply Request Form can be grouped into six sections: Order/Shipping Information Summary of Benefits Formularies Provider Directories Brochures Additional Items

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Humana Supply Request Form – Job Aid

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  1. Humana Supply Request Form is used to reorder Humana products and brochures specific to your state. • The Supply Request Form can be grouped into six sections: • Order/Shipping Information • Summary of Benefits • Formularies • Provider Directories • Brochures • Additional Items • 1. Order/Shipping Information • Requestor Name – Name of person completing the Supply Form • Date – Date the form is being completed • ATTN – Name of person that materials should ship to • Street Address/City/State/Zip – Address that should receive the materials (PO Boxes not allowed) • Email Address – order confirmation will be sent to this address 1 2 3 4 5 6 Humana Supply Request Form – Job Aid Amount of agents this order supports – required field, justifies the quantities requested • Place the order in sections 2-6: • Use the drop down buttons on the form to select the appropriate item (note: drop down button appears once field is selected) • Use the up and down arrows to scroll through the listings to identify the desired items • Once the desired items are selected, enter a quantity next to each item. Do not exceed quantity maximums. -1- September 2012

  2. Summary of Benefits • Order any materials that are either State or Plan specific from this section. -- Locate the Product type first (HMO, PPO, PFFS, PDP) -- Find the state -- Identify the Plan ID to be ordered by the first 8 characters (see below) • Formulary Order any materials that are either State or Plan specific from this section. -- Locate the Product type first (HMO, PPO, PFFS, PDP) • -- Find the state • -- Identify the Plan ID to be ordered by the first 8 characters (see below) H2012-051 H2012-051 Humana Supply Request Form – Job Aid • Provider Directories • Order any materials that are either State or Plan specific from this section. • -- Locate the Product type first (HMO, PPO, PFFS, PDP) • -- Find the state • -- Identify the area of the state the directory is needed HMO Directory for Birmingham, AL • Brochures • Order Sales, Point of Purchase (POP) and Educational Brochures from this section. • Additional Items • Order Applications, Abbreviated Applications, Business Reply Envelopes, MAPD and PDP Sales Presentations as well as miscellaneous forms from this section. •  Supply Form Submission  • Reorder Quantity limits for 2013 can be located at the bottom of the supply form along with additional ordering guidelines. Reorder requests must stay within the quantity limits per agent for the order to successfully process. • E-mail the supply request form to agentsupport@humana.com (or fax to 502-508-0062) for quick and efficient processing time. -2- September 2012

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