Translated forms and documents

Available materials

The 2023 and 2024 Enrollment Application and other plan documents are available in Chinese, Korean and Spanish for certain plans.

Chinese documents

Applications

Full application – Chinese – 2024

Full application – Chinese – 2025

D-SNP application – Chinese – 2024

D-SNP application – Chinese – 2025

Plan documents

2024 Medicare Transition Policy – Chinese

2025 Medicare Transition Policy – Chinese

Low Income Premium Subsidy

Humana Gold Plus® H3533-033 (HMO)

Summary of benefits – Chinese Brooklyn and Queens, NY – 2024

Evidence of coverage – Chinese – Brooklyn & Queens, NY — 2024

Evidence of coverage – Chinese – Brooklyn & Queens, NY — 2025

Annual Notice of Change – H3533-033 – Chinese – Brooklyn & Queens, NY - 2025

CMS 3533 Plan Star Ratings – 2024

CMS 3533 Plan Star Ratings – 2025

Prescription Drug Guides 20240076PDGCH2449224 – 2024

Prescription Drug Guides – Abbreviated 20250020PDGCH2545625 – 2025

Prescription Drug Guides 20240076PDGCH2449224C – 2024

Prescription Drug Guides – Comprehensive 20250020PDGCH2545625C – 2025

Benefits at a Glance – Chinese – Brooklyn & Queens, NY – 2024

Humana Gold Plus H3533-034-001 (D-SNP)

HumanaChoice® H5525-055 (PPO)

Summary of benefits – Chinese – San Francisco and Marin County, CA – 2024

Evidence of coverage – Chinese – San Francisco & Marin Counties, CA – Chinese – 2024

Evidence of coverage – Chinese – San Francisco & Marin Counties, CA – 2025

Annual Notice of Change – Chinese – H5525-055 — San Francisco, Marin Counties, CA —2025

CMS 5525 Plan Star Ratings – 2024

Prescription Drug Guides 20240056PDGCH2449624 – 2024

Prescription Drug Guides – Comprehensive 20250012PDGCH2545625C– 2025

Prescription Drug Guides - Abbreviated 20250012PDGCH2545625– 2025

Benefits at a Glance – Chinese – San Francisco and Marin Counties, CA – 2024

Provider and Pharmacy Directories

2024

H3533NYHS01ACCH24 – 2024

H3533NYHS01BCCH24 – 2024

H3533NYHS01CCCH24 – 2024

H3533NYHS01DCCH24 – 2024

H3533NYHS01EGCH24 – 2024

H3533NYHS01FGCH24 – 2024

H3533NYHS01GCCH24 – 2024

H3533NYHS01HGCH24 – 2024

H5525CALP01CH24 – 2024

2025

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Hudson Valley

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP New Jersey

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Brooklyn

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Connecticut

H3533 – Chinese - Humana Gold Plus HMO - Humana Gold Plus HMO D-SNP Queens

H5525 – Chinese - Humana Choice PPO San Francisco and Marin Counties, CA

Korean documents

Applications

Full application – Korean – 2024

D-SNP application – Korean – 2024

Plan documents

2024 Medicare Transition Policy – Korean

2025 Medicare Transition Policy – Korean

Annual Notice of Changes – Korean –2025

Humana Gold Plus H5619-155 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Dual Select H5619-165 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) - Korean, King and Snohomish Counties, WA—2025

Evidence of Coverage – Korean – 2025

Humana Dual Select H5619-165 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) - Korean, Select Counties, WA—2025

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) - Korean, King and Snohomish Counties, WA—2025

Summary of Benefits—Korean—2025

Humana Dual Select H5619-155 (HMO D-SNP)

Humana Dual Select H5619-165 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP)

Prescription Drug Guide—Korean—2025

Humana Dual Select H5619-165 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP)

HumanaChoice® H5619 (HMO)

CMS 5619 Plan Star Ratings – 2025

Annual Notice of Changes – Korean –2024

Annual Notice of Changes – Korean – Clark County, WA —2024 

Annual Notice of Changes – Korean – Snohomish County, WA —2024

Annual Notice of Changes – Korean –  Whatcom & Skagit Counties, WA —2024

Annual Notice of Changes – Korean –  Washington state — 2024

Humana Gold Plus SNP-DE H5619-136 (HMO D-SNP)

Evidence of coverage – Korean – Clark County, WA – 2024

Evidence of coverage – Korean – Snohomish County, WA – 2024

Evidence of coverage – Korean – Whatcom & Skagit Counties, WA – 2024

Evidence of coverage – Korean – Washington state – 2024

Summary of benefits – Korean – Clark County, WA – 2024

Summary of benefits – Korean – Snohomish County, WA – 2024

Summary of benefits – Korean – Whatcom and Skagit Counties, WA – 2024

Summary of benefits – Korean – Washington state – 2024

Summary of benefits – Korean – Whatcom and Skagit Counties, WA – 2024

Benefits at a glance – Korean – Clark County, WA – 2024

Benefits at a glance – Korean – Snohomish County, WA – 2024

Benefits at a glance – Korean – Whatcom and Skagit Counties, WA – 2024

Benefits at a glance – Korean – Washington state – 2024

Humana Gold Plus SNP-DE H5619-155 (HMO D-SNP)

Evidence of coverage – Korean – King & Snohomish Counties, WA – 2024

Evidence of coverage – Korean – King & Snohomish Counties, WA – 2025

Summary of benefits – Korean – King and Snohomish Counties, WA – 2024

Summary of benefits – Korean – King and Snohomish Counties, WA – 2025

Benefits at a glance – Korean – King and Snohomish Counties, WA – 2024

Provider and Pharmacy Directories - 2024

H5619WAHS01AGKO24 – 2024

H5619WAHS01BGKO24 – 2024

H5619WAHS01CGKO24 – 2024

H5619WAHS01DGKO24 – 2024

H5619WAHS01EGKO24 – 2024

H5619WAHS03AGKO24 – 2024

H5619WAHS03BGKO24 – 2024

Provider and Pharmacy Directories - 2025

H5619 – Korean - Humana Gold Plus HMO D-SNP Snohomish County

H5619 – Korean - Humana Gold Plus HMO D-SNP Washington

H5619 - Korean - Humana Gold Plus HMO D-SNP King and Pierce Counties

Application forms—2025

Full/Korean Application Form 2025

D-SNP/Korean Application Form 2025