A granddaughter hugging her grandparents.

You and your Medicare-eligible family members can benefit from the comprehensive healthcare program that North Carolina State Health Plan and Humana provides. 

Continue reading to learn about your plan benefits, additional resources and how to get in touch with Humana to answer any of your questions.

Humana provides coverage for State Health Plan Medicare-eligible members under a Group Medicare Advantage PPO and Prescription Drug Plans. These plans offer a “passive” network, which allows you to continue seeing your current healthcare provider regardless of being in or out of Humana’s network. If your healthcare provider participates in Medicare and agrees to bill Humana, you can continue with the doctor you see today—even if they are out of network.

There is a provider flyer that you may download and print to give to your healthcare provider that explains how the State Health Plan Humana Group Medicare Advantage PPO and Prescription Drug Plans works. 

Provider flyer

Member events

If you’re looking for additional information, including details about our informational meetings and other useful resources, you may find what you need here.

The 2026 Bringing Humana to You (BH2U) educational seminars will be available throughout the year. These seminars are for our new retirees, as well as current retirees who may want a refresher on everything their healthcare plan has to offer. Topics include an overview of the plan benefits, SilverSneakers® and the Go365 by Humana® rewards program, and resources and tools available through our North Carolina State Health Plan custom website.

  • Humana Group Medicare Advantage PPO and Prescription Drug Plans
  • SilverSneakers® fitness program
  • Go365 by Humana–Humana’s wellness and rewards program

You’ll also have available resources on your.Humana.com/ncshp, including coverage documents and helpful online tools.

These events are offered through the State Health Plan’s Humana Group Medicare Advantage PPO and Prescription Drug Plans at no extra cost to you.

State Health Plan retirees are invited to attend an informative presentation about your benefits. Register for an online session that is convenient for you to learn more.”

Coverage and communications

2026 Plan Information 2025 Plan Information

2026 State Health Plan Medical Annual Notice of Change – Base

2026 State Health Plan Prescription Annual Notice of Change – Base

2026 State Health Plan Medical Annual Notice of Change – Enhanced

2026 State Health Plan Prescription Annual Notice of Change – Enhanced

2026 State Health Plan Medical Evidence of Coverage – Base

2026 State Health Plan Prescription Evidence of Coverage – Base

2026 State Health Plan Medical Evidence of Coverage – Enhanced

2026 State Health Plan Prescription Evidence of Coverage – Enhanced

2026 State Health Plan Medical Summary of Benefits – Base

2026 State Health Plan Prescription Summary of Benefits – Base

2026 State Health Plan Medical Summary of Benefits – Enhanced

2026 State Health Plan Prescription Summary of Benefits – Enhanced

2026 State Health Plan Prescription Drug Formulary

2026 Rx Transition Fill Policy

2026 State Health Plan Enrollment Packet

2026 State Health Plan Guide

2026 Value Added Items and Services (for residential addresses in all states except Florida and Puerto Rico)

2026 Value Added Items and Services (for residential addresses within Florida)

2026 Value Added Items and Services (for residential addresses within Puerto Rico)

Tools and resources Member forms Flyers

Find care

Use Humana’s Find care tool to help find nearby doctors, hospitals and other healthcare providers in the Humana network. You can get phone numbers, addresses and maps, customize your search by specialty and see the distance from your home or work.

Find care

Medication Adherence

Taking your medicine every time as prescribed by your doctor can help you manage your conditions and reduce the risk of complications. Forgetting to take your medicine or skipping doses for conditions such as high blood pressure or heart disease may lead to unwanted results. For example, missing doses may increase your risk of heart attack, stroke, kidney failure or other health problems.

For information and helpful tips, review Why you should take your medicine .

Pharmacy finder

Locate a pharmacy in your area by selecting the link below, using a ZIP code or your Humana member ID. Then select the Humana Medicare Employer Plan (Group) Network.

Find a pharmacy

You have the choice of pharmacies for prescription retail and mail-order services. CenterWell Pharmacy™ is one mail-order pharmacy option. With a mail-order pharmacy, like CenterWell Pharmacy, your medications will securely ship to your home. Using a mail-order service may help you follow your prescribed treatment schedule with convenient, no-contact mail delivery. Also, some in-network pharmacies, like CenterWell Pharmacy offers order tracking, refill reminders and automatic refills. See if a mail-order pharmacy, like CenterWell Pharmacy is right to meet your prescription needs. Other pharmacies are available in the network.

Explore CenterWell Pharmacy

Your diabetic supplies—needles and syringes, test strips, lancets and meters—are covered through your State Health Plan Humana Group Medicare Advantage Preferred Provider Organization (PPO) Plan. This plan covers a variety of diabetic testing supplies. Select the links below to learn more

True Metrix® voucher

Accu-Chek® voucher

Everyone needs a little help now and then. Many people trust a family member or close friend to help them with their healthcare, someone who may help you talk with us about your insurance plan, keep track of your benefits and claims, or ask healthcare questions on your behalf.

With Humana’s resources and tips, caregivers can find the support they need to help their loved ones.

Caregiver resources

As a member of the State Health Plan Humana Medicare Advantage PPO and Prescription Drug Plan, we are excited to offer you the Health and Well-being Assessment (HWA) program.

A licensed clinician comes to your home for an HWA. Humana works with Signify Health (Signify) to schedule and complete the HWA for our state health plan members. The assessment is not a substitute for regular healthcare provider visits, but it does help to provide another layer of support for you.

This program is optional, available at no additional cost to you as part of your Humana plan and does not affect your health plan rates or benefits. The results are shared with your primary care physician via Signify to better understand your whole health picture. The assessment provides valuable information to you and your healthcare provider that you may not have had time to discuss.

After completing a visit, you will receive a $15 Walmart gift card* in the mail.

Learn more about the HWA program

Your safety is our highest priority. Signify providers follow the Centers for Disease Control and Prevention (CDC) guidelines to protect you during your assessment. They are required to self-screen for COVID-19 symptoms before the assessment and utilize personal protective equipment (PPE) during the assessment. A virtual option may be available.

* This gift card cannot be used to purchase prescription drugs or medical services covered by Medicare, Medicaid or other federal healthcare programs, nor alcohol, tobacco, e-cigarettes or firearms. This card may not be converted to cash.

Schedule your Annual Wellness Visit

It's covered by your Humana Medicare plan.

Make the most of your plan. It's worth it to use all the benefits of your coverage, especially your Annual Wellness Visit. There's no cost to you, and you can earn $25 in rewards from Go365 by Humana® for completing your visit.

Your Annual Wellness Visit is a great way to create a personalized plan for managing your health. It is not a typical checkup or physical. It's a relaxed conversation between you and your doctor—with more time to focus on protecting your overall wellness and health.

You can also schedule a preventive physical examination each calendar year. This includes a head-to-toe checkup, medical history, routine tests and screenings as recommended by your doctor. 

Don’t have a doctor or want to switch? Find care.

Learn more: Medicare Annual Wellness Visit

Flu season begins in October and typically peaks between December and February. Some years it lasts as late as May. You can receive your annual flu shot at no cost to you and you can earn $5 in rewards from Go365 by Humana® for receiving your annual flu shot.

It’s recommended to get a flu shot every year for a few reasons:  

  • Your body’s immune response from the vaccination naturally declines over time, and flu viruses change constantly. 
  • You should try to get your shot early before flu season begins because it takes about 2 weeks to become effective.
  • You can still get the shot after flu season has begun, but you’re at risk of catching the flu until the vaccine becomes effective.

Learn more about the flu shot

Extra benefits and services

Discover your path to wellness. Go365 by Humana® gives you personalized activities—as well as tracking, support, and rewards—to keep you inspired along the way. Get detailed information about the Go365 wellness and rewards program available to you.

Use your MyHumana account credentials to access Go365. To get started with Go365 or register for your MyHumana account, visit Go365

Go365 flyer

Go365 Activity Tracker

A health coach works with you to create a personal vision for your health and well-being, brings clarity to your goals and priorities and provides accountability and support. 

Go365 Wellness Coaching flyer

 

Your Humana Medicare Advantage Plan includes the SilverSneakers® Fitness Program—a fitness membership at participating fitness centers at no additional cost.

Learn more about SilverSneakers 

SilverSneakers flyer

Humana Well Dine 

Receive 28 nutritious meals delivered to your door at no cost—courtesy of Humana—after an overnight hospital or nursing facility stay. Choose from regular, diabetic, puree, vegetarian, kosher and renal-supportive meal options.

Call the Humana Well Dine® food program at 866-96MEALS (866-966-3257). You can reach us Monday – Friday, 8 a.m. – 9 p.m., and Saturday, 9 a.m. – 5 p.m., Eastern time.

Visit Humana Well Site

Humana Well Dine Flyer   

Post-discharge personal home care

After a member’s overnight in-patient stay in a hospital or nursing facility, members may receive assistance performing daily living activities within the home. Types of assistance include bathing, dressing, toileting, walking, eating and preparing meals 

If you would like more information about this post-discharge benefits, please contact the dedicated North Carolina State Health Plan Humana Customer Care department at 888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. – 9 p.m., Eastern time.

Post-discharge transportation services

After a member’s overnight in-patient stay in a hospital or nursing facility, members are provided transportation to approved locations by car, van or a wheelchair-accessible vehicle at no cost.

If you would like more information about this post-discharge benefits, please contact the dedicated North Carolina State Health Plan Humana Customer Care department at 888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. – 9 p.m., Eastern time.

Humana Care Management is a service offered through your Humana Medicare Advantage plan at no extra cost for members with a qualifying condition. Our care managers will help you make the best choices regarding your health. Eligible members will develop a care plan with a care manager who will check in on a member's progress. We will then follow up to make sure the service is working for you.

Visit Humana Care Management

Humana Care Management flyer

Connect with a provider or behavioral health professional* virtually

Your primary care provider and your specialist may offer virtual visits. Virtual visits connect you with your healthcare provider via telephone or video chat using your phone, tablet or laptop.† With virtual visits, you can talk with a provider from the comfort of your home. These visits are private, secure and confidential. 

Providers are available to treat many conditions, including, but not limited to:

  • Allergies
  • Fever
  • Cold and flu symptoms
  • Insect bites
  • Stress
  • Anxiety
  • Depression

Learn more about telehealth

Virtual visits may be able to address other needs, such as changes to medicines and refills, ordering labs, tests or screenings, and helping with the management of chronic conditions.‡

Call your provider to find out if they offer virtual visits and if so, what you need to do to get started. 

If you don’t have a primary care provider or if your PCP doesn’t offer virtual visits, you can use the Find care tool on Humana.com or call the number on the back of your member ID card to get connected with a provider that offers this service.

* Behavioral health visits are by appointment.

† Standard data rates may apply.

‡ Not all in-network providers offer telehealth services.

There’s a difference between a grievance and an appeal.

Grievance 

A grievance is a complaint that expresses dissatisfaction with any aspect of the operations, activities or behaviors of a Humana plan, including the provision of plan benefits, such as care provided by in-network healthcare providers. A grievance isn’t submitted to dispute a denied claim or service; an appeal is used in these cases. Humana may take up to 30 days from the date it receives a grievance to respond. Visit our Medicare grievance page for detailed information on how to submit a grievance by mail, fax or phone.

Humana Medicare members can also use our online form to submit a grievance.

Appeal

An appeal is a request for Humana to reconsider the plan’s decision made about the member’s benefits. Some examples of what an appeal may involve are:

  • How a claim was denied, partially denied or paid
  • A request or authorization for a medical service, medical equipment or prescription that was denied

Visit our Exceptions and appeals page for information on submitting appeals by mail, fax and phone. Humana Medicare members can also use our online form to submit an appeal. This online form is not used for expedited appeals.

Expedited appeals 

A request for an expedited (fast) appeal can be submitted if the standard response time frame could seriously jeopardize the member’s life, health or ability to regain maximum function. Expedited appeals aren’t used for claims that have already been paid or denied. 

Visit our Medicare expedited appeals page for information on submitting an expedited appeal. Humana has 72 hours to respond with a decision after receiving an expedited appeal.”

Standard response time frames

Once Humana receives an appeal, we’ll issue a decision within the following time frames based on what’s being appealed:

  • Denied or partially denied medical claim: 60 calendar days
  • Denied prescription claim: 14 calendar days
  • Denied request or authorization for a medical service or medical equipment: 30 calendar days
  • Denied request or authorization for a prescription: 7 calendar days”

Appointment of Representative

When a request for a grievance or appeal is submitted by someone other than a member, an Appointment of Representative (AOR) form or other types of legal authority documentation is required. Visit our How to appoint a representative page for detailed information and the AOR form. The completed form or document is mailed or faxed with the grievance or appeal. If submitting the grievance or appeal by phone, use the appropriate mailing address or fax number below.

Humana Grievance and Appeal Department
P.O. Box 14165
Lexington, KY 40512-4165
Fax: 855-251-7594”

To report suspected fraud, waste or abuse, you can contact Humana in 1 of these ways:

  • Phone: 800-614-4126 (TTY: 711), Monday – Friday, 8 a.m. – 4 p.m., Eastern time
  • Fax: 920-339-3613
  • Email: siureferrals@humana.com 
  • Mail: Humana, Special Investigation Unit, 1100 Employers Blvd., Green Bay, WI 54344

Visit our Addressing fraud, waste and abuse page for more information.

Learn more

Have questions?

Call Humana’s Group Medicare Customer Care team at 888-700-2263 (TTY: 711), Monday – Friday, 8 a.m. –9 p.m., Eastern time.

MyHumana sign in

Sign in securely to view your account information. Sign in 

State Health Plan members can register for MyHumana using your Humana ID number or your Medicare number. Register now

Contact North Carolina State Health Plan

For eligibility questions, please contact the Plan’s Eligibility and Enrollment Support Center at 855-859-0966, Monday – Friday, 8 a.m. – 5 p.m., Eastern time.

All product names, logos, brands and trademarks are property of their respective owners, and any use does not imply endorsement.

Some links on this page may take you to Humana non-Medicare product or service pages or to a different website.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis race, color, national origin, age, disability, sex, sexual orientation, gender, gender identity, ancestry, ethnicity, marital status, religion, or language. We also provide free language interpreter services. See our full accessibility rights information , non-discrimination disclosure , and language options.

Humana is a Medicare Advantage PPO organization and a stand-alone PDP prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.