This fall, the State Health Plan is offering in-person sessions, webinars and Telephone Town Halls so you can learn more about your 2027 health plan options in order to make an informed decision for you and your family during Open Enrollment. Visit North Carolina State Health Plan’s website.

Open Enrollment is October 12th to October 30th.

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

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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

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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

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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

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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”