2015 Humana OTC Health and Wellness Products Catalog
This document is the 2015 catalog and order form for Humana's over-the-counter (OTC) health and wellness products. It provides instructions on how to place an order through RightSource. You will also find information on benefit limits and payment methods.
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How do I fill this out?
To fill out this form, you need to complete your personal information and product selection accurately. Ensure to submit your order before the 20th of each month to process within the applicable benefit month. Remember, if your order exceeds the benefit amount, include payment for the remaining balance to avoid delays.
How to fill out the 2015 Humana OTC Health and Wellness Products Catalog?
1
Complete your personal information.
2
Select the products you wish to order.
3
Ensure your order is within the benefit amount limit.
4
Include payment if the order exceeds the benefit amount.
5
Submit the order form before the 20th of each month.
Who needs the 2015 Humana OTC Health and Wellness Products Catalog?
1
Humana plan members who have OTC benefits and want to utilize them.
2
Individuals looking to purchase health and wellness products from Humana's RightSource pharmacy.
3
Humana members who need to regularly order OTC products for health maintenance.
4
People who prefer mail-order pharmacies for their OTC needs.
5
Anyone aiming to maximize their health plan benefits through OTC product purchases.
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Add your legally-binding signature.
On PrintFriendly, you can sign this PDF form digitally using our signature tool. Add your signature directly to the form without needing to print. Submit the signed document easily to RightSource for processing.
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With PrintFriendly, you can edit this PDF form effortlessly using our intuitive PDF editor. Modify personal details, update addresses, and adjust product selections directly in the file. Save and download the edited form to submit it accurately.
1
Open the PDF form on PrintFriendly.
2
Enter your personal details in the designated fields.
3
Select the desired OTC products to order.
4
Make any necessary updates to addresses or phone numbers.
5
Save and download the edited form.
What are the instructions for submitting this form?
To submit this form, you can mail it to RightSource, PO Box 1197, Cincinnati, OH 45201-1197. Alternatively, fax the completed form to 1-800-379-7617 or place your order online at RightSourceRx.com. Ensure all information is complete and include payment if your order exceeds the benefit amount. It is advisable to keep a copy of the submitted form for your records.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, submit your orders before the 20th of each month to ensure processing within the applicable benefit month. Start submitting from January 1st of each year.
What is the purpose of this form?
The purpose of this form is to allow Humana members to utilize their over-the-counter (OTC) benefits for health and wellness products. Members can select desired products and place orders through Humana's RightSource mail-order pharmacy. This form helps in tracking and managing monthly OTC product orders efficiently.
Tell me about this form and its components and fields line-by-line.
- 1. Member ID: Enter your Humana ID card number.
- 2. Date of birth: Provide your date of birth in MM/DD/YYYY format.
- 3. First name: Enter your first name.
- 4. Last name: Enter your last name.
- 5. Street number and name: Provide your street address.
- 6. Gender: Select 'Male' or 'Female'.
- 7. Apt/Suite #: Enter your apartment or suite number if applicable.
- 8. City: Enter your city of residence.
- 9. Daytime phone: Provide your daytime phone number.
- 10. State: Enter your state of residence.
- 11. Evening phone: Provide your evening phone number.
- 12. ZIP code: Enter your ZIP code.
- 13. New address checkbox: Check if this is a new address.
- 14. Product code: Enter the code of the product you wish to order.
- 15. Product name: Enter the name of the product you wish to order.
- 16. Quantity: Enter the quantity of the product you wish to order.
What happens if I fail to submit this form?
Failure to submit this form will result in a delay in the shipment of your order. Ensure to submit the form and payment in full to avoid issues.
- Delay in shipment: Your order might not be shipped on time if the form is not submitted correctly.
- Unprocessed orders: Orders exceeding benefit amounts without payment will remain unprocessed.
How do I know when to use this form?
- 1. Ordering OTC products: Use this form to order OTC health and wellness products.
- 2. Submitting payment: Include payment information if your order exceeds your benefit limit.
- 3. Updating information: Use the form to update addresses or phone numbers.
Frequently Asked Question
Can I edit this form online?
Yes, you can edit the form online using PrintFriendly's PDF editor.
How do I submit the completed form?
Submit the form via mail, fax, or online through RightSource's website.
Where can I find my benefit information?
Your benefit information is available on your Humana ID card or by contacting RightSource.
Can I order products for future months?
Yes, orders can be placed for the current or a future month.
What happens if my order exceeds the benefit amount?
Include a check, money order, or credit card information to cover the remaining amount due.
Who do I contact for questions about the form?
Contact RightSource at 1-855-211-8370 (TTY: 711) for any questions.
Can I sign the form digitally?
Yes, you can sign the form digitally using PrintFriendly's signature tool.
How do I share the completed form?
Share the form via email or direct link using PrintFriendly's sharing feature.
When should I place my order?
Place your order before the 20th of each month to ensure processing within the applicable benefit month.
What if my personal information changes?
Update your new address or phone number on the form before submission.
