- Step 1:
Click on "Download the Enrollment Form" to open the Humana Part D Enrollment Form (saved as PDF)
- Trouble opening the Medicare Part D Enrollment Form? - Download and install the Adobe Reader (link below
- Step 2:
Simply Print the Medicare Part D Enrollment Form.
- Step 3:
Complete the Simple 3 Page Enrollment Form
- Pages 1, 2, & 3 of the download are instructions/examples
- Pages 4, 5, & 6 are the actual enrollment form
- Having problems? We can help - Give us a call and we can answer your questions, or fill out the enrollment form for you and mail it to you.
- Step 4:
Once you have completed the enrollment form, please make a copy for your records and mail the signed original to:
Our Mailing Address:
JustHealthQuotes.com
Attn: Humana Part D Enrollment Dept.
5036 Dr. Phillips Blvd., Suite 293
Orlando, FL 32819
When you send us your enrollment form, we will check it to be sure that it is complete and properly signed.
If you have any questions, please call us at 1-888-925-Quote (7868).
