Humana Apply

Please note that all applications will be submitted in the name of Wiley Long, the president of HSA for America.  If you have already been working directly with one of our advisors, then that person will be noted in our system as your personal contact. Before you apply, be sure to view your Humana state brochure PDF below for the Autograph plan you are interested in.  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.

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Click here for these states: AL, AR, IA, IN, NE, NV, OK, SC, UT, and VA

Apply Online

The easiest way to apply with Humana is through their Secure SSL Online Application.  Please note that you must used Internet Explorer when you use Humana’s online application. 

Internet Explorer required

Gather the following information before you start the application in order to speed the process:

1. Your doctors’ names, addresses, and phone numbers
2. Medications you currently take or recently took, including dosage and frequency
3. Dates of hospitalization
4. The name of the plan for which you are applying
5. Your requested effective date
6. Your credit card information to cover the initial premium

Apply by Phone, Fax or Mail

You also have two other options to apply with Humana:

1. You can submit a paper application by running an instant quote, then click "Apply" next to the plan you are interested in and select "download an application."  When the Adobe Acrobat reader opens with the application, use the menu bar at the top to save the application to a file or simply print it out right from the reader.  Follow the instructions on the first page and complete the entire application.

   Please fill out the application completely and include all pages.  Any unanswered questions will delay the processing.  If you have any questions about filling out the application, call application processing department at 866-749-2039, or email us at info@HSAforAmerica.com, leave your name and phone number, and someone from our office will call you back and answer any application questions you have.

   Fax your application toll-free to 1-888-771-0010.  Or Mail it to:

   HSA for America
   1001-A East Harmony Road, #519
   Fort Collins, CO 80525

2. You can also apply with Humana over the phone by calling 1-800-211-4561, and you will be connected with an underwriter on the spot.  Please note that you must let the underwriter know that Wiley Long is your agent.  This will enable us to track your application through underwriting, and to assist you with any questions.  The phone call generally takes from 15 to 30 minutes.  However, the call can go longer based on the number of people applying for coverage and medical history, and there is the chance that you may be on hold for up to 30 minutes before someone can speak with you.
   
   If your spouse is also applying for coverage, you both need to be available to authorize any requests for medical information from the Medical Information Bureau, if necessary.
   
3. For details on all of the information you should have available before calling Humana, please view the Humana One Application Preparation Sheet below.

Note:  All policies come with a money-back guarantee.  After receiving your policy, you have 10 days to review it.  If for any reason you decide not to keep the policy, you will receive a full refund of your initial premium.  Remember that you also have access to the guaranteed lowest life insurance rates available, with easy online quotes and applications.

In order to better assure the application process goes smoothly, we strongly encourage you to
prepare for the call by having the following information available prior to placing the call.

Name of Agent Writing the Policy/Agent of Record:                Wiley Long            


Agent's Business Telephone Number:                                  866-749-2039            


Requested Effective Date:                                                                                    


Requested Medical Deductible:                                                                            

Please make sure the following information is available for each person applying for coverage:

Birthdate 


Social Security Number   


Height/Weight    


Current/past prescription medications and their dosage


Medical history including diagnosis, treatment, dates of service and current status


Date of last Doctor office visit


Doctor's names, addresses and phone numbers


Information on current and past insurance coverage including:  policy number,
effective dates, termination dates, and phone number

PAYMENT OPTIONS:

For your convenience, the following payment options are accepted:

• For the initial payment, Humana accepts Visa, MasterCard or Automatic Check Draft.
• After the initial payment, all payments need to be made either monthly through an
  Automatic Check Draft or they can be paid quarterly or semi-annually by direct bill to you
  ($10 administrative charge per direct bill).
  

Additional helpful hints:

• Application calls can generally take from 15 to 30 minutes.  However, the call can go longer based on
  the number of people applying for coverage and medical history.
  
• If you are applying for coverage for your spouse also, please have your spouse available to authorize any requests for medical information from the Medical Information Bureau (when applicable).