2026 Humana Health and Wellness Product Order Form at a glance
What it is: 2026 Humana Health and Wellness Product Order Form: plans with an over-the-counter (OTC) allowance allow you to purchase OTC health and wellness products from CenterWell Pharmacy.
Where and when to file: If you have a monthly allowance, submit your order by the 20th of each month.
A filled-in 2026 Humana Health and Wellness Product Order Form example: a member orders one product within the allowance
How to fill out 2026 Humana Health and Wellness Product Order Form, box by box
Member ID, Date of Birth, First Name, Last Name and MI
Enter your Member ID (found on Humana ID card) and your Date of Birth.
Enter your First Name, Last Name and MI.
Street Number, Street Name, City, State and ZIP Code
Enter your Street Number, Street Name and Apt/Suite #, and the Urbanization Code (for Puerto Rico addresses only).
Enter your City, State and ZIP Code, then your Daytime Phone and Evening Phone, and check the box if this is a new address.
During which month would you like to receive this order?
During which month would you like to receive this order? If a month is not selected, your order will be processed the month your request is received.
PAYMENT INFORMATION
If your total order is less than your plan's allowance, you DO NOT need to include payment and you will receive the items you ordered.
If your order exceeds your plan's allowance, please include a check or money order to pay the remaining amount due.
If you order over your allowance and you have the Humana Spending Account Card with a Healthy Options Allowance, check this box to apply the remaining balance to your Healthy Options Allowance on your Humana Spending Account card.
Do not send cash.
To make a payment using your credit card, please call 855-211-8370 (TTY:711). Please allow 5 business days for your order to be received before calling to make payment.
If your order exceeds your plan's allowance, check this box to authorize CenterWell Pharmacy to charge your credit card on file.
PRODUCT SELECTION
Write in the quantity of the product you would like to receive, not the package size listed in catalog.
For each product, enter the Product Code, Product Name and Quantity, and the Price.
Your total order amount, OTC allowance and Total remaining amount due
Enter Your total order amount, the OTC allowance and the Total remaining amount due.
Sales tax may apply to items based on state tax regulations
More rules for 2026 Humana Health and Wellness Product Order Form
Orders can take 5-7 business days to be delivered from the time your order is received.
Common questions about 2026 Humana Health and Wellness Product Order Form
Is there a deadline?
If you have a quarterly allowance, submit your order by the 20th of the last month of your allowance period. Last month of quarters are March, June, September, and December.
Where do I file it?
To order by mail, send the completed Humana Health and Wellness Product Order Form page along with payment (if needed) to: CenterWell Pharmacy P.O. Box 1197 Cincinnati, OH 45201-1197
Sources
[1] 2026 Humana Health and Wellness Product Order Form, Humana (the Official source link on this page).
