Message from Wiley Long
President - ColoHealth
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Humana Apply

Please note that all applications will be submitted in the name of Stephen Adams Jr, the vice president of ColoHealth  If you have already been working directly with one of our Personal Benefits Managers, then that person will be noted in our system as your personal contact.

Before you apply, please view the brochure of the plan you are applying for to see detailed information including Plan Provisions, Limits & Exclusions, and State Variations:


Plan Type Plan Brochure
 Portrait:   Share 80 Plus Rx/Copay Adobe Acrobat Reader Information
 Autograph HSA:    Total Plus Rx/HSA Adobe Acrobat Reader Information  -  Total HSA Adobe Acrobat Reader Information  -  Share 80/HSA Adobe Acrobat Reader Information
 Autograph Non-HSA:   Share 80 Plus Rx/Copay Adobe Acrobat Reader Information  -  Share 70 Plus Rx Adobe Acrobat Reader Information
 Monogram:    Total Plus Rx Adobe Acrobat Reader Information



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The fastest and easiest way to apply for any Humana plan is through their secure SSL Online ApplicationPlease note that you must used Internet Explorer when you use Humana’s online application.

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

If you are not interested in applying online, you have two other options to apply with Humana:

  1. Run 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.  Simply follow the instructions on the first page and complete the application. 

  2. Another way to apply with Humana is to call 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.

    For details on all of the information you should have available before calling Humana, please view the Humana One Application Preparation Sheet below.

Please fill out the application Completely. Any unanswered questions will delay the processing. If you have any questions about filling out the application, you can try to reach one of us by calling at letting the receptionist know that the call is URGENT. You can also email us at, leave your name and phone number, and someone from our office will call you back and answer any application questions you have.

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.

Humana One Application Preparation Sheet

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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- 2045            
  • Requested Effective Date:                                                                                    
  • Requested Medical Deductible:                                                                            
  • Requested Prescription Deductible 
    ($500 - or $0 for an extra premium):
  • Are you requesting Maternity Coverage?                       YES  or  NO                    
  • Are you requesting an office visit co-pay?                     YES  or  NO                     
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

For your convenience, the following payment options are accepted:
  • For the initial payment, Humana accepts MasterCard or Automatic Check Draft.
  • After the initial payment, all payments need to be made either monthly through an
    Automatic Check Draft or 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 applying for spousal coverage, it is necessary to have the primary applicant and their spouse available to authorize any requests for medical information from the Medical Information Bureau (when applicable).
To complete the application process, contact 
Humana's Application Specialists at: