Get Member Social Security Number Exception Request Form - Anthem

Filling out the Member Social Security Number Exception Request Form - Anthem is essential for Medicare beneficiaries who cannot provide their Social Security Number. This guide will help you navigate the process of completing this form online with clarity and ease.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Enter the member's name in the designated field. Ensure that the name matches the records you have with Medicare.
3. Fill in the member's date of birth in the format MMDDYYYY to ensure accurate identification.
4. If the subscriber or employee name differs from the member's name, provide the correct name in the specified field.
5. Include the subscriber or employee identification number for reference.
6. State the employer's name in the appropriate section to link the form with the correct group plan.
7. Input the group number assigned to the member's health plan to facilitate processing.
8. Select the appropriate response to indicate whether the member is not providing or does not have a Social Security Number.
9. In the provided space, briefly explain the reason for your selection clearly and concisely.
10. The individual completing this form must sign in the designated area and print their name below the signature.
11. Finally, provide the date of completion to ensure timely processing of the request.
12. Once the form is complete, you can save the changes, download, print, or share it as needed.

Take action now and fill out the Member Social Security Number Exception Request Form - Anthem online to ensure your benefits are processed correctly.