Get Member Ssn Exception Request Form - Anthem

Filling out the Member SSN Exception Request Form - Anthem online is a crucial process for those who may not be able to provide their Social Security Number. This guide will walk you through each step of the form to ensure accurate completion.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the Member SSN Exception Request Form and open it in your chosen editor.
2. Enter the member's full name in the designated field. This is important for identifying the individual associated with the request.
3. Provide the member's date of birth in the specified format. Accurate date of birth is necessary to validate the member's identity.
4. If the subscriber or employee name differs from the member's name, fill in that information in the respective section. This helps clarify relationships and responsibilities.
5. Input the subscriber or employee identification number. This number is crucial for processing and verifying the request.
6. Include the employer's name in the provided space. This connects the member to their health plan.
7. Fill out the group number of the member's health plan. This information assists in identifying the correct insurance coverage.
8. Select the appropriate response indicating the reason the member is not providing their Social Security Number. Options are provided for clarity.
9. In the provided space, briefly explain the reason for your selection. A clear explanation helps facilitate the review process.
10. The information must be provided by an individual authorized to fill out the form. Include their signature, printed name, and the date in the designated areas.
11. Once the form is completely filled out, you have several options for submission. You can save changes, download, print for mail, or share the completed form according to your preference.

Complete your Member SSN Exception Request Form online today.