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SSN Exception Request Form from Anthem

Oct 26, 2011


Should a member, enrolling in Anthem Blue Cross Small Group, be unable or unwilling to comply with the request to provide their Social Security Number (SSN), the Member Social Security Number Exception Request Form must be completed and returned to Anthem so Anthem may comply with the federal law.

IMPORTANT NOTE
: This form will be required at least once every 12 months, as long as the member continues to be unable or unwilling to provide their SSN.

Please contact any member of your b&p Sales Team for assistance with this requirement - 888.722.3373.
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