Member Address Change Request

I want to request an address change.

Agent Name Agent NPN Agent Email Address Agent Last 4 digits SSN Member First Name Member Last Name Member ID or Medicare Number Member DOB Member Email Address

NEW Address:

Member Address 1 Member Address 2 Member City Member State Member Zip Code Address Type: Update permanent address Update mailing address Permanent and mailing address is the same
Important Information:

* Please note changes may take up to 7 business days for completion. Members will need to be contacted by SCAN before certain changes are completed.

Attestation:

* By clicking “Submit”, you attest that, as a licensed sales agent, you are requesting the above changes on the subject member’s behalf. You also attest that these changes were requested by the member, and that you have not and will not receive any compensation, inducement, or incentives for assisting the member with these changes.
* You further attest that, prior to submitting these changes, you have discussed them with the member and have received consent to request these changes on the member’s behalf.

Once you click Submit, you'll be redirected back to the Contact Us page.

Please click on the above Submit button only once.

Member Address Change Request

I want to request an address change.

NEW Address:

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