If you would like a SCAN representative to contact you and answer your questions, schedule an appointment to come to your home and discuss benefits, or to enroll, simply complete the information below. You will be contacted within two business days. You can also request additional information about SCAN be sent to you. Se habla español. Thank you for your interest in SCAN. * Required Information Name First Last Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware D.C. Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Phone Number Area Code - Phone Number Extension Preferred Time to Call Please send me more information about SCAN and SCAN benefits Please have a SCAN representative call me at the phone number indicated