Request a SCAN Form

SCAN Member Requests
As a member of our plan you may ask a question, request a replacement member identification card, request member materials or change your contact information.

Additionally, as a member of our plan, you have the right to get a summary of information about appeals, grievances and exceptions that other members have filed against our plan in the past.
Member Information
Caregiver Information
Contact Information
Request a SCAN Form

Click on the box indicating the form you would like:

Please enter a 5 digit zip code.