Providence Health Plan Request for Social Security Number

Employees enrolled in the Providence Health Plans (Statewide & Choice) that are between the ages of 45 and  64,  or have dependents between the ages 45 and 64, have and/or will receive a letter from Providence  requesting the employee to provide Providence with your and your dependent’s Social Security Number (SSN) or to sign an annual waiver that you or your dependents have not received Medicare benefits.

Your response is required.

This is a reporting requirement of the Centers for Medicare & Medicaid Services (CMS) and is intended to help Medicare properly coordinate payment of benefits among plans so that claims are paid promptly and correctly.

Online - register your

  • Enter your Group ID number (from your Providence insurance card)
  • Enter your Member ID number (from your Providence insurance card)
  • Click on “Submit”
  • You will then be prompted to enter the SSN for all of your dependents

By Mail – register your SSN or submit the annual wavier: