Scope of Sales Appointment Confirmation
The Centers for Medicare & Medicaid Services requires agents to document the scope of a marketing appointment prior to any individual sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential.
Initial beside each product type you'd like to discuss
A stand-alone drug plan that adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans.
Medicare Advantage Plans, including HMO, PPO, PFFS, and HMO-POS plan types, provide all your Part A and Part B benefits — and often Part D prescription drug coverage — through a private plan approved by Medicare.
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By signing, I confirm I want to discuss the products I initialed above. No signature obligates me to enroll, affects my current or future Medicare enrollment status, automatically enrolls me, or affects my benefits.