The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure an 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 and should be completed by each person with Medicare or his/her authorized representative. Fields marked with an asterisk (*) are required.
By signing this form, you agree to a meeting with a sales agent to discuss the types of products you indicated above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.
Signing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or enroll you in a Medicare plan.
Also, by signing this form; I acknowledge that David Trout has communictaed to me the following:
We may not offer every plan available in your area. Currently we represent at least 7 Medicare Advantage organizations which offer at least 50 different plan options in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP), to get information on all of your options.
As licensed insurance agents, we are required to follow the CMS rules as to how we work with consumers. These rules are there so you may require the information so you can make the best decision for your coverage. Under a new rule, we are required to have this completed 48 hours prior to an appointment. And, this SOA is valid for 12 months so we may collect this from you well in advance of our discussion. Thank You .