Scope of appointment

By Ed Crowe | Agent blog | 0 comment | 2 April, 2019 | 0

Scope of appointment

If you are a broker/agent who sells Medicare products, you need to understand the use of a Scope of appointment. A scope of appointment is a form that the CMS requires agents/brokers to use. If you conduct marketing activities, you may not market any health care product that the beneficiary has not agreed to and specified on the scope of appointment. Before you meet any client to talk about Medicare Advantage or Part D prescription drug plans, you must get a scope of appointment form from the client.

Agents are only authorized to discuss products that were agreed upon in advance with clients.

Scope of appointments are required for:

Meetings/appointments with either new or existing clients. These meetings can take place in office, a client’s home, coffee shop or any other location.

Scope of appointments are NOT required for:

Either formal or informal Sales events, because they are reported to the CMS beforehand.

During educational events, you cannot distribute, display or collect SOAs.

If you are giving a Medicare supplement presentations. Although, you should get a SOA before a Medicare Supplement appointment so you can offer PDP plan options if your client asks about them during your appointment.

New rule for SOA’s

In 2018, the Centers for Medicare & Medicaid Services had the following rule about SOAs:

“When conducting marketing activities, in-person or telephonically, a Plan/Part D Sponsor may not market any health care related product during a marketing appointment beyond the scope that the beneficiary agreed to before the meeting. The Plan/Part D Sponsor must document the scope of the appointment prior to the appointment.”

What is different in this statement is; the wording that stated you need to collect the SOA 48 hours before your scheduled appointment now just says you need to collect the SOA before the meeting. That gives no actual time line as to how far in advance the scope must be signed. Although currently, the Medicare Communications and Marketing Guidelines (MCMG), still say that you must document SOAs “prior to the appointment,” you can take that to mean; scopes you collect on the day of the appointment are still compliant. These new guidelines can make the whole sales appointment process easier. You will not have to deal with the delay of waiting 48 hours after collecting the SOA to conduct your appointment. Your client can meet with you sign the scope and apply for a health plan in one meeting.

In the event that your client mentions another health product not on the SOA;

You can simply get a new SOA to add that product and continue with your meeting. If your client wants to discuss non-health products, you will have to make an appointment for another day to do that. If you take the SOA at the time of the appointment, you must give a reason for doing so. You can list reasons such as, walk in or scope change.

Please Note:

Each carrier may have different rules for collecting SOAs, so you should be aware of these rules and conduct your business accordingly.

You can only use CMS approved SOA forms. You should not make your own form.
The client will need to initial next to each product they wish to discuss at the appointment and sign the SOA form. The agent must complete the rest of the form.
Each SOA is valid until you use it or until the end of the applicable election period. If you have another client meeting you will need to fill out a new SOA.

The CMS requires the following information to be on the scope of appointment form or on the recorded phone call:

1. The types of products you will discuss
2. Date the appointment took place.
3. Contact information for both the beneficiary and the agent
4. A statement that says the client is under no obligation to enroll in a plan and that their Medicare status will not be impacted and no automatic enrollment will occur.

What do you do with the SOA after you collect it:

You should submit the SOA to the carrier with every PDP or MAPD application. If you enroll your client electronically, you will still need to collect the SOA. CMS requires that you keep all SOA s for 10 years after the current year. You should do this even when the client chooses not to enroll in a plan or cancels the appointment.