Scope of Appointment Forms Permission and agreement to hear a presentation on
Medicare Advantage or Part D Rx

AARP – UHC  fillable pdf and you can type your signature!
It’s Generic, so it can be used for ANY company.

Blue Cross SOC

Blue Shield Scope of Appointment  SOA  2019 Rev.

Telephone & Face to Face Meetings require a Scope of Appointment

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 CMS 2018 Marketing Rules – 70.4.3

The Plan/Part D Sponsor must document the scope of  the appointment prior to the appointment

SOA documentation is subject to the following requirements:

The documentation may be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement.  Any technology (e.g., conference calls, fax machines, designated recording line, pre-paid envelopes, and email) can be used to document the scope of appointment.

422.2268(g) Marketing Standards   (g) Market any health care related product during a marketing appointment beyond the scope agreed upon by the beneficiary, and documented by the plan, prior to the appointment (48 hours in advance, when practicable).  and (h),

Excerpt from unnamed, well known Medicare Advantage Company’s Confidential Agent Guide – Manual:

Scope of Appointment (SOA) Form

Before a sales meeting, one must obtain a completed and signed Scope of Appointment form from each Medicare-eligible consumer present at a telephonic or in-person one-on-one plan presentation of a Medicare Advantage and/or Prescription Drug Plan product  

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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Audio MP 3

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Intake Form - We can better prepare for the meeting

Interpretation?

Humana’s guidance & interpretation  10.2015  Click to enlarge

Excerpt of Humana's Rules

Definition Marketing Activities

20 – Communications and Marketing Definitions 42 CFR §§ 422.2260, 423.2260

Communications means activities and use of materials to provide information to current and prospective enrollees. This means that all activities and materials aimed at prospective and current enrollees, including their caregivers and other decision makers associated with a prospective or current enrollee, are “communications” within the scope of the regulations at 42 C.F.R. Parts 422, 423 and 417.

Marketing is a subset of communications and includes activities and use of materials that are conducted by the Plan/Part D sponsor with the intent to draw a beneficiary’s attention to a MA plan or plans and to influence a beneficiary’s decision-making process when selecting a MA plan for enrollment or deciding to stay enrolled in a plan (that is, retention-based marketing). Additionally, marketing contains information about the plan’s benefit structure, cost sharing, and measuring or ranking standards.

 

FAQs / Ask Us a Question

 

Hey fellow agents:


Let’s meet for lunch, video conference  and talk about it.  My guess is, only other agents are googling for this page. 

How about we meet and exchange ideas?   

Email me, [email protected] or set a meeting time.  

 

Well this get’s confusing… 

Guidance on Plain Meaning Rule and how to read and interpret law, rules & statutes

Secret Shopper’s Check List 423.2262,

Review and distribution of marketing materials 423.2268 (g) and (h) 

Standards for Part D marketing 42 CFR 422.2262, Marketing Materials

2016 Research

70.9.3 Scope of Appointment 2016 – Medicare Marketing Rules

When conducting marketing activities, a Plan/Part D Sponsor may not market any health care related product during a marketing appointment
 
The term used in the actual guidelines is Marketing Appointment – NOT Face to Face!  This is one reason why I hate the crappy slide presentations in AHIP and most training seminars.  They don’t show you the actual code or reference material.
 
beyond the scope that the beneficiary agreed before the meeting with that individual.

42 CFR 422.2262 Review & Distribution of Marketing Materials

422.2268(g) and (h) can’t market what’s not listed in the scope of appointment

423.2262 Part D Rx Review of marketing materials

423.2268 (g) and (h) Part D can’t market what’s not in scope of appointment

Medicare Training Wikipedia – Meeting

 

telephone

4 comments on “Scope of Appointment – Telephone & Face to Face Meetings

  1. Is a scope of appointment required if benefits are going to be discussed prior to a beneficiary enrolling on their own via the PURL?

    Personalized URL (PURL): Receive commissions when Medicare beneficiaries use your personalized URL (non-agent-assisted) to enroll online in a WellCare plan.

    • I don’t see any way around the mandate to get a scope of appointment. Check with your agency manager.

      https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY2019-Medicare-Communications-and-Marketing-Guidelines_Updated-090518.pdf

      Scope of Appointment Must be documented for all marketing activities, in-person, telephonically, including walk-ins to Plan/Part D sponsor or agent offices

      The term “marketing” is referenced at Section 1851(h) and 1860 D-4 of the Social Security Act (the Act), as well as in CMS regulations. The scope of the definition of “marketing materials” extends beyond the public’s general concept of advertising materials.

      70.4.2 – Personal/Individual Marketing Appointments 42 CFR 422.2268(f)-(h), 423.2268(f)-(h)
      All Plans/Part D Sponsors conducting one-on-one appointments with beneficiaries, regardless of the venue (e.g., in home, telephonic, or library), must follow the scope of appointment (SOA) guidance (see section 70.5.3).

      • If a person registers for a marketing seminar for a specific plan/carrier and wants to sign up, is A scope of appointment still required since they obviously registered for the event.

        • Yes! One of the things I hate about all these rules, is the AHIP and Company training that we are not allowed to share and is secret.

          Here’s excerpts from something I found it google to answer your question:

          https://www11.anthem.com/agent/noapplication/f1/s0/t0/pw_e235866.pdf?refer=ahpagent&state=va

          There are two types of sales events, formal and informal. At a marketing/sales event, plan representatives may discuss plan specific information like premium, cost-sharing, and/or benefits, as well as, distribute and/or collect enrollment applications.”

           Formal marketing/sales events are structured events of an audience/presenter style with a sales person providing specific plan information via a specific CMS approved sales presentation.

          Don’ts

          Require or otherwise use personal contact information, collected for purposes of a raffle or other event giveaway, as means of permission for future contact.

          Require the completion of or pressure event attendees to fill out a sign in sheet or business reply card (‘thank you’ card).

          ***Thus, there is NO Registration!

          SCOPE OF APPOINTMENTS (SOA) and Individual Appointments Practices

          Don’t

          Begin discussing MA or PDP plans prior to the beneficiary signing the SOA Form.

          https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/Downloads/CY2019-Medicare-Communications-and-Marketing-Guidelines_Updated-090518.pdf

          50.2 – Marketing/Sales Events
          42 CFR §§ 422.2268(b)(1-5), 423.2268(b)(1-5)
          Marketing/Sales Events are designed to steer or attempt to steer potential enrollees, or the retention of current enrollees, toward a plan or limited set of plans. The following requirements apply to all marketing/sales events:

           Plans/Part D sponsors must submit scripts and presentations to CMS prior to use, including those to be used by agents/brokers;
          Sign in sheets must clearly be labeled as optional;
           Health screenings or other activities that may be perceived as, or used for, “cherry picking” are not permitted;
          Plans/Part D sponsors may not require attendees to provide contact information as a prerequisite for attending an event; and
           Contact information provided for raffles or drawings may only be used for that purpose.

          Scope of Appointment (Communications)

          Must be documented for all marketing activities, in-person, telephonically, including walk-ins to Plan/Part D sponsor or agent offices

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