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

• Blue Cross SOC
• Blue Shield Scope of Appointment  SOA  2022 Rev.
• United Health Care
• SCAN
  • We can now do SOC’s via recorded phone or Zoom meeting! Must state why not done earlier. Per AHIP Training Module 4 page 12, Blue Shield training page 120
  •   www.SteveShorr.com/Meeting
• Needs Assessment Questionnaire – so we can help you better, fit your needs.

MAPD & Part D Rx Telephone & Face to Face Meetings
require a Scope of Appointment

• Before a sales meeting, the agent  must obtain a completed and signed Scope of Appointment form from each for example both husband and wife Medicare-eligible consumer – prospect present at a telephonic or in-person one-on-one plan presentation of a Medicare Advantage and/or Prescription Drug Plan product
• Agents are required that when  conducting marketing activities, in-person or telephonically, that they nor their Plan/Part D Sponsor Insurance Company may not market sell or present 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.
• 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),  422.2268(g)

Interpretation?

Humana’s guidance & interpretation  10.2015 

Click on image to enlarge

• Secret Shopper’s Check List 423.2262,
• Quotit Compliance Checklist for agents
• 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
• 422.2268(g) and (h) can’t market what’s not listed in the scope of appointment
• Medicare Training Wikipedia – Meeting

Sales Process Meetings must be #recorded

Agents and brokers will need to record all sales calls with beneficiaries in their entirety including the enrollment process. The recordings must be retained in a HIPAA compliant manner for 10 years. This will apply to new and existing clients.

• 42 CFR § 422.2274 (g) (2) (ii) Records all calls with beneficiaries in their entirety, including the enrollment process.
  • CMS confirmed that the regulations at §§ 422.2274(g)(2)(iii) and 423.2274(g)(2)(iii) are for coverage year 2023 enrollment, beginning Oct. 1, 2022, and require all calls be recorded, including the calls regarding the enrollment process, setting appointments, educational and casual conversations with beneficiaries via personal cell phones. If a prospect does not wish to be recorded, the transaction must end. ^{Broker Bulletin} * 
  • Medicare Advantage Marketing Policies Contract Year 2023 – Frequently  Asked Questions
  • CMS Monitoring Activities and Best Practices during the Annual Election Period
• Effective October 1, 2023, the only calls required to be recorded are marketing, sales and enrollment calls. General calls, such as setting appointments, are no longer included in the requirement.  ^{FAQ CMS.Gov  *  Blue Shield Agent Bulletin *  CMS Definition of Marketin}g *
• AGA 2024 Summary

What is considered a sales call?

• Anything that falls under the “chain of enrollment’ which is defined as the events from the point when a beneficiary becomes aware of an MA/PDP plan to the end of the enrollment process. This means when you are calling leads, scheduling appointments, collecting drug and provider lists and conducting education meetings and phone enrollments. All of these calls would fall under this guidance.
• Medicare Supplements are not included in the new call recording rules however, if you are selling a Medicare Supplement in tandem with a Prescription Drug Plan, the call would need to be recorded due to the Part D discussion.
• Zoom meetings will also need to be recorded. Only in person, face to face marketing and sales appointments are excluded, however any follow up calls to related to sales and completing the enrollment process would need to be recorded. Sales calls conducted on cell phones also fall under the recording guidelines. ^{Ptt Financial} *

Website and Sales Call Disclaimer

We don’t offer every plan ^{Ptt Financial}

Bibliography, Resources & Links

• Our Webpages on:
  • Set a Meeting – Zoom, Skype or Phone
    • Meeting – Expectations – Terms of Service
      • Privacy Statement
        • Privacy – Federal HIPAA
          • California Privacy Laws – Health Insurance
            • Right to review your Medical Records
          • Email – Expectation of Privacy
        • Visitor Agreement
  • Fraud Prevention – Both Beneficiaries, Insurance Companies – Brokers?
• Federal Register Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; 
• Regulators Aim to Curb Medicare Plan Lead-Generation Firms Read More>>> Think Advisor.com
  • commpartners.com/issues/2022-07-28
  • wsj.com/celebrity-medicare-sales-pitches-are-toned-down-after-scrutiny
  •  
• Third Party Marketing Organization disclaimer § 422.2267(e)(41)
  • 42 CFR § 422.2274 –  (same on ECFR.gov) Agent, broker, and other third-party requirements – recording calls
    • insurancenewsnet.com/recording-requirement-could-risk-senior-data
    • A Guide to the Rulemaking Process  Prepared by the Office of the Federal Register
    • insure me kevin.com/calls-must-be-recorded
• Broker ONLY Jarvis