Scope of Appointment Policies and Procedures

Policy and Procedures for Leads and Scope of Appointment

Scope of Appointment Procedures

The Centers for Medicare and Medicaid Services (CMS) requires that the Scope of Appointment (SOA) must be agreed to by the Medicare beneficiary prior to any face-to-face personal/individual marketing appointment for a Medicare Advantage or Prescription Drug Plan. An SOA is not required for Medicare Supplement Plan presentations. Agents can document the SOA in writing via an SOA form. If the SOA is being documented by recording a phone call in advance of the appointment, the call should be placed by the plan sponsor and not the agent. Agents shall only discuss during that appointment those products that have been agreed upon by the beneficiary during that appointment. If the client requests to discuss a product outside of the original SOA form, the agent must complete a new SOA form and schedule a second appointment no sooner than 48 hours. Agents shall comply with each plan sponsor’s requirements for submission of the SOA form and retain a copy of the form for at least 10 years. An SOA form cannot be used for more than one appointment; each appointment requires a separate completed SOA form.

Unsolicited Contact, Lead Management and Lead Referral Process Policy and Procedures

Unsolicited Contact

The Centers for Medicare & Medicaid Services (CMS) prohibits making unsolicited contact with consumers. Consumers must grant permission for agents to reach out to them with regard to Medicare Advantage (MA) or Prescription Drug Plans (PDP). Some examples of unsolicited contact include, but are not limited to, door-to-door solicitation and telephonic or e-mail solicitation without permission to contact. Agents shall not contact consumers about MA or PDP without procuring a permission to contact.

Lead Management

Agents are responsible for ensuring that if they use a lead generation company, the leads are obtained in a manner that is compliant with CMS regulations and respective plan sponsor(s) policies. Agents may not accept MA or PDP leads resulting from an unsolicited contact made by a third party to a consumer. Agents are responsible to ensure MA or PDP leads purchased have the required permission to call documented.

Lead Referral

Agents may not ask a beneficiary for referrals. Agents, however, may give their business card to a beneficiary if the beneficiary would like to refer a friend or relative to the agent. In all cases, a referred individual needs to contact the agent directly.