The Medicare Agent’s Guide to Electronic Scope of Appointment Management

What is the Scope of Appointment for Medicare insurance plans?

The Scope of Appointment (SOA) is a federally required form for all new and renewal sales appointments with a Medicare insurance agent. This form, along with other CMS compliance regulatory changes, helps increase transparency for customers to promote more understanding about buying health insurance and Medicare coverage. 

The SOA form provides potential policyholders and beneficiaries with a list of topics that may be discussed during their meeting with a Medicare sales agent. These topics usually include Medicare plans like Medicare Advantage, Medicare Supplement, and Part D prescription plans, as well as other insurance products that the beneficiary can select. This ensures the Medicare sales agent only covers the products the beneficiary is interested in and is intended to prevent the unwanted pressure of being sold additional products. 

Once the Scope of Appointment form has been returned, it creates a contract between the beneficiary and the Medicare insurance agent about what they will and will not discuss at their meeting.

Understanding the Scope of Appointment Form for Medicare Insurance Sales

Now that we’ve covered what the Scope of Appointment form is, let’s dive into some common questions and what Medicare insurance agents need to know about issuing and gathering the SOA form.

What information is required on a Scope of Appointment form?

The Scope of Appointment is an opportunity for the customer/beneficiary to select the topics they do and do not want to cover during a meeting with a Medicare insurance agent. It is one of the most important forms for Medicare agents and agencies. 

As such, the information present should include an overview of the form, a checklist of plan types you could cover, and what their signature means. However, it should be noted “only CMS approved SOA forms can be used. Agents should not create and use their own form.” 

When do Medicare agents need to collect a Scope of Appointment form from a beneficiary?

Per the CMS Final Rule 2024, all Scope of Appointment forms must be gathered at least 48 hours before the appointment — and this time limit should be taken literally. 

If the SOA form is taken at the time of the appointment, the reason must be documented and specifically stated as to why. These reasons could include:

• Scope of appointment change by the customer/beneficiary
• Scope of appointment change by the agent
• Unscheduled walk-in meetings initiated by the customer/beneficiary
• Call in

Agents do not need to collect SOA forms for: 

• Formal or informal sales events as these are already reported to CMS
• Educational events
• Medicare supplement presentations

Some other important key things to note: 

1. You do not need to collect a Scope of Appointment form if you will not discuss either Medicare Advantage or Part D prescription drug plans.
2. The 48-hour rule does not apply to beneficiaries approaching the last 4 days of an enrollment period, including Annual Election Period (AEP), Open Enrollment (OEP), the Initial Coverage Election Period (ICEP), and a Special Election Period (SEP).
3. Scope of Appointment forms cannot be displayed, distributed, or collected at any educational events.

How long is the Scope of Appointment form valid? 

A Scope of Appointment form is valid until “it is used or until the end of the applicable election period.” If an agent holds another qualifying sales meeting with the beneficiary, they will be required by law to issue and gather a second SOA form. Additionally, if the beneficiary or agent decides to change or expand the scope of the meeting, a second SOA form will be required.

How long do agents, agencies, and GAs need to store completed Scope of Appointment forms? 

Medicare agents, agencies, and GAs must keep all completed SOA forms on file for a minimum of 10 years regardless if the plan was sold. This includes no-shows and canceled appointments. Additionally, if the conversation took place over the phone or on a video call, the recording must be kept on file for a minimum of 10 years, in accordance with call recording regulations launched in 2023. 

Where do agents/agencies submit the completed Scope of Appointment form?

NABIP states: “A completed Scope of Appointment should be submitted to the carrier with each MAPD or PDP enrollment application. This includes all applications keyed in electronically or submitted through any electronic means.”

How to Electronically Manage Scope of Appointment Forms & Stay Compliant with AgencyBloc Solutions

There have been many changes in the regulatory landscape in recent years. With these changes, it’s essential for agents, agencies, GAs, and IMO/FMOs to maintain compliance and stay current with the changes. 

Using technology that is built specifically for your insurance organization’s needs can make compliance easier.

AgencyBloc’s AMS+ solution provides individual health, group benefits, and senior insurance agencies, GAs, IMO/FMOs, and call centers with electronic compliance tools that take the stress out of the equation. Our industry-specific solutions are built for the insurance market, and our team monitors changes to ensure your organization has the tools you need to succeed. 

Source | AgencyBloc

Electronically send Scope of Appointment and Consent to Contact forms digitally to prospects and clients to maintain compliance all from AMS+. Then, once the form is signed, AMS+ will attach it to the contact’s profile for easy access and streamlined management. Using these tools, your teams can easily maintain compliance while achieving other revenue-generating goals. 

Posted by Allison Babberl on Tuesday, January 9, 2024 in Senior Market Insurance

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