Fill Out Your Scope of Appointment

The Scope of Appointment form is a required document by CMS (Centers for Medicare & Medicaid Services) that helps us tailor our conversation to your specific needs. Think of it as your personalized roadmap for our chat! By filling it out, you're ensuring we stick to the topics that matter most to you and stay compliant with all the important regulations. Plus, it helps us get straight to the good stuff without any detours.

Let us help find you the best medicare plan for you.

Scope of Appointment Confirmation Form

Before meeting with a Medicare beneficiary (or their authorized representative), Medicare requires that Licensed Sales Representatives use this form to ensure your appointment focuses only on the type of plan and products you are interested in. A separate form should be used for each Medicare beneficiary.

By signing this form, you agree to meet with a Licensed Sales Representative to discuss the products checked above. The Licensed Sales Representative is either employed or contracted by a Medicare plan and may be paid based on your enrollment in a plan. They do not work directly for the federal government.

Signing this form does not affect your current or future enrollment in a Medicare plan, enroll you in a Medicare plan or obligate you to enroll in a Medicare plan. All information provided on this form is confidential.

By providing my telephone number or email address, I agree to allow a licensed sales representative to contact me regarding information related to Medicare health plans and health insurance plans, products, services, and/or educational information related to health care

Clear

A Policybenefitsplus Expert licensed in your state will contact you to review the information that we send on your customized quote. We offer outstanding,

no-hassle service to help you obtain Market Place Insurance.

Policybenefitsplus is an insurance broker that connects individuals with insurance providers. Products and services are provided exclusively by the providers. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. By submitting your phone number, you are giving policybenefitsplus permission to communicate with you via automatically-sent text message.

Licensed Insurance Agency

Not connected with or endorsed by the United States government or the federal Medicare program.

We do not offer every plan available in your area. Any information we provide is limited to those plans we offer in your area. Please contact Medicare.gov or ‍1-800-MEDICARE to get information on all of your options.

Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.