Scope of Appointment

As you know, full compliance with the CMS Medicare Marketing Guidelines is a critical responsibility for all Coventry-certified brokers and agents. CMS holds Coventry accountable for ALL actions of agents/brokers selling Coventry Medicare products. As a valued partner with Coventry, you are responsible for being familiar with and knowing how to apply the guidelines.

To view the full 2012 CMS Medicare Marketing Guidelines (MMG), released on May 17, 2011, go to: http://www.cms.gov/ManagedCareMarketing.  The Scope of Appointment (SOA) topic appears under Sections 70.9, 70.9.1, and 70.9.2.

Agent/broker necessary actions for compliance with the CMS Scope of Appointment (SOA) requirements are listed below.

ANY in-home or personal/individual face-to-face sales appointment with a beneficiary/existing member/client requires the agent/broker to identify and disclose in advance the type of plan(s) the beneficiary has agreed to be discussed during the appointment. The SOA form documents those products agreed upon by the beneficiary. Distinct lines of business include: MA, MA-PD, PDP products.  

• The SOA form is required even if an appointment does not result in a sale.
• The sales person is bound to only discuss during the appointment those products that have been agreed upon by the beneficiary during that appointment.

Beneficiary/existing member/client must agree in advance to the scope of products to be presented by signing a CMS-approved SOA form prior to any face-to-face meeting.

• The SOA form must be obtained by the sales person and returned by the beneficiary prior to the appointment.

ANY in-home or personal/individual face-to-face sales/marketing appointment resulting with an application must have the signed CMS-approved SOA form attached to it before sending it to Coventry.  

The documentation of a SOA must be in writing, in the form of a signed agreement by the beneficiary, or a recorded oral agreement placed only by Coventry; NOT the agent/broker.

• All documentation must be maintained for 10 years; this includes initial and second SOA forms obtained at the same appointment.
• Information must be produced upon the request of either CMS or Coventry.

Coventry has made the decision NOT to record SOA's. All SOA's must be secured on the CMS-approved SOA forms.

• Both CMS-approved SOA forms can be found on the Broker Portal (CMS model & Coventry's non-model).

If it is not feasible to obtain the SOA form prior to the appointment, the agent may have the beneficiary sign the form at the beginning of the appointment. 

• An agent/broker must record in writing directly on the last page of the SOA in the space provided why it was not feasible to obtain the SOA prior to the appointment and maintain documentation.
• An agent/broker cannot agree to the SOA on behalf of the beneficiary, but can confirm the appointment.

A new SOA form is required to be completed:

• If the beneficiary has requested to discuss another MA, MA-PD, or PDP product type during a personal/individual appointment that was not previously agreed to be discussed.
  • If other health care related products are requested by the beneficiary to be discussed (i.e., dental/hearing/vision; hospital indemnity).
  • NOTE:  The Coventry CMS-approved, non-model SOA does list dental/ hearing/vision; and hospital indemnity product options.

However, a new appointment is not required.

• The additional product(s) can be discussed as soon as the beneficiary's request is properly documented on a new SOA form.
  • NOTE:  A second appointment must be scheduled 48 hours after the initial appointment if no signed SOA form was obtained prior to meeting with a beneficiary to discuss MedSupp/Medigap insurance and now the beneficiary is requesting to discuss MA, MA-PD, or PDP products.  (MMG, Section 70.5.1)

Examples of circumstances that may warrant "same date" completion of the Scope of Appointment form:

• A beneficiary or authorized representative walks into an agent's office requesting to meet regarding MA, MA-PD, or Part D products (must indicate on the form that beneficiary was a walk-in).
• During a public sales seminar/event, a beneficiary requests to speak with the agent individually or wants "more information" on another MA, MA-PD, or Part D product.  Agent must obtain a signed SOA, then may proceed with appointment right after public sales presentation. 
  • If non-health care products are being requested to be discussed, then the cooling-off period is required.

If a beneficiary requests information on a non-health care product during an MA, MA-PD, or Part D appointment (i.e., annuities, life insurance or VAIS), the agent must make a second appointment.

• The follow-up appointment CANNOT be scheduled until a 48-hour waiting (cooling-off period) after the initial appointment has occurred.

Beneficiaries are not required to complete and sign a SOA form prior to participating at public sales seminars/events because they are not personal/individual face-to-face appointments.

• The scope of products to be discussed during a public sales seminar/event must be indicated on all event advertising materials.
• Beneficiaries may sign a SOA form at a public sales seminar/event for an individual, MA, MA-PD or Part D follow-up appointment that they initiate/request to take place immediately after the seminar event.
• SOA form should not be completed until a meeting has been scheduled.  The SOA form is specific to a scheduled face-to-face meeting.

On-Demand Overview of SOA Requirements - View the recently updated Brainshark presentation that provides Coventry's selling partners SOA information in an optional format and let's you download a .pdf of the slides to use as a handy reference. (The presentation is also accessible on the Forms and Resources page of the Medicare Broker Portal at http://broker.cvty.com.) 

Reminder:  Access recent Compliance Connection broker messages on the Broker Portal, including the September 1, 2011 release Medicare Marketing Do's & Don'ts.

If you have additional questions or need assistance, please contact your upline marketing organization.  You may also contact Coventry directly through: the Broker Services Department at 1-866-714-9301, Monday-Friday, 8 a.m. to 6 p.m., or brokersupport@cvty.com, your Account Director, or if you are contracted locally to sell, the local health plan's sales management team.

 _____________