I’ve been getting questions about whether or not agents are required to fax in a Scope of Appointment form for all Appointments IN ADVANCE of any potential sale.
From everything I’m hearing, the Scope of Appointment form will need to be obtained 48 hours in advance, however, the Scope will only need to be sent to the company for SOLD business.
In prior years, some companies would require the Scope with the Enrollment application and some companies would only require that you retain it. Keep in mind that CMS DOES require you to maintain a Scope for 10 years.
In 2011, I’m seeing virtually all carriers will be requiring the Scope of Appointment to be submitted with the enrollment form, so we are recommending that you submit the Scope with the enrollment in ALL CASES!
Also, there is a 2011 version of the Scope of Appointment for some carriers. I believe that CMS will be coming out with a Generic Scope soon (non carrier specific). I’ve only heard that one company (Molina Healthcare) will not be accepting a generic scope (I have the Molina specific scope filed under “applications” in our Forms section).
I’ll post the 2011 version when I have it!
Here are some more thoughts on UHC’s “Fax-the-Scope-before-the appointment” requirement:
Other companies are interpreting the law as follows:
1) When possible, send a Scope in advance of the appointment.
2) If a sale is made, fax in the Scopoe with the app.
3 Or, if a sale is not made, retain the Scope for 10 years.
OK, just how does one know IN ADVANCE whether or not a sale will be made? That would seem to refute UHC’s position.
United Health Care in Arizona (Secure Horizons) local manager has said nothing about faxing the scope to UHC even before the actual appointment.
What about community meetings held by the company? Do they have to get a scope if an attendee fills out an applications? I was at a meeting yesterday for people with plans terminating. 15 apps were filled out but no scopes were taken. Scopes are not faxed in with the app but sent to another location – so who will really track if the scope is submitted or not?
Per CMS guidelines, if you advertise a community even then you do not need to obtain a Scope of Appointment form. The purpose of the Scope is for the beneficiary to understand in advance what they are going to be presented in the face-to-face meeting. CMS expects that community/sales meetings were appropriately reported through the plan and that appropriate disclaimers identifying the event as a sales presentation and what will be discussed were made. Therefore, attendees have full disclosure in advance and have chosen to attend. If the attendee requests and additional one-on=one appt after the marketing/sales event later that day at their home or the following day, then the scope can be signed at the event and the 48 waiting period does not apply.
If you are new to this process and have not sold Medicare Advantage plans, you might be surprised to find that it is not as difficult. Many clients are aware of the Scope process since it has been in place for some time. I have many clients who fax or scan it back to me and I use SASE’s for those that dont have computers. If you have made the relationship connection already with them, then most seniors appreciate you are following rules to protect them. I think its how you spin it.
How does a person to get a scope signed a day before an appointment. Lets see, I’ll call my client and get them to give me their email or fax number, have them sign it and have them fax or email it back to me. They will think I am some kind of weirdo for asking them to do that.
Does CMS employees who come up with this stuff live in some underground bubble or what?
From the communications I have been getting from the company, United Health Care is requiring the Scope to be faxed in 24 hours BEFORE the appointment ! That’s pretty annoying. UHC insists that they are only following CMS’s rules; and, if so, we can expect the other companies to soon make the same onerous requirement. I understand that an exception may be allowed – it has to be documented on their Scope form – e.g., the client mailed it back to you, but it got lost in the mail; or the dog ate it.
The government is assuming that Medicare advantage agents are crooks, so they are placing marbles in our path.
There were a lot of liars and crooks in our business in 2006 and 2007, but most of them have by now left for greener pastures – perhaps as government beurocrats.
You may want to check the updated Scope of Appointment newsletter on the UHC website. The quideline effective October 1, 2010 requires that you send in all Scopes, even those that cancel or do not close as you mention. They would prefer you send the Scope in as soon as possible, but you do have until 48 hours after the appointment to submit. Therefore, I dont think you are held to the 24 in advance requirement. Also, since you can use the generic form and many plans already have the generic form, this will be difficult if the client thinks they want AARP and then changes to Healthnet upon arrival. I dont know any other carrier that is perceiving this requirement the same as United. Not Anthem, nor Healthnet as examples. They only want the SCOPE if the sale closes. United is always the most conservative. For example, while Medicare Supplements can be sold via cold calling with many of the other carriers as long as MA products are not mentioned, United does not allow it. This is not the law, but this is United’s law, so hopefully only United will follow this conservative approach.
It seems to me that when a company has large changes in their benefits and/or premiums or if they are terming a plan where they have a lot of business that they interpret more strictly for that benefit year only. I know that another company I represent took this stance the year they had changes and since they didn’t have a strong network in place and many benes were moving towards PPO plans from PFFS plans the company said they wanted the SAF for every appt whether enrolled or not. I have not seen them request it since that year.
This year in our area UHC has many plan terms and they are interpreting this way and also if agents do not contact their clients by a certain date, they will be calling them. Most of the regs are wrote with the concept that an agent represents only one company and that agents who are required to keep their SAFs for 10 years will lose them all, so the company to protect themselves, is requesting that they all come in. I understand that. The regs very seldom consider the independent agent and you would think with the massive volume of regs being published that all of these things are addressed… For instance if UHC is correct and all companies need the SAF even when someone doesn’t enroll I would now have to fax each SAF to more than 5 companies. By the time that I get in from a full day of appts during an already short time frame to meet every one requesting assistance would be spent faxing SAFs.
The concept that in a published sales meeting every one knows in advance what they are coming to see and will not require a SAF should apply to an independent agents current clients also. If you have a client for 5 years now and they request an appt for an annual review and possible marketing, they are not in a position where they should have to complete a form for whether or not they want to discuss just PDP and/or MAPD. This was caused by the Big Name Store/Big Name company relationship that sales people sitting in the store gave an MAPD to people only seeking a PDP because they pushed their 0 plan premium for MAPD on every one inquiring. Later the bene did not know they had changed more than just getting PDP… This form does very little in way of protecting the bene. It should probably only apply to new prospects that an agent does not already have an existing relationship with.
I agree it will be received okay by benes if you remind them that it is put in place to agree on what products will be discussed prior to the appt and for their protection to confirm that they wish to meet with an agent. But the form is not friendly. People see the word beneficiary and think of the lottery or life insurance. They never thought of their agent as a bad person, they love their agent and are thankful that they can get guidance, the boxes look like checkboxes and not places to initial. Wouldn’t a form that agrees to meet with a sales agent and is a mini needs analysis work better if necessary at all? Wouldn’t it be better to use if for prospects and for current clients just come up with a replacement form in case a client makes a change much like what is done in Med Supps, etc.?
Things that make me go hmmmm…
Catherine, This is how I see it as well!
I contact my Medigap clients annually, asking if they would like me to review their medications and Part D plans. If they do, I ask that they list the medications and return the form I have sent them. How does the Scope of Appointment form fit into this? Do I need to have them sign that IN ADDITION to the letter (which basically says “yes I would like you to review my Part D for me”)? Or is it not necessary because they are existing clients and its service not marketing?
For the life of me I cannot find the answer ANYWHERE. Thanks.
Alicia:
The scope is required with every face to face appointment. If you are holding a meeting with the client as follow up on the Part D questionnaire, I would go ahead and send the scope.
If you are just going to send them to 800-MEDICARE or Medicare.gov, you don’t need a Scope because you are not going to enroll them.
Since most (if not all) companies are requiring a scope with an enrollment form, if you plan on taking an enrollment, you’ll need the Scope as well.
Does this help?
Great clarification on this critical subject. Thanks
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