The Centers For Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any Face-to-Face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this Form is confidential and should be completed by each person with Medicare or his/her authorized representative. Agents must be licensed, contracted and certified, where applicable, to sell each of the plans listed below.
By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly For the Federal government. This individual may also be paid based on your enrollment in a plan.
Signing this Form does NOT obligate you to enroll in or apply For a plan or affect your current enrollment.
