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Scope of Sales Appointment Confirmation Form

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For questions about this form, see FAQs below.

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Fill out the form below to request a Scope of Appointment Form.

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You will receive an email with a link to sign your personal Scope of Appointment Form.

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Sign the form and submit, you’re all set!

Scope of Appointment Request

Agent(Required)
This field is for validation purposes and should be left unchanged.

Frequently Asked Questions

If you are working with a licensed agent, the Scope of Appointment form is a Medicare required form for an in-person or over-the-phone appointment. The SOA form serves as a written record of what Medicare beneficiaries have agreed to discuss with a broker during the scheduled appointment. The form must be completed and signed by both the beneficiary (you) and the agent.

The SOA form must be completed, at minimum, 48 hours prior to the scheduled appointment time with your agent. There are very few exceptions to this rule, so it is important to complete your SOA in a timely manner to avoid delays or cancellations to your appointment.

The scope of appointment is valid for 12 months from your signature date.

Senior Insurance Agency is required to keep and store completed Scope of Appointment forms for 10 years.

The scope of appointment form is required by Medicare to help prevent scams and fraud in the Medicare marketplace. If you are working with a licensed agent who is requiring that you sign a SOA, you are the right place! The Scope of Appointment form can be looked at as peace of mind that your broker has your best interest in heart, and is following the right protocols required by the Centers for Medicare & Medicaid Services (CMS).

If you wish to have a sales meeting with an agent or broker, you cannot opt out of the Scope of Appointment form. This form is mandated by CMS to ensure transparency, and to protect you from receiving information about plans that you might not be interested in.

The Scope of Appointment form is only required for Medicare Part C and D, which are regulated federally by Medicare. Medigap plans are private health insurance plans that are regulated by the state and the National Association of Insurance Commissioners (NAIC). The sales process is less regulated compared to Medicare Advantage (C) and Part D plans.

Prefer to talk to us in person?

Call us direct to meet with a knowledgeable agent at Senior Insurance Agency.

Call us direct: (775) 829-9600

We do not offer every plan in your area. Currently, we represent (See Below) organizations which offer (See Below) products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Carson City 6 organizations which offer 26 products in your area - Churchill 5 organizations which offer 19 products in your area - Clark 7 organizations which offer 50 products in your area  Nye 5 organizations which offer 38 products in your area -  Douglas 5 organizations which offer 19 products in your area - Lyon 6 organizations which offer 22 products in your area - Mineral 1 organizations which offer 4 products in your area - Storey 6 organizations which offer 23 products in your area - Washoe 9 organizations which offer 40 products in your area - NV 6 organizations which offer 14 PDP products in your area