Before we talk about plans, please tell us what you want to cover.

Medicare rules require us to document what topics you’d like to discuss before we review any specific plans or benefits. This is called a “Scope of Sales Appointment” (SOA).

This form is not an application and does not enroll you in any plan. It simply tells your agent which product types you're comfortable hearing about today.

• If there’s a product you do not want to discuss, just leave it unchecked.
• You can stop or change your mind at any time.
• Signing this form does not obligate you to enroll, change plans, or take any action.

Please complete the contact section and sign at the bottom so we can keep a copy for compliance.

TruShield Health is an independent insurance agency. We do not work for Medicare or the Federal government.

Scope of Sales Appointment Confirmation Form

The Centers for Medicare and Medicaid Services (CMS) requires agents to document the scope of a marketing appointment prior to any sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). Please check the product types you want to discuss. Signing this form does NOT obligate you to enroll in a plan, affect your current enrollment, or enroll you in a Medicare plan. The agent discussing these products is contracted with Medicare plans and may be paid based on your enrollment. They do not work for the Federal government.