Hi , this is Ebony .
I Am A Licensed Health And Life Insurance Agent For DC, VA , MD , DE And PA. The Following Is Additional Information On Healthcare and Life Insurance. Please Clarify A Request For Enrollment.

Scope Of Appointment Confirmation Form

Federal Government Requires Licensed Sales Representatives To Document A Scope Of An Appointment Prior To Any Sales Meeting To Ensure Understanding Of What Will Be Discussed Between Them And The Beneficiary Or Their Authorized Representative.

All Information Provided On This Form Is Confidential. A Separate Form Should Be Completed For Each Beneficiary.

To Ensure Your Appointment Focuses Only On Those Products You Want To Discuss With Your Licensed Sales Representative , Please Indicate By Checking The Appropriate Box(es) Beside The Product (s) In Which You Are Interested.

By Signing This Form , You Agree To A Meeting With A Licensed Sales Representative To Discuss The Summary Of Benefits For The Types Of Products You Checked.

Please Note , The Person Who Will Discuss The Products Is Appointed.

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 A Plan , Affect Your Current Or Future Enrollment , Or Enroll You In A Plan.

The Topics Below Are Only To Facilitate An Enrollment .
  • Check Box
    Living Trust
    Health Insurance Under Age 65
    Health Insurance Over Age 65
    Obamacare Alternatives
    Prescription Telemedicine
    Cash Plans
    Living Benefits Whole Life Insurance
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