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 .
Health Insurance Under Age 65
Health Insurance Over Age 65
Living Benefits Whole Life Insurance
Do you currently have a health insurance plan?
Do you have an Employer Sponsored health plan or Private Individual insurance ?
Employer Sponsored health plan
Private Insurance Carrier
Do you know if you qualify for a Subsidy through your States Exchange?
If you currently have Medicaid , do you know you can add Tele - medicine , Dental and Vision services ?
Did you know that if you have a Bronze plan or any other High - deductible health plan that Lonestar offers a Prescription Assistance program for Brand name drugs and also a Mail order program for generic prescriptions ?
Do you think you are paying too much for your health insurance premiums ?
Would you like to request a call back to learn more about any Obamacare alternatives and Lonestars Select Rx program ?
Comparison Report Questions
List Carrier Name
Health Plan Name
Can you please locate your Summary of Benefits ?
Copayment Primary Care
Copayment Specialty Care
Annual Maximum Out of Pocket