Wellcare | 48-Hour Scope of Appointment Rule Reminder
Helping members make informed choices about their healthcare coverage is a win-win objective for all sales encounters. As a reminder, the 2024 CMS Final Rule outlines the requirement regarding a 48-hour waiting period between the signing of the Scope of Appointment (SOA) form and the actual meeting or call with the beneficiary. This period gives the beneficiary time to consult resources that help them make the best decisions regarding their coverage options.
The 48-hour waiting period went into effect September 30 and applies to all 2024 Medicare Advantage and Prescription Drug Plan selling activities.
Exceptions to the 48-Hour Rule
CMS has identified two exceptions to the 48-hour rule:
- SOAs that are completed during the last four days of a valid election period (AEP, ICEP, IEP, SEP, MA OEP, etc.) for the beneficiary.
- Unscheduled in person meetings (walk-ins) initiated by the beneficiary, including inbound calls.
Guidelines for the 48-Hour Rule Application
Please take a few moments to review the guidelines for determining whether the 48-hour SOA applies and common scenarios providing more detail on determining the correct course of action:
Common Scenarios
A beneficiary calls you to inquire about a plan:
- You conduct a telephonic presentation and enrollment, the 48-hour rule does not apply.
- You schedule an in-home appointment, the 48-hour rule does apply.
A beneficiary approaches your informal event and wants information about the plan:
- You meet with them in the moment, at the event, the 48-hour rule does notapply.
- You schedule an in-home appointment with them, the 48-hour rule does apply.
A beneficiary approaches you at the end of your formal event and wants information about the plan:
- You meet with them in the moment, at the event site, the 48-hour rule does notapply.
- You schedule an in-home appointment with them, the 48-hour rule does apply.
You call a beneficiary from a lead provided by the plan (e.g. cross-sell lead), a Consent to Contact (C2C) card, or are returning a voicemail message:
- You conduct a telephonic presentation and enrollment, the 48-hour rule does not apply.
- You schedule an in-person appointment, the 48-hour rule does apply.
As a general rule, agents should not arrive at a beneficiary’s home to conduct a presentation without a Scope of Appointment having been captured at least 48 hours in advance.
Please reach out to your local Sales Leader should you have any questions about the 48-Hour SOA rule.
As always, thank you for your continued partnership!
1 (800) 772-6881 x7731 | sales@pfsinsurance.com
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