Free template: a fill-in-the-blank Medicare Scope of Appointment form aligned to CMS 42 CFR §422.2264. Enter your email to download it (PDF + Word).
What the template covers
- Beneficiary name, contact, and appointment details
- Plan types authorized for discussion (MA, Part D, or both)
- Beneficiary signature and date
- TPMO / agent identification
Why the SOA matters
The SOA is the first document a CMS market-conduct examiner requests. Presenting plans outside its scope is a compliance violation — and a missing SOA is a finding you'll have to explain.
Get the SOA template
Enter your work email and we'll email you the SOA template (PDF + Word).