Dave - Scope of Appointment - MEDICARE OPTIONS FOR YOU

MEDICARE OPTIONS FOR YOU

A Scope of Appointment form is required in all personal or individual face-to-face appointments where MA, MA-PD, PDP, and Cost Plan products are to be discussed with Medicare beneficiaries.

Please complete the form below.

Scope of Appointment Form - Agents Dave Trout & David Hanson

The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any face-to-face sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative. Fields marked with an asterisk (*) are required.

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you indicated above. Please note, the person who will discuss the products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan.

* Indicates required field

Beneficiary or Authorized Representative Signature *

Date of Signature *

Agent Name: Dave Trout & David Hanson
Agent Phone Number: 828-658-1472

Beneficiary Name *

First

Last

Beneficiary Phone *

Beneficiary Address *

Line 1

Line 2

City

State

Zip Code

Country

Plans Represented During the Meeting: MAPD, PDP, Dental/Vision/Hearing Products

Date Completed *

Submit

We do not offer every plan available in your area. Currently we represent at least 8 organizations which offer at least 57 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Trout Insurance Services
Visit: 29 N Main St
Weaverville, NC 28787

Mail: PO Box 1414
Weaverville, NC 28787

Ph: 828.279.4681
Fax: 1-888-221-4842
[email protected]

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Not affiliated with the U.S. Government or Federal Medicare Program.

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Trout Insurance is a full line insurance agency based in WNC. We serve clients in North and South Carolina as well as national companies. Trout Insurance offers life, health, disability, Medicare supplement, Medicare Health Plans, Medicare Prescription Plans, Long term care insurance, Home and Auto insurance for individuals. For businesses we offer group health & benefits, commercial liability, property & worker's compensation as well as plans for business owners.

Dave Trout, David Hanson and Idelle Davids are independent insurance agents with Trout Insurance.

We do not offer every plan available in your area. Currently we represent at least 8 organizations which offer at least 57 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Effective June 28, 2024 ; Jessica Cody & Jeremy Sheridan are no longer associated or appointed with or through Trout Insurance Services, Inc.

They may be reached at:
828-713-8640 – Cody
828-606-7994 – Sheridan

This is an amiable separation and they have the our confidence they will continue to act as the professional agents they have demonstrated over the years with TIS. Our agreement includes provisions that they will retain the agreed policies which they previously directly managed under the Trout Insurance agency license. They will be initiating “Agent of Record Transfers “ to their new agency and /or insurance companies and we will honor those requests. Until those transfers are effective, Trout Insurance retains the fiduciary responsibility under our North Carolina Department of Insurance license & obligations to service your policy. Our commitment is to do so in a polite, effective and efficient manner.
Please send any and all requests and questions to this designated email address: [email protected] or call 828 – 519-5218. these are monitored daily. Please allow three working days for our response and resolution. And, please note policy changes may not be changed or bound via voicemail or merely email. Per insurance regulations, a licensed agent appointed by that company must make the change.

Scope of appointment

Scope of Appointment Form - Agents Dave Trout & David Hanson

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