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Confirming your appointment on May 22, 2024 with a licensed insurance agent.

I, , provide my electronic signature as an indication of my intent to discuss Medicare Advantage (Part C) and/or Medicare Prescription Drug (Part D) Plans with a Licensed Insurance Agent. This scope of appointment is effective as of May 19, 2024 and an agent from Health Insurance Associates LLC will contact me on May 22, 2024 to discuss the above plan types. I understand that I am under no obligation to enroll in a Medicare plan, that my future Medicare enrollment status will not be impacted by this call, and that automatic enrollment will not occur. My consent or scope of appointment can be revoked at any time by contacting [email protected].

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