AEP Reporting

AEP 2022 Reporting

* Indicates required field

Name *

First

Last

MAPD *

PDP plans *

Medicare Supplements *

Hospital Indemnity Plans *

AOR *

Total Medicare Applications *

Did you participate in ACA? *

Yes No Referred to other party

ACA applications *

ACA referrals *

Life insurance or the other products *

ex: 5/ $2125 AP

Primary marketing source ? Store, etc *

Store? Mail? Events? Past clients?

Years or Selling Medicare? *

1 Year 2 Years 3 Years 4 Years 5+ Years

Did you hit your AEP goals? *

Yes No Did not have a goal

What would you change for next AEP? *

How can SBC help you for 2021? *

Submit

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