Recording Agreement SBHIS Insurance Services recording recommendation consent form Name(Required) First Name Last Name Work Email(Required) Please Select an option(Required) I am Opting In to the SBHIS Insurance Services recording recommendation I am Opting Out of the SBHIS Insurance Services recording recommendation Phone Recording System Name(Required) In accordance with SBHIS policy, you are required to provide the name of the phone recording system that I will use. Opting Out Consent(Required) I agree and fully read the below Opting out recommendation.SBHIS Insurance Services 740 Bay Blvd Chula Vista, CA 91910 Re: Opting Out of SBHIS Insurance Services recording recommendation – Zoom Phone Dear Compliance Department, This document indicates that I am opting out of using SBHIS Insurance Services recommended Zoom Phone application to comply with CMS requirements. This application was recommended because it meets all of CMS’ recordings requirements for all telephonic/virtual communications with Medicare clients and prospects. By opting out, I accept responsibility on finding my own phone recording system and using it to record all telephonic/virtual conversations. I also accept the responsibility on keeping all recordings for a minimum of 10 years as required by CMS and providing any recording as requested from any Health Plan, CMS, SBHIS or Medicare. Furthermore, in accordance with SBHIS policy, I am required to provide the name of the phone recording system that I will use. The provided information will be subject to verification to ensure compliance with CMS requirements. As an independent agent (not employee) of SBHIS, I will shall hold SBHIS Insurance Services harmless from any and all claims, actions, suits, charges and judgements whatsoever that arise from my decision to opt-out from using their recommended application. SBHIS reserves the right to modify, amend, or adjust its requirements and policies as deemed necessary. Any changes will be communicated to all relevant parties with a minimum notice period of 30 days in advance. Sincerely, July 27, 2024 at 12:11 AMOpting In Consent(Required) I agree and fully read the below Opting In recommendation.SBHIS Insurance Services 740 Bay Blvd Chula Vista, CA 91910 Re: Using SBHIS Insurance Services recording recommendation – Zoom Phone Dear Compliance Department, This document indicates that I am opting in to use the SBHIS Insurance Services recommended Zoom Phone application. This application was recommended because it meets all of CMS’ recordings requirements for all telephonic/virtual communications with Medicare clients and prospects. By using the zoom app, I commit to use it in all my telephonic communications and follow CMS and Medicare rules regarding enrollments. SBHIS will be responsible to keep records of all calls and store them for a minimum of 10 years. In the event that any Health Plan, CMS, SBHIS or Medicare request the calls, SBHIS will be responsible to provide them in a timely fashion. Additionally, as an opt-in participant, I acknowledge and understand the fee associated with using SBHIS’s recording system to record, store, and maintain calls in accordance with CMS requirements. The fee will not be applicable if I submit at least 1 application a year AND I use the Zoom recording app for all my telephonic communications with clients and prospects. This recording system is solely for calls with members/prospects associated to plans you are appointed with SBHIS, in accordance with HIPAA regulations. SBHIS reserves the right to modify, amend, or adjust its requirements and policies as deemed necessary. Any changes will be communicated to all relevant parties with a minimum notice period of 30 days in advance. Sincerely, July 27, 2024 at 12:11 AM Signature(Required)By signing this form you are agreeing to the information you provided is accurate and you fully understand the SBHIS Insurance Services recording recommendation