Hidden Form Field (Do Not Delete)
To start your submission, add your Agency's name below...
Agency Name
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Agency NPN
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Use "NA" if not applicable
Agency EIN
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Use "NA" if not applicable
Contact Info of Submitter
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Last Name
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Mobile Phone
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Work Email
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Agent NPN Number
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Use NA if not applicable.
Did a Lead Marketing Vendor create this material?
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Did a Lead Marketing Vendor create this material?
Yes
No
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Marketing Vendor Name
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Vendor Service Provided
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Service Provided
Marketing
Lead Generation
Enrollment
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Vendor Start Date of Relationship
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Does this vendor perform any TPMO function(s) outside the United States (i.e., offshore)?
TPMO function(s) outside the United States?
Yes
No
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Vendor Point of Contact
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Marketing Vendor Email
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Marketing Vendor Phone Number
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Marketing Vendor Address
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Type of Material:
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Marketing
Communication
Contract/Submission Type: This material includes or addresses any of the following content.
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Benefits - Document contains information about plan benefits.
Cost Share - Document contains information about beneficiary cost sharing. This could be C, D, or Optional Supplemental cost sharing.
PDM - For Part D Payment Modernization Model Content
PDSS - For Part D Senior Savings Model content
PDSS Other (non-R&I) - For marketing materials that contain Part D Senior Savings model information, excluding rewards and incentives (Please use the PDSS R&I for materials containing this content).
PDSS Updated Member Materials-CY2025 - A zipped file of all PDSS updated member materials per HPMS Memo "Updates to PDSS Model Communications and Marketing Guidelines for Contract Year 2025
Plan Comparisons - Document compares plan benefits/cost sharing/premiums/provider network/etc. to other plan(s). This could also include "generic" comparison such as "We have the lowest premium in the area." Any type of comparison must be noted.
Premiums - Document contains information about plan premiums. This could be C, D, or combined premiums. Could also be Optional Supplemental Premiums.
Provider Network - Document contains information about provider network.
Ranking Standards, other - Document provides all ranking standards (e.g. private company ratings) other than CMS' Star Ratings or Plan Comparisons identified in "Plan Comparisons" Content Type.
Rewards and Incentives - Document provides information about potential rewards and/or incentives for completion of plan identified health "activities."
SSBCI - Document provides information regarding Special Supplemental Benefits for the Chronically Ill (benefits, cost sharing, etc.)
Star Ratings - Document mentions CMS Star Ratings
VBID - Document provides information regarding Value-Based Insurance Design benefits, cost sharing, etc. For non marketing materials containing VBID content, please submit under "CMS Required"
Please select the Carriers your agency are contracted with below:
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Aetna
Cigna
Devoted
Elevance (Anthem)
Humana
Wellcare
UHC-United Health Care
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Are Carrier Logos Present in Your Submission?
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Yes
No
Carrier Logos: Select All That Apply
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Aetna
Cigna
Devoted
Anthem Brands
Humana, Inc
UHC
Wellcare
Other Regional (ex. Zing)
Is Co-Branding present in your submission?
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Yes
No
Please provide website homepage link below.
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Add Material ID/SMID
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Do not add more than one!
Material Description
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Please be specific and explain sales use case strategy and intent!
File Upload: Choose a File to Upload...
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*Limit 10 files (Zip file is preferred for multiple files)
Attestation: Please Acknowledge Before Submitting:
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Based on my knowledge, information, and belief, I attest that the submitted material is complete, accurate, and truthful, and has been prepared in accordance with the IFG Marketing Oversight submission guidance.
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