Marketing Compliance Review Request
Basic Information
Agent/Agency Name
Agent ID
Email
example@example.com
Request Date
/
Month
/
Day
Year
Date
Name and description of piece (include URL for website)
Planned year to be used
Applicable States
Are you requesting funding for this piece through the Marketing Co-Op program?
Yes
No
MARKETING PIECE DETAILS
Check all that apply
Marketing website which contains plan-specific information
Marketing website used to obtain beneficiary information for the purposes of marketing and/or enrollment into a Medicare Advantage or Prescription Drug Plan
Business Reply Card to obtain permission to contact, SOA, or sales/marketing event response
Sales or enrollment script
Mentions any carrier plan name, premiums or benefits
Mentions or co-markets with a provider
Contains AGA Medicare Options name or logo
None of the above apply, my material is generic
Is this a new or revised piece?
Revised
New
If revised, what has changed?
When was this last reviewed by AGA?
To avoid delay, please make sure you reference the Generic Material Job Aid, starting on page 2, and that this piece complies with CMS Medicare Marketing and Communication Guidelines, such as:
Fonts are at least the height and width of 12 point Times New Roman
Agent title is compliant and does not include the word Medicare
No prohibited terminology such has superlatives, absolute language or scare and high-pressure tactics
All claims and/or references to research/studies are supported and cited
The material is not misleading, such as appearing to look like the Medicare card or official government notification
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