Skip to main content.

Provider Marketing Attestation Form

INSTRUCTIONS:
This form must be completed by all participating providers (also referred to as first-tier or downstream entities) existing and new, that will be displaying or providing marketing materials on behalf of the health plan. Learn more about Provider Education Marketing in a Healthcare Setting.

Providers treating Medicare patients are required to follow a set of rules and standards established by the Centers for Medicare and Medicaid Services (CMS). These rules guide what you may and may not do in regard to discussing Medicare Advantage health plans with your patients.

CMS holds plan sponsors responsible for any comparative/descriptive material developed and distributed on their behalf by their contracting providers. Providers are not authorized to engage in any marketing activity on behalf of the plan without the express written consent of an authorized Health Plan representative, and then only in strict accordance with such consent.
 

If you are a participating provider, indicate your business name and tax identification (ID) number below.

Please enter your name, title and telephone number.

You have read and understand that providers must adhere to all applicable laws, regulations and CMS guidelines regarding MA plan marketing, including Chapter 3 of the Medicare Communications and Marketing Guidelines (August, 2019) Section 60.1 (42 CFR 422.2260, 423.2260).


Medicare Advantage (“MA”) plan marketing is regulated by the Centers for Medicare and Medicaid Services (“CMS”).
 
Providers should familiarize themselves with CMS regulations at Code of Federal Regulations (CFR) Title 42; Chapter IV, Subchapter B/Part 422/Subpart V/ 422.2266  (September 2021), which include regulations governing “Provider Based Activities” and “Marketing in a Health Care Setting.” Providers must adhere to all applicable laws, regulations and CMS guidelines regarding MA plan marketing, including without limitation CFR 422.2266.
["https://enterprise.sapphirethreesixtyfive.com/?ci=SummaCareMedicare","https://enterprise.sapphirethreesixtyfive.com/?ci=SummaCareMedicare&network_id=15&geo_location=&locale=en","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMC&postalCode","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMC&postalCode=","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMK&postalCode=","https://enterprise.sapphirethreesixtyfive.com/?ci=SummacareIndividual-Family","https://client.formularynavigator.com/Search.aspx?siteCode=3822601471","https://client.formularynavigator.com/Search.aspx?siteCode=7139238863","https://client.formularynavigator.com/Search.aspx?siteCode=3184374974","https://openenrollment.medimpact.com/#/plancode?SUM032021PL","https://openenrollment.medimpact.com/#/web/sum/pharmacy"]
[{"RootId":"a7b694b6-2900-400a-abd1-35cff4b9f3ce","RootUrl":"/medicare/understanding-medicare/glossary/"},{"RootId":"bb4c888a-5dd6-4576-bf4c-88afff4f77ef","RootUrl":"/medicare/understanding-medicare/faqs/"}]