{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["Instructions","Submission Attestation","Intake Form","Provider Related","Co-Branded Non-Provider Related","Drop Down Selections"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":0,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":32,"n_cols":2,"rows_kept":32,"cut":false,"hidden":false,"merged":[[0,0,0,1],[2,0,2,1],[20,0,20,1],[26,0,26,1],[13,0,13,1]]}
["Instructions for Humana Material Submission (Last Updated: 7/12/2023)\nPlease review instructions prior to submitting the spreadsheet to ensure the most complete and accurate information is captured."]
[]
["Overarching Guidance"]
[" - ","Copies of materials indicated in the spreadsheet, in addition to the completed spreadsheet are required for every review. Failure to provide complete information will delay the start of your review."]
[" - ","The spreadsheet must be completed entirely for each material that is submitted.  This includes the \"Submission Attestation\" and \"Universal Form\" tabs.  All fields are equired."]
[" - ","All Marketing Materials must be submitted for review and approval prior to filing in HPMS."]
[" - ","Humana requires all communication based TV/Digital Videos and Permission to Contact Forms to be submitted for review and approval prior to use."]
[" -","If your organization has not created an account with HPMS, and needs an HPMS account, please engage your Account Executive."]
[" -","A \"clean\" spreadsheet must be used for every unique submission."]
[" - ","If there are multiple materials to be reviewed at the same time, a single submission spreadsheet should be leveraged to log all materials.  One material per line."]
[" - ","All new concepts, defined as any new/innovative tactic or tool that has not been previously submitted or explained, should be submitted via your Account Executive. Example: new ways of collecting, transferring or utilizing prospect or member data for marketing purposes."]
[" - ","ATTN: If there is a connection to a provider (doctor(s), hospital system, retail pharmacy, etc), you are required to complete the Provider or IPA Related Content Tab.  Failure to provide complete information will delay the start of your review."]
[]
["Column/Field Specific Guidance"]
[" - ","Downline (Column C) column must be completed when you are submitting a material for an affiliated downline partner."]
[" - ","New, Revised Material or Annual Re-File No Changes (Column \"D\") New materials have not previously been submitted for review. Revised materials  include materials previously submitted for review with minimal content changes. For material that are required to be refiled each year and do not have substantial changes, select Annual Re-File. All changes must be submitted as a Word Document with red lines. "]
[" - ","Additional Notes (Column \"L\"): This section should include information that would be helpful to reviewers such as:"]
[]
[" - ","Multi-Plan or Humana Exclusive (Column \"M\"): If the material meets any of the following criteria, select Humana Brand"]
[]
["Material Submission Requirements"]
[" - ","Websites and Other Digital Content:  Include screen shots of the website in a Word document.  If your website has \"templated\" (aka variable) content, please indicate templated content with [brackets] (per 2022 MCMG).  Additional, include the variables for all templated fields."]
[" - ","Television Ads:  Include the script and/or storyboard for the commercial as well as screen grabs in a Word document."]
[" - ","Mailers and Other Print Materials:  Submit via a PDF or editable Word document."]
[" - ","Radio and/or Audio Content: Radio or audio only content should include a script in a Word document and an audio file if available."]
[]
["SMID Guidance"]
[" - ","Do not submit a material to Humana without a SMID."]
[" - ","SMIDs are material specific.  You cannot submit or file multiple materials with the same SMID. "]
[" -","See CMS guidance for more detail on SMID creation."]
[" - ","CMS Guidance for SMIDs on Lead Aggregator Materials:\n"]
[null,"The TPMO is accountable for filing in HPMS as required. Per CMS instruction, adjust the original SMID to add an indicator of their company, such as initials before _M. For example: MULTIPLAN_originalSMID_<initials>_M. Then, in the filing comment section, add a note explaining that the piece was already approved under XXX material id."]

{"sheet":"Submission Attestation","index":1,"n_rows":12,"n_cols":3,"rows_kept":12,"cut":false,"hidden":false,"merged":[[0,0,0,2]]}
["To avoid delays, please confirm the following. \nIf the TPMO cannot confirm, the materials are not ready for submission: "]
[]
[null,null,"I have submitted all materials as an editable Word document "]
[null,null,"The materials have been proofread "]
[null,null,"The materials have been fact-checked for accuracy "]
[null,null,"Credible sources like medicare.gov have been consulted. Indicate sources on the document submitted"]
[null,null,"Humana's Medicare Disclaimer Chart has been consulted "]
[null,null,"If Medicare-related, these material comply with CMS and other regulations, including, but not limited to: "]
[null,null,"Fonts (Website fonts hard coded) are at least the height and width of 12-point Times New Roman, or 16 pixels. "]
[null,null,"No prohibited terminology such as superlatives, absolute language, scare and high-pressure tactics "]
[null,null,"AII claims or references to research/studies are supported and properly cited "]
[null,null,"The material and content are not inaccurate, confusing, or \nmisleading. such as appearing to look like official government \nnotification "]

{"sheet":"Intake Form","index":2,"n_rows":1,"n_cols":16,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Partner Name\nYour organizationor the upline accountable for filing \n","SMID \nProvide the EXACT SMID that will be used for filing in HPMS.  Failure to do so will delay review and optin.","Downline  \nIf submitting for a downline, specify downline.","Type of Submission\nNew, Revised Material, Annual Re-File No Changes, or disclaimer change only?\nSee instructions tab for clarity on drop down options.","Original Submission SMID \n(if revision is selected) \nIf a revision or annual re-file (of prior submission), include the prior SMID. If not a revision, enter NA.","Medium\n","National Distribution\n If you answer \"no\", you must indicate the applicable states within the \"additional notes\" column.","Page Count","If Lead Company Created, Name of Lead Company\nThis is an essential field and failure to provide will delay the review.","If Website or Commercial, Provide Link\n","Time Period to be Used\n\n","Additional Notes\nDistribution area, communication start/end dates, intent, strategy, and any special circumstances  ","Is this material \"Multi-Plan\" or \"Humana Exclusive\"?\nSee instructions tab for the definition of \"Multi-Plan\" and \"Humana Exclusive\"","LOB Promoted\nTo select more than one, hold down the \"ctrl\" key while making your selections.","Do the materials contain any reference to a Provider, Provider Group, Pharmacy, or IPA?\nIF MATERIALS REFERENCE A PROVIDER, PROVIDER GROUP, PHARMACY, OR IPA, THE TPMO MUST ANSWER THE  ADDITIONAL QUESTIONS ON THE \"PROVIDER RELATED\" TAB.","Are the materials co-branded with another non-provider entitiy or being mailed by another non-provider entitiy? \nIF MATERIALS REFERENCE A NON- PROVIDER ENTITY THE TPMO MUST ANSWER THE  ADDITONAL QUESTIONS ON THE \"PROVIDER RELATED MATERIALS\" TAB."]

{"sheet":"Provider Related","index":3,"n_rows":69,"n_cols":6,"rows_kept":69,"cut":false,"hidden":false,"merged":[[59,0,59,1],[59,2,59,5],[61,0,61,5],[50,1,50,5],[51,1,51,5],[52,1,52,5],[53,1,53,5],[54,1,54,5],[55,1,55,5],[56,1,56,5],[57,1,57,5],[27,0,27,1],[19,0,19,1],[20,0,20,1],[22,0,22,1],[24,0,24,1],[25,0,25,1],[26,0,26,1],[14,0,14,1],[16,0,16,1],[21,0,21,1],[23,0,23,1],[13,0,13,1],[15,0,15,1],[17,0,17,1],[18,0,18,1],[0,0,0,5],[2,0,2,1],[2,2,2,5],[3,0,3,1],[4,0,4,1],[4,2,4,5],[6,0,6,1],[10,0,10,1],[12,0,12,1],[7,0,7,1],[8,0,8,1],[9,0,9,1],[11,0,11,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[33,0,33,5],[34,1,34,5],[35,1,35,5],[49,1,49,5],[47,1,47,5],[48,1,48,5],[36,1,36,5],[37,1,37,5],[38,1,38,5],[39,1,39,5],[40,1,40,5],[41,1,41,5],[42,1,42,5],[43,1,43,5],[44,1,44,5],[45,1,45,5],[46,1,46,5],[69,1,69,5],[70,1,70,5],[62,0,62,5],[63,0,63,5],[65,0,65,1],[65,2,65,5],[66,0,66,1],[66,2,66,5],[67,0,67,1],[67,2,67,5],[68,0,68,1],[68,2,68,5]]}
["For Materials containing any reference to a Provider, Provider Group, Pharmacy, or IPA\nThe sales agency partner must answer the questions on this form and provide attestation/signature below.  All fields must be completed.  \nFailure to provide complete information will delay the start of your review."]
[]
["Partner Name"]
["Applicable SMIDs / Projects "]
["Date"]
[]
["Provider Name",null,"<PROVIDER ABC>","<PROVIDER ABC>","<PROVIDER ABC>","<PROVIDER ABC>"]
["Does the Provider have a direct or indirect ownership interest in the Agency?"]
["Does the Agency have a direct or indirect ownership interest in the Provider?"]
["Who is paying for:"]
["Development/creation of the ad? "]
["Printing of the ad (if printed)? "]
["Mailing, publication or distribution of the ad?"]
["Who is the target audience?"]
["If the ad is a flyer, brochure, or other communication to be handed out: "]
["Who is distributing it?"]
["Where will it be distributed? "]
["If the ad is a direct mail piece"]
["Will the piece be mailed by the Provider or the Agency? "]
["What is the return address?"]
["Who is it being sent to?"]
["Where did the list of contacts/addresses come from?"]
["If purchased, what entity purchased them?"]
["If the ad includes Provider testimonial or endorsement: "]
["Name of provider/celebrity personality:"]
["Are they currently a practicing physician? If not, please list the date that they stopped practicing. "]
["Are they contracted with any medical groups? "]
["Are they contracted with any MA Organization or Part D Plan sponsors? "]
["What is their specialty? "]
["If a TV personality, please provide a brief description of their program (is it on TV, internet, etc.): "]
["If filed in HPMS, provide the date filed "]
["Dates the material was in distribution \n(MM/DD/YY - MM/DD/YY)","Dates the material was in distribution (mm/dd/yy - mm/dd/yy)"]
[]
["Please certify that each of the following statements are true prior to submitting the marketing material for review.  If Sales Agency cannot certify the truth of all of the statements listed below, the material cannot be submitted for review:"]
[null,"There is no remuneration directly or indirectly exchanged between the Provider and Agency."]
[null,"There is no quid pro quo agreement or understanding between the Provider and Agency that one entity will refer Medicare beneficiaries to the other in an inappropriate way."]
[null,"Both the Agency and Provider only conduct marketing activities in compliance with CMS, HIPAA, and any other applicable federal and state laws, rules, and regulations, including, but not limited to:"]
[null,"The Agency does not cold call or approach patients of the Provider in violation of CMS’s non-solicitation requirements."]
[null,"The Agency does not use the Provider’s patient information to send materials to the Provider’s patients in violation of CMS or HIPAA requirements. "]
[null,"The Agency’s sales or marketing efforts are targeted towards the community, not only to the Provider’s patients. "]
[null,"The Agency does not solicit or conduct sales activities in areas where care is being administered, including, but not limited to: Exam rooms, hospital patient rooms, pharmacy counter area, and treatment areas where patients interact with providers/clinical team and receive treatment (i.e. dialysis treatment facilities). "]
[null,"Plans are only sold or solicited by sales agents who are appropriately licensed, certified and appointed to sell those plans. "]
[null,"The Provider remains neutral and only provides assistance to beneficiaries at the request of the patient or as a matter of a course of treatment, when meeting with the patient as part of the professional relationship between the provider and patient."]
[null,"The Provider does not make phone calls or direct, urge or attempt to persuade their patients to enroll in a specific plan based on financial or any other interests of the Provider. "]
[null,"The Provider does not mail marketing materials on behalf of MA organizations."]
[null,"The Provider does not accept/collect scope of appointment forms."]
[null,"The Provider does not accept Medicare enrollment applications."]
[null,"The Provider does not conduct health screenings as a marketing activity."]
[null,"The Provider does not distribute marketing materials or enrollment forms in areas where care is being delivered."]
[null,"The Provider does not offer anything of value to induce enrollees to select the Provider."]
[null,"The Provider does not offer inducements to persuade their patients to enroll in a particular MA organization."]
[null,"The Provider does not accept compensation for any marketing or enrollment activities performed on behalf of the MA organization, either directly or indirectly. "]
[null,"If there is a phone number on the ad, it clearly states which entity the phone number will reach. "]
[null,"If there is a web address on the ad, it clearly states whose web address it is. "]
[null,"The ad clearly explains why both the Provider and Agency appear on the ad. "]
[null,"For instance: "]
[null,"o   Are sales meetings being held at the Provider’s facilities? "]
[null,"o   Is the Agency owned by the Provider?"]
[]
["Additional Information If Statements \nNot Certified Above: "]
[]
["THIS FORM MUST BE SIGNED BY ANY SALES AGENCY REQUESTING THE USE OF ANY MATERIALS OR COLLATERAL WITH HEALTHCARE PROVIDERS."]
["TERMS OF SIGNATURE"]
[" I understand that providing my electronic signature by typing my name below constitutes a legal signature confirming that I certify the accuracy and truthfulness of the information provided in this form. "]
[]
["Sales Agency Representative Electronic Signature",null,"<Please Type First and Last Name>"]
["Sales Agency Representative Title:"]
["Sales Agency Name:"]
["Sales Agency Representative Signature Date: "]

{"sheet":"Co-Branded Non-Provider Related","index":4,"n_rows":71,"n_cols":6,"rows_kept":71,"cut":false,"hidden":false,"merged":[[2,2,2,5],[3,0,3,1],[4,0,4,1],[4,2,4,5],[6,0,6,1],[9,0,9,1],[10,0,10,1],[11,0,11,1],[8,0,8,1],[12,0,12,1],[48,1,48,5],[49,1,49,5],[36,1,36,5],[37,1,37,5],[23,0,23,1],[29,0,29,1],[30,0,30,1],[27,0,27,1],[28,0,28,1],[0,0,0,5],[2,0,2,1],[25,0,25,1],[26,0,26,1],[24,0,24,1],[13,0,13,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[17,0,17,1],[18,0,18,1],[19,0,19,1],[20,0,20,1],[21,0,21,1],[22,0,22,1],[7,0,7,1],[51,1,51,5],[38,1,38,5],[52,1,52,5],[31,0,31,1],[32,0,32,1],[34,0,34,5],[50,1,50,5],[39,1,39,5],[40,1,40,5],[41,1,41,5],[42,1,42,5],[43,1,43,5],[44,1,44,5],[45,1,45,5],[46,1,46,5],[47,1,47,5],[53,1,53,5],[54,1,54,5],[55,1,55,5],[69,0,69,1],[69,2,69,5],[68,2,68,5],[57,1,57,5],[58,1,58,5],[59,1,59,5],[61,0,61,1],[61,2,61,5],[63,0,63,5],[56,1,56,5],[70,0,70,1],[70,2,70,5],[64,0,64,5],[65,0,65,5],[67,0,67,1],[67,2,67,5],[68,0,68,1]]}
["For Materials co-branded with another entity or are being mailed to a clients of another entity such as:\nBank, financial advisory firm, insruance company, credit uniotn, loan agency, non-profit organization, or any other entity\nThe sales agency partner must answer the questions on this form and provide attestation/signature below.  All fields must be completed.  \nFailure to provide complete information will delay the start of your review."]
[]
["Partner Name"]
["Applicable SMIDs / Projects "]
["Date"]
[]
["Entity Name",null,"<PROVIDER ABC>","<PROVIDER ABC>","<PROVIDER ABC>","<PROVIDER ABC>"]
["Does the Entity have a direct or indirect ownership interest in the Agency?"]
["What is the relationship between the TPMO and the Entity?","What is the relationship between the TPMO and the Entity?"]
["Describe the type of services provided by the Entity"]
["Who is paying for"]
["Development/creation of the ad? "]
["Printing of the ad (if printed)? "]
["Mailing, publication or distribution of the ad?"]
["Who is the target audience?"]
["If the ad is a flyer, brochure, or other communication to be handed out: "]
["Who is distributing it?"]
["Where will it be distributed? "]
["If the ad is a direct mail piece"]
["Will the piece be mailed by the TPMO or the Non-Provider Entity? "]
["What is the return address?"]
["Who is it being sent to?"]
["Where did the list of contacts/addresses come from?"]
["If purchased, what entity purchased them?"]
["If the ad includes Provider testimonial or endorsement: "]
["Name of provider/celebrity personality:"]
["Are they currently a practicing physician? If not, please list the date that they stopped practicing. "]
["Are they contracted with any medical groups? "]
["Are they contracted with any MA Organization or Part D Plan sponsors? "]
["What is their specialty? "]
["If a TV personality, please provide a brief description of their program (is it on TV, internet, etc.): "]
["If filed in HPMS, provide the date filed "]
["Dates the material was in distribution \n(MM/DD/YY - MM/DD/YY)","Dates the material was in distribution (mm/dd/yy - mm/dd/yy)"]
[]
["Please certify that each of the following statements are true prior to submitting the marketing material for review.  If Sales Agency cannot certify the truth of all of the statements listed below, the material cannot be submitted for review:"]
[]
[null,"There is no remuneration directly or indirectly exchanged between the Provider and Agency."]
[null,"There is no quid pro quo agreement or understanding between the Provider and Agency that one entity will refer Medicare beneficiaries to the other in an inappropriate way."]
[null,"Both the Agency and Provider only conduct marketing activities in compliance with CMS, HIPAA, and any other applicable federal and state laws, rules, and regulations, including, but not limited to:"]
[null,"The Agency does not cold call or approach patients of the Provider in violation of CMS’s non-solicitation requirements."]
[null,"The Agency does not use the Provider’s patient information to send materials to the Provider’s patients in violation of CMS or HIPAA requirements. "]
[null,"The Agency’s sales or marketing efforts are targeted towards the community, not only to the Provider’s patients. "]
[null,"The Agency does not solicit or conduct sales activities in areas where care is being administered, including, but not limited to: Exam rooms, hospital patient rooms, pharmacy counter area, and treatment areas where patients interact with providers/clinical team and receive treatment (i.e. dialysis treatment facilities). "]
[null,"Plans are only sold or solicited by sales agents who are appropriately licensed, certified and appointed to sell those plans. "]
[null,"The Provider remains neutral and only provides assistance to beneficiaries at the request of the patient or as a matter of a course of treatment, when meeting with the patient as part of the professional relationship between the provider and patient."]
[null,"The Provider does not make phone calls or direct, urge or attempt to persuade their patients to enroll in a specific plan based on financial or any other interests of the Provider. "]
[null,"The Provider does not mail marketing materials on behalf of MA organizations."]
[null,"The Provider does not accept/collect scope of appointment forms."]
[null,"The Provider does not accept Medicare enrollment applications."]
[null,"The Provider does not conduct health screenings as a marketing activity."]
[null,"The Provider does not distribute marketing materials or enrollment forms in areas where care is being delivered."]
[null,"The Provider does not offer anything of value to induce enrollees to select the Provider."]
[null,"The Provider does not offer inducements to persuade their patients to enroll in a particular MA organization."]
[null,"The Provider does not accept compensation for any marketing or enrollment activities performed on behalf of the MA organization, either directly or indirectly. "]
[null,"If there is a phone number on the ad, it clearly states which entity the phone number will reach. "]
[null,"If there is a web address on the ad, it clearly states whose web address it is. "]
[null,"The ad clearly explains why both the Provider and Agency appear on the ad. "]
[null,"For instance: "]
[null,"o   Are sales meetings being held at the Provider’s facilities? "]
[null,"o   Is the Agency owned by the Provider?"]
[]
["Additional Information If Statements \nNot Certified Above: "]
[]
["THIS FORM MUST BE SIGNED BY ANY SALES AGENCY REQUESTING THE USE OF ANY MATERIALS OR COLLATERAL WITH HEALTHCARE PROVIDERS."]
["TERMS OF SIGNATURE"]
[" I understand that providing my electronic signature by typing my name below constitutes a legal signature confirming that I certify the accuracy and truthfulness of the information provided in this form. "]
[]
["Sales Agency Representative Electronic Signature",null,"<Please Type First and Last Name>"]
["Sales Agency Representative Title:"]
["Sales Agency Name:"]
["Sales Agency Representative Signature Date: "]

{"sheet":"Drop Down Selections","index":5,"n_rows":36,"n_cols":8,"rows_kept":36,"cut":false,"hidden":true,"merged":[]}
["Yes","LOB","Humana Exclusive","User Determined","AEP","TV","New","Call Center"]
["No","CarePlus","Multi-Plan","Contract Year","OEP","Digital","Revised","FMO"]
[null,"Medicare Advantage (MA/MAPD)",null,"Evergreen","Rest Of Year","Email","Annual Refile, No Changes","Both"]
[null,"PDP (Stand Alone)",null,null,"Year Round","Enrollment Forms","Disclaimer Change Only"]
[null,"Special Needs Plan (SNP)",null,null,null,"Mailer"]
[null,"Commercial/Individual (Dental or vision)",null,null,null,"Online Video"]
[null,"Medicare Supplement",null,null,null,"Other"]
[null,null,null,null,null,"Permission to Contact"]
[null,null,null,null,null,"Social"]
[null,null,null,null,null,"Telephonic Enrollment Script"]
[null,null,null,null,null,"Telephonic FMO Script"]
[null,null,null,null,null,"Telephonic Sales Script"]
[null,null,null,null,null,"Telephonic Script Other"]
[null,null,null,null,null,"Website "]
[]
[]
[null,null,null,null,null,"HPMS list of applicable media types"]
[null,null,null,null,null,"Mail"]
[null,null,null,null,null,"Billboard"]
[null,null,null,null,null,"Email"]
[null,null,null,null,null,"Enrollment Script"]
[null,null,null,null,null,"Mobile Applications"]
[null,null,null,null,null,"Newsletter"]
[null,null,null,null,null,"Newspaper/Magazine"]
[null,null,null,null,null,"Poster/Flyers/Sign"]
[null,null,null,null,null,"Press Release/Service Area Expansion"]
[null,null,null,null,null,"Provider Office"]
[null,null,null,null,null,"Radio"]
[null,null,null,null,null,"Sales Presentation"]
[null,null,null,null,null,"Social Media"]
[null,null,null,null,null,"Telephonic Message"]
[null,null,null,null,null,"Telephonic Sales Script"]
[null,null,null,null,null,"Television/Online Video"]
[null,null,null,null,null,"Text Message"]
[null,null,null,null,null,"Website"]
[null,null,null,null,null,"Other"]