Other Forms

  • Direct Deposit Form

    Have your commission payments sent directly to a bank.

  • Producer Information Sheet

  • Business Associate Confidentiality Agreement

    Complete the Business Associate Confidentiality Agreement: one signed by the agent and one signed by an officer or principal of the agency, if also appointing the agency.

  • Agent/Agency Agreement

    Signed ConnectiCare Agent/Agency Agreement: one signed by the agent and one signed by an officer or principal of the agency, if also appointing the agency

  • ConnectiCare Benefits, Inc. Producer Agreement

    Signed ConnectiCare Benefits, Inc. Producer Agreement: one signed by the agent and one signed by an officer or principal of the agency, if also appointing the agency

  • Review instructions on submitting the above requirements.

Additionally, you must provide a completed W9 and a copy of your Declarations page of your Errors & Omissions policy. 

In order to sell CT exchange plans, you must complete Access Health CT certification requirements.

Broker Sell individual plans services

online service

Register for Our Secure Broker Website

Licensed and appointed brokers can use the secure broker website to view and manage their book of business and provide valuable service to their clients. 

Large Group Sales

Small Group and Individual Sales

Leadership