How to Apply
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You can apply for ConnectiCare SOLO if you are:
- A legal resident of Connecticut
- Under age 65
- Not enrolled in Medicare
- Single or married, or belong to a civil union/domestic partnership*
Note: Families may apply for coverage for unmarried, dependent children under age 26
* Domestic Partners must submit Domestic Partner Verification Form or other satisfactory certification.
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Ask your friends and neighbors what they think of their ConnectiCare insurance coverage. We’re sure you’ll hear first-hand why we received the highest member satisfaction score for customer service in Connecticut, according to the 2007 Consumer Assessment of Health Plans Survey.
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Steps to Apply:
- Complete, sign and date the Individual Application/Change Form – Part 1 – no more than 60 days prior to the requested effective date.
- Accurately and completely answer all questions on the Individual Health Statement – Part 2 – for each family member applying for coverage.
- Complete, sign and date the Underwriting Authorization Form – Part 3.
- For applicants under 18, the application must have a parent/guardian’s signature and date, and the parent/guardian’s full name must be written on the application.
Other required documentation, if applicable:
- Domestic Partner Verification Form or other satisfactory certification
- Disabled Dependent Form
- Election of Electronic Funds Transfer Form
