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Get Appointed to Sell ConnectiCare
Brokers who are marketing ConnectiCare products in the states listed below must submit the following:
- Direct Deposit Form: Have your commission payments sent directly to a bank.
- Completed W-9 Form
- Copy of Declarations page of Errors & Omissions policy
- 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.
- 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.
- 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.
You must complete the requirements for becoming appointed with ConnectiCare as outlined in the Connecticut section above.
- Direct Deposit Form: Have your commission payments sent directly to a bank.
- Completed W-9 Form
- Copy of Declarations page of Errors & Omissions policy
- 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.
- Signed ConnectiCare of Massachusetts Agent/Agency Agreement; one signed by the agent and one signed by an officer or principal of the agency, if also appointing the agency.
**Please note: All forms are in PDF format and require the freely available Adobe Acrobat reader. Download Adobe Acrobat reader if you don't have it already.
