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Broker Forms and Documents

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What Are You Looking For?

 

Large Group

 

SOLO

 

Small Group

ConnectiCare plans for small group customers are sold through our partners. Forms can be found on their websites.

  • Connecticut Business & Industry Association (CBIA) Service Corp. - Fully-Insured, ACA Plans

  • CBIA Health Connections - Fully-Insured, ACA Plans and Fixed Funding Solutions Level-Funded Plans

  • Access Health CT Small Business Plans

  • Small Group Rate Sheets

  • Small Group Benefit Summaries

  • Dental Rate Sheets

  • Dental Benefit Summaries

  • Benefits of a Health Savings Account (HSA)

    Employee flyer
 

Exchange

  • Access Health CT Product Brochure

  • ACA Drug List

    Drugs covered without a cost-share under the Affordable Care Act.

  • Benefits of a Health Savings Account (HSA)

 

Other forms

  • 2023 Exchange Direct Application

  • Medicare Advantage

    Forms for members of Medicare Advantage plans.

  • Members Under 65

    Find forms members may need.
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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary,or other plan documents for specific information about your benefits coverage.