Brokers who are marketing ConnectiCare products in the states listed below must submit the following:
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Visit a ConnectiCare Center
Sell Individual and Group Plans
First, a Few Forms
Commission Plans
Small-Group Fully-Insured Plans (50 or Fewer Eligible Employees)
Middle-Market (51-99 Eligible Employees)
Other Forms
- 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.
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Large Group Sales
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Phyllis Guardiano
Senior Sales Executive, Large Group
860-674-2009
Small Group and Individual Sales
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Broker Sales and Support
Monday-Friday, 8 a.m. - 5 p.m.
800-723-2986 -
Bob Twombly
Account Executive, Small Group Sales
860-674-5709 -
Denise Roy
Account Executive, Small Group Sales
860-674-5843
Leadership
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Terri Guidone
Vice President, Individual and Small Group Sales
860-674-5722
