Sell Individual Group Plans
Forms
2025 Individual Plans
2025 Small-Group (50 or Fewer Eligible Employees)
2025 Middle-Market (51-99 Eligible Employees)
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.
Register for Our Secure Broker Website
Large Group Sales
- Jennifer Cerrito
- Phyllis Guardiano
Small Group and Individual Sales
- Broker Sales and Support
Monday-Friday, 8 a.m. - 5 p.m.
- Nancy Benis
- Deanna Ericson
Leadership
- Terri Guidone
