Brokers who are marketing ConnectiCare products in the states listed below must submit the following:
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Popular Tasks
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.
- Exchange commission plan
- You must complete the requirements for becoming appointed with ConnectiCare as outlined in the Connecticut section above.
- In addition, you must be trained and certified by Access Health CT prior to signing and submitting this ConnectiCare Benefits, Inc. Producer Agreement.
- Completed agreement should be faxed to 1-860-678-5224 or emailed to: ccibrokercommission@connecticare.com.
- Learn about training and certification.
- 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.
online service
Register for our secure broker website
Licensed and appointed brokers can use the secure broker website to view and manage their book of business and provide valuable service to their clients.
Large group sales
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Phyllis Guardiano
Senior Sales Executive, Large Group
1-860-674-2009 -
Robert Holt
Senior Sales Executive, Large Group
1-860-674-5479
Small group and individual sales
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Broker sales and support
Monday-Friday, 8 a.m.-5 p.m.
1-800-723-2986 -
Bob Twombly
Account Executive, Small Group Sales
1-860-674-5709 -
Denise Roy
Account Executive, Small Group Sales
1-860-674-5843
Leadership
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Brian Pagliaro
Senior Vice President, Sales and Marketing
1-860-674-2277 -
Terri Guidone
Vice President, Individual and Small Group Sales
1-860-674-5722
