Commission Plans
Small-Group (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.
- Producer Information Sheet
- 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.
- Review Instructions on submitting the above requirements.
- You must also complete Access Health CT certification requirements to sell CT exchange plans.
