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.
- 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.
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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
