First, a few forms

Brokers who are marketing ConnectiCare products in the states listed below must submit the following:

Commission Plans

Individual plans

Small-group fully-insured plans (50 or fewer eligible employees)

Middle-market (51-99 eligible employees)

 

Other Forms

  • 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.
  • Completed W-9 Form
  • Copy of Declarations page of Errors & Omissions policy
  • 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.

Broker Sell individual plans services

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

Small group and individual sales

Leadership