To apply for coverage under one of ConnectiCare’s Medicare Supplement plans, you must:
- Be eligible for Medicare;
- Reside in Connecticut;
- Not have coverage provided by Medicaid; and
- Not have coverage by any other health insurance plan.
How to Enroll
You can download our application and mail it to us along with a check for the first payment.
If you do not send a payment with your application, we will send you an invoice after the application is processed, once your eligibility has been confirmed.
We will send you an identification card along with your contract within 7-10 business days after all parts of the application have been received and the premium has been paid, unless you request a later effective date.
Download, print and complete the application:
Mail your completed ConnectiCare Medicare Supplement Application Form application to:
P.O. Box 2820
New York, NY 10016-2820