Join Our Broker Team
We greatly appreciate your interest in HealthyCT! We’re looking forward to working with you to deliver a new health insurance option to individuals and small groups in our state. HealthyCT will accept new cases, renewals, or agent of record changes for brokers who complete the application process. To apply, please provide the following:
- A completed Producer Information Sheet.
- A completed Form W-9.
- A copy of your current Connecticut producer license. If you are affiliated with a corporation, you must also submit a copy of the corporation’s Connecticut License.
- A copy of the declarations page of your Errors and Omissions insurance policy. The document should list the limits of liability, as well as the policy effective and end dates.
- A signed HealthyCT, Inc. Producer Agreement. We will return an executed Agreement to you upon receipt of all required items. If you are applying for yourself and a corporation, you and the principal of the corporation must sign two (2) copies and return both copies to the address below.
- A completed Direct Deposit Form. (Optional)
- A check, made payable to HealthyCT, Inc., to cover the application fee. The fee is $150.00 for each independent agent and agency, as well as each agent affiliated with the latter.
Attention: Broker Appointment
35 Thorpe Avenue, Suite 104
Wallingford, CT 06492
PROTECT OUR MEMBERS’ PRIVACY – READ THIS FIRST
Privacy is important to us. This contact form is not a secure vehicle for transmitting personal information and it is only monitored during normal business hours.
Please do not transmit any personal health information (such as medical conditions, diagnosis or treatment information) or member ID numbers and other account information through this box. If you have questions that relate to a member’s account, personal health status or medical/insurance needs, please call us at 1-855-HLTHYCT (1-855-458-4928).