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Frequently Asked Questions
Producer Registration Form  

All producers must be licensed and appointed prior to representing ConnectiCare, Inc. and/or registering online. Click here for information regarding the appointment process.

Please provide the following information (all fields are required):     *   =   Required

*First Name: 
*Last Name: 
*Email Address: 
*Select Username:  (Any combination of letters and numbers with no spaces. Must be at least 6 characters.)
*Select Password:  (Password is case sensitive. Must be at least 6 characters. May contain letters and numbers.)
*Retype Password: 

*Producer License Number: (Provided by the state of CT, MA or NY.) License number may contain 9 digits. Add preceding zero’s as needed (e.g. 009999999).)

*Tax ID:
(Social Security Number) 
(Example: 045123456) HELP

Become a ConnectiCare Producer
Appointment Process
Register Now!
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Frequently Asked Questions