HPHC Insurance Company, Inc.
Harvard Pilgrim sells its Connecticut products through two licensed companies: Harvard Pilgrim Health Care of Connecticut, Inc. (HMO products) and HPHC Insurance Company (PPO products). When you credential with Harvard Pilgrim, they require that you become appointed with both companies, even if your intent is to sell only products affiliated with one Harvard Pilgrim company.
Please complete and return the following items to the contact noted below. The original of the EFT form needs to be sent back via U.S. mail with a voided check to our Treasury Department to the address listed on the form.
- Broker Application
- Signed W-9
- Checklist and Instructions for Completing Broker Agreement and Business Associate Agreement
- Broker Agreement (please return all pages)
- Business Associate Agreement (please return all pages)
- HPHConnect for Brokers form (this includes Online quoting)
- EFT
- CT Appointment form (to sell in CT)
Harvard Pilgrim also requires a copy of your Connecticut Producer License (Massachusetts, Maine, and/or New Hampshire also if you plan on doing any business there) and a copy of your evidence of Errors & Omissions coverage.
The initial appointment fee ($180 per appointee) is paid by the broker. The CID setup fee and administrative fees are paid by Harvard Pilgrim. Future renewal fees (2016 and beyond) will be paid by Harvard Pilgrim.
All completed forms can be either faxed, mailed, or emailed to:
Fax #: 617.509.2515
Email: broker_relations@harvardpilgrim.org
Harvard Pilgrim Health Care
Broker Relations
93 Worcester St., Suite 100
Wellesley, MA 02481