Harvard Pilgrim Health Care of Connecticut, 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
• HPHConnect for Brokers form (this includes Online quoting)
• EFT
• CT Appointment form (to sell in CT)
• Broker Agreement
  (Please contact HPHC Broker Relations for current version – see below for contact information)
• Business Associate Agreement
  (Please contact HPHC Broker Relations for current version– see below for contact information)

   

HPHC Broker Relations
Phone: 800.424.7285
Email: broker_relations@harvardpilgrim.org

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. Renewal fees are paid by Harvard Pilgrim.

Mail all completed forms and fee to:

Harvard Pilgrim Health Care
Broker Relations
93 Worcester St., Suite 100
Wellesley, MA 02481