On this page, we're asking about a medical insurance policy that covers one or more of the people in your home.
You’ve told us that someone has medical insurance. Next, we'd like to know the name of this person's insurance company and how much and how often they pay premiums. If you have this information, please type it in the boxes.
Next, we're asking about the policy number for this policy. The policy number is also known as the "identification number" or "subscriber number." If you have this information, please type it in the boxes.
In the next section, we'll ask about the people in the home who are covered by this policy.
First, you'll need to check the box for each person who is covered.
If the policy is held by someone outside of the home, we'll ask how the covered person is related to the person who holds the policy. For example, if your child has health insurance through a parent who is not living in your home, you'll need to choose "Child" from the list.
Next, please tell us when the coverage started for each person. If you're not sure of the exact date, just make your best estimate.
When you type these dates, be sure to use this format: MM/DD/YYYY. For example, if the person's coverage started on is March 1, 2005, type 03/01/2005. Be sure to use slashes when you type the date.
Last, we're asking whether this person holds another insurance policy that covers someone in your home. For example, if a parent has two jobs and both jobs provide health insurance, you should answer yes to this question.
If you're telling us about a policy held by someone outside of your home, you should answer yes if this same person OR someone else outside of the home holds another health insurance policy that covers someone in your home. For example, if you have children who are each covered by a different parent who is living outside of the home, you should answer yes to this question.
If you answer yes to this question, we'll ask about the next health insurance policy on the next page.
To close this window and return to ConneCT without saving, click the CANCEL & EXIT button.
To save your application and return to ConneCT, click the SAVE & EXIT button.