You told us that someone in your home pays medical bills. Please answer the questions to tell us more about the medical expenses.
Select the type of medical expense.
Enter the name of medical care provider.
Enter the date of service in the following format: MM/DD/YYYY. Be sure to use slashes (/).
Select how frequently the of medical expense is paid.
Enter the amount paid.
If the medical bill is paid in full, please choose Yes.
Enter the amount pending on the bill.
If the person listed on the page pays other medical bills, select Yes. If they don't, select No.
To continue, click the NEXT button.
To go back to the prior page, click the PREVIOUS button.
To save the renewal or exit the page, click the SAVE & EXIT button. This takes you to the SAVE and EXIT screen where you have a choice of saving or continuing to work on the renewal.
To close this window and return to ConneCT, click the CANCEL & EXIT button.