Connector Tool Sign Up

Check the following statements that are true for you: *

I provide Healthcare.gov enrollment assistance

I provide BadgerCare Plus enrollment assistance

I do not charge a cost to the consumer for enrollment assistance

I provide enrollment assistance to anyone (not only clients/patients)

For insurance agents/brokers only: I am contracted with all Qualified Health Plans available within the zip code of our agency address

For insurance agents/brokers only: I explore comprehensive health insurance options (i.e. Healthcare.gov and BadgerCare Plus) before considering fixed benefit plans, short terms plans, or non-insurance options such as health care sharing ministries.

I provide enrollment assistance all year long

How do you provide enrollment assistance? *

In-Person

Telephone

Virtual/Zoom

Your Name (for Covering Wisconsin administrator purposes only) *

First Name

Last Name

Agency Address *

If you agency has more than one address where enrollment assistance is provided, please fill this out for each location by submitting another form.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agency Phone *

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