INSURER FORMS AND APPLICATIONS

Find a list of downloadable and online forms for insurance companies.

Connecticut Data Security Forms

CYBERSECURITY NOTIFICATION FORM 

Complete this form and email to cid.mc@ct.gov along with all required attachments.

Surveys

CONSUMER REPORT CARD SURVEY PART 1 

Five worksheets in this excel workbook

CONSUMER REPORT CARD SURVEY PART 2 

Seven worksheets in this excel workbook

FORMULARY SURVEY 

Complete this form and email to LHCompliance@ct.gov along with all required attachments.

OUTPATIENT PRESCRIPTION DRUG COST SURVEY 

Use of this portal is ONLY available during the reporting period - from January 1 to September 1 every year.

OUTPATIENT PRESCRIPTION DRUG COST SURVEY USER GUIDE  

For the Outpatient Prescription Drug Cost Survey Tool

Network Adequacy Surveys

Heart rate

DENTAL – MEDICAL – VISION

Network Adequacy Survey Tool
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USER GUIDE

Network Adequacy Survey Tool