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Subscriber Information

To find your Enrollment ID number, sign into your account at MAhealthconnector.org, go to My Enrollments, and enter the Enrollment ID number of your insurance plan. Your Billing Account Number can be found on the top right area of your Health Connector Insurance Bill. This number begins with 7. If you didn’t get a bill yet, please choose one of the other ID types. Enter the Social Security number of the primary subscriber on your application. If you did not provide a Social Security Number on your application, or you are authorized to make a payment but don’t have that number, please choose one of the other ID types.

Enter the information below for the primary subscriber on your account.

Select ID *

Enrollment ID *

Confirm Social Security Number *

Subscriber Details

Enter the information below for the primary subscriber on your account.

First Name *

Middle Name

Last Name *

Suffix

Date of Birth *

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