DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Matousek, Kerrin T	DOIID	1014465	NAIC NPN	3165544

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	10/10/2018		12/31/2024
Active	Non Resident	Agent	Health	10/10/2018		12/31/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	10/15/2024	12/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Dental Care Plus Inc.	301495	Agent - Health	7/9/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/19/2018	7/30/2021
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	10/19/2018	7/30/2021
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	10/19/2018	7/30/2021
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/19/2018	7/30/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Of Arizona Inc	511502	Agent - Health	11/6/2018	3/6/2020
Inactive	Willis Of Arizona Inc	511502	Agent - Life	11/6/2018	3/6/2020
Inactive	Willis Towers Watson Insurance Services West Inc	538729	Agent - Health	2/1/2020	8/17/2021
Inactive	Willis Towers Watson Insurance Services West Inc	538729	Agent - Life	2/1/2020	7/30/2021