DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Larose, Shimron Fritz	DOIID	1033291	NAIC NPN	17663953

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/19/2019	12/31/2021
Inactive	Non Resident	Agent	Life	3/19/2019	12/31/2021
Inactive	Non Resident	Independent Adjuster	Property & Casualty	12/16/2021	12/31/2023
Active	Non Resident	Staff Adjuster	Property & Casualty	5/16/2024		12/31/2025
* 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
Staff Adjuster	10/15/2025	12/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Life	9/4/2020	12/31/2021
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	10/10/2019	12/31/2021
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	9/4/2020	12/31/2021
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/28/2020	12/31/2021
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/10/2019	12/31/2021
Inactive	American Continental Insurance Company	643130	Agent - Life	9/4/2020	8/11/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/13/2019	3/21/2020
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/13/2019	5/8/2020
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	6/1/2020	2/5/2021
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	9/4/2020	12/31/2021
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/21/2019	3/11/2020
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/10/2019	12/31/2021
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	3/28/2019	3/5/2020
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/6/2019	3/5/2020
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/28/2019	3/5/2020
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	3/28/2019	3/5/2020
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	6/26/2020	12/29/2021
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	6/26/2020	12/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	4/15/2019	5/8/2020
Inactive	Designated Agent Company Inc.	681257	Agent - Health	4/15/2019	12/31/2021