DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Sicard, Justin	DOIID	1063504	NAIC NPN	19332749

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/30/2019	1/31/2022
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	3/11/2020	1/31/2022
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/30/2020	1/31/2022
Inactive	Aetna Life Insurance Company	301140	Agent - Health	3/11/2020	1/31/2022
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/5/2019	4/19/2020
Inactive	Independence American Insurance Company	524747	Agent - Health	11/21/2019	12/18/2020
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Health	11/21/2019	1/31/2022
Inactive	SilverScript Insurance Company	663526	Agent - Health	3/11/2020	1/31/2022

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 - Health	11/5/2019	1/31/2022