DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kistler Tiffany Benefits General Agency LLC	DOIID	1074480	NAIC NPN	19363948

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	2/14/2020		3/31/2026
Active	Non Resident	Agent	Life	2/14/2020		3/31/2026
* 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
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/29/2020
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	11/6/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	9/29/2020
Active	Arch Insurance Company	300688	Agent - Health	11/23/2020
Active	SilverScript Insurance Company	663526	Agent - Health	11/6/2020

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Bruckman, Adam D	553893	Agent - Health	2/14/2020
Active	Bruckman, Adam D	553893	Agent - Life	2/14/2020