DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Stack, Jacob	DOIID	1089744	NAIC NPN	19013002

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	7/17/2020		10/31/2024
* 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	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Active	Aetna Health Inc. (PA)	660717	Agent - Health	7/22/2020
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	12/11/2020
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/22/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	7/22/2020
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	12/11/2020
Active	SilverScript Insurance Company	663526	Agent - Health	7/22/2020
Inactive	Tier One Insurance Company	301056	Agent - Health	5/26/2023	11/9/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	5/24/2023	11/7/2023