DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ulysse, Simon	DOIID	1136393	NAIC NPN	10989665

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/26/2021		8/31/2024
Active	Non Resident	Agent	Life	5/26/2021		8/31/2024
* 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	06/15/2024	08/31/2024

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	5/31/2021
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	5/31/2021
Active	Aetna Life Insurance Company	301140	Agent - Health	5/31/2021
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/30/2021	5/6/2024
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	11/30/2021	5/6/2024
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	11/30/2021	5/6/2024
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	7/24/2023	5/16/2024
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/21/2022
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	11/30/2021	5/6/2024
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/2/2023	5/16/2024
Inactive	Humana Insurance Company	301104	Agent - Health	11/21/2022	5/16/2024
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	12/7/2021	12/13/2022
Active	SilverScript Insurance Company	663526	Agent - Health	5/31/2021
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	8/14/2021
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/14/2021	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	8/14/2021	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/14/2021
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	9/29/2021
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	11/14/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assurance IQ, LLC	919554	Agent - Life
Inactive	Assurance IQ, LLC	919554	Agent - Health	11/3/2022	5/15/2024