DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Maya Jewl-Mone	DOIID	1144581	NAIC NPN	19921831

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	4/25/2023		10/31/2026
Active	Non Resident	Agent	Life	4/25/2023		10/31/2026
* 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
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	8/22/2024	6/26/2025
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/22/2024	6/26/2025
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/22/2024	6/26/2025
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	5/8/2023	5/31/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	5/8/2023	5/31/2023
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	6/20/2024	5/14/2025
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	6/20/2024	5/14/2025
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	6/20/2024	5/14/2025
Inactive	Golden Rule Insurance Company	301943	Agent - Health	6/3/2022	11/2/2022
Inactive	SilverScript Insurance Company	663526	Agent - Health	8/22/2024	6/26/2025
Active	Tier One Insurance Company	301056	Agent - Health	5/19/2023
Active	Tier One Insurance Company	301056	Agent - Life	5/19/2023
Inactive	Unified Life Insurance Company	543169	Agent - Health	6/28/2022	10/19/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Sutherland Global Services Inc	601788	Agent - Health	5/8/2023
Active	Sutherland Global Services Inc	601788	Agent - Life	5/8/2023