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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	08/15/2026	10/31/2026

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	9/3/2025	11/18/2025
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/3/2025	11/18/2025
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/3/2025	11/18/2025
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
Inactive	Tier One Insurance Company	301056	Agent - Health	5/19/2023	7/12/2025
Inactive	Tier One Insurance Company	301056	Agent - Life	5/19/2023	7/12/2025
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
Inactive	Sutherland Global Services Inc	601788	Agent - Health	5/8/2023	7/12/2025
Inactive	Sutherland Global Services Inc	601788	Agent - Life	5/8/2023	7/12/2025