DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Edward Robert	DOIID	1146155	NAIC NPN	19696345

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	7/21/2021	7/31/2022
Inactive	Non Resident	Agent	Life	7/21/2021	7/31/2022
* 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	Accendo Insurance Company	300312	Agent - Health	11/24/2021	7/31/2022
Inactive	Accendo Insurance Company	300312	Agent - Life	11/24/2021	7/31/2022
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	8/15/2021	7/31/2022
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	11/24/2021	7/31/2022
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/15/2021	7/31/2022
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/15/2021	7/31/2022
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/18/2021	7/31/2022
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/26/2021	7/31/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/26/2021	7/31/2022
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/26/2021	7/31/2022
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	11/24/2021	7/31/2022
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	11/24/2021	7/31/2022
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	10/15/2021	9/20/2022
Inactive	Humana Insurance Company	301104	Agent - Health	12/6/2021	9/19/2022
Inactive	SilverScript Insurance Company	663526	Agent - Health	8/15/2021	7/31/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	9/21/2021	7/15/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	9/21/2021	7/15/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/21/2021	3/26/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/21/2021	3/26/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	8/21/2021	12/23/2021
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/21/2021	3/26/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Iq Insurance Services, Inc	882220	Agent - Life	9/21/2021	7/31/2022
Inactive	Health Iq Insurance Services, Inc	882220	Agent - Health	9/21/2021	7/31/2022