DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Haczyk, Piotr	DOIID	1152118	NAIC NPN	17894023

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	8/17/2021		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
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	10/22/2021	1/10/2024
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	4/6/2022	1/10/2024
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/21/2022	1/10/2024
Inactive	Humana Insurance Company	301104	Agent - Health	10/18/2021	1/10/2024
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	6/9/2023	1/10/2024
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	6/7/2022	1/10/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Trubridge Inc	717747	Agent - Health	2/14/2022	1/10/2024