DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Green, Dervin	DOIID	1274789	NAIC NPN	18371239

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/16/2023		1/31/2025
* 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	11/15/2024	01/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	9/29/2024
Active	CompBenefits Insurance Company	301864	Agent - Health	9/29/2024
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/23/2023	8/29/2024
Active	Humana Insurance Company	301104	Agent - Health	9/29/2024

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	1/22/2024	8/29/2024