DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Tiya	DOIID	1293605	NAIC NPN	20810974

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	8/22/2023	12/31/2024
Active	Non Resident	Agent	Life	8/22/2023	12/31/2024
* 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	10/15/2024	12/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	8/28/2023	11/17/2023
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/18/2023
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	8/28/2023	5/8/2024
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/18/2023
Active	Aetna Life Insurance Company	301140	Agent - Health	9/18/2023
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/23/2023	2/1/2024
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	8/23/2023	2/1/2024
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	8/23/2023	2/1/2024
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	10/23/2023	1/30/2024
Inactive	CHA HMO, Inc.	300662	Agent - Health	10/23/2023	1/30/2024
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	9/1/2023
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	9/25/2023	1/29/2024
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	9/13/2023	2/9/2024
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	9/13/2023	2/9/2024
Inactive	Cigna Healthcare of Colorado, Inc.	1098153	Agent - Health	11/24/2023	4/12/2024
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	8/23/2023	2/1/2024
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	8/28/2023	5/8/2024
Active	Guardian Life Insurance Company of America	301316	Agent - Health	9/20/2023
Active	Guardian Life Insurance Company of America	301316	Agent - Life	9/20/2023
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/10/2024	1/30/2024
Inactive	Humana Insurance Company	301104	Agent - Health	10/25/2023	1/30/2024
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/23/2023	1/30/2024
Inactive	Medco Containment Life Insurance Company	301557	Agent - Health	11/6/2023	3/5/2024
Inactive	Monitor Life Insurance Company of New York	1117550	Agent - Health	10/14/2023	1/29/2024
Inactive	Monitor Life Insurance Company of New York	1117550	Agent - Life	10/14/2023	1/29/2024
Inactive	Omaha Health Insurance Company	301296	Agent - Health	10/8/2023	2/1/2024
Active	SilverScript Insurance Company	663526	Agent - Health	9/18/2023
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/25/2023	1/29/2024
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/25/2023	1/29/2024
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	10/21/2023	2/25/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Extend Insurance Services, LLC	625753	Agent - Life	9/13/2023	2/1/2024
Inactive	Extend Insurance Services, LLC	625753	Agent - Health	9/1/2023	2/1/2024