DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Dominick	DOIID	1301443	NAIC NPN	20558360

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/27/2023	10/31/2024
Inactive	Non Resident	Agent	Life	9/27/2023	10/31/2024
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	10/20/2023	10/31/2024
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	10/20/2023	10/31/2024
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/20/2023	10/31/2024
Inactive	Humana Insurance Company	301104	Agent - Health	11/27/2023	10/31/2024
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/20/2023	10/31/2024
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	11/11/2023	10/31/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	TZ Insurance Solutions LLC	727470	Agent - Life
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	1/19/2024	10/31/2024