DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bluegrassmedicare LLC	DOIID	1319345	NAIC NPN	21047305

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	1/16/2024		3/31/2026
Active	Resident	Agent	Life	1/16/2024		3/31/2026
* 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
Active	ACE Property and Casualty Insurance Company	300520	Agent - Health	6/27/2024

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Potts, Thomas Wahl	311377	Agent - Health	1/16/2024
Active	Potts, Thomas Wahl	311377	Agent - Life	1/16/2024