DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Petterssen, Mary Elizabeth	DOIID	312540	NAIC NPN	630433

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	2/13/2015	11/30/2020
Inactive	Resident	Agent	Health Maintenance Organization	7/27/1999	3/1/2001
Inactive	Resident	Agent	Health	2/20/2015	11/30/2020
* 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
Denied	Allianz Life Insurance Company of North America	301791	Agent - Health
Denied	Allianz Life Insurance Company of North America	301791	Agent - Life
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	10/12/2017	7/12/2018
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	5/6/2015	7/12/2018
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	5/6/2015	7/12/2018
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/13/2014	11/30/2014
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	11/30/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/6/2015	7/12/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	7/27/1999	3/1/2001
Inactive	Humana Insurance Company	300118	Agent - Health	7/27/1999	1/3/2002
Inactive	Humana Insurance Company	301104	Agent - Health	5/6/2015	7/12/2018
Inactive	Humana Insurance Company	301104	Agent - Life	5/6/2015	7/12/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	5/6/2015	7/12/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	5/6/2015	7/12/2018
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/13/2014	11/30/2014
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	7/12/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	5/6/2015	11/12/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	5/6/2015	11/12/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	1/22/2002	4/1/2009
Inactive	Humana MarketPOINT Inc.	398092	Agent - Life	1/22/2002	4/1/2009