DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kubik, Jeffery J	DOIID	321007	NAIC NPN	528401

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	6/24/1997		10/31/2024
Active	Non Resident	Agent	Life	6/24/1997		10/31/2024
* 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	08/15/2024	10/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/17/2012	3/14/2019
Inactive	CompBenefits Insurance Company	301864	Agent - Health	7/18/2012	6/26/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Life	7/18/2012	6/26/2013
Active	Dental Concern Inc. (The)	301641	Agent - Health	3/22/2021
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	1/22/2013	2/23/2018
Active	Humana Health Plan, Inc.	300142	Agent - Health	3/22/2021
Active	Humana Insurance Company	301104	Agent - Health	3/22/2021
Inactive	Humana Insurance Company	301104	Agent - Life	7/17/2012	12/19/2019
Active	Humana Insurance Company of Kentucky	300826	Agent - Health	3/22/2021
Active	Humana Insurance Company of Kentucky	300826	Agent - Life	3/22/2021
Inactive	HumanaDental Insurance Company	301457	Agent - Health	7/18/2012	12/19/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	7/18/2012	12/19/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/17/2012	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/17/2012	10/22/2015
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/24/1997	11/21/2005
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/24/1997	11/21/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Employee Benefit/Risk Management Services LLC	1184425	Agent - Life	6/24/2022
Active	Employee Benefit/Risk Management Services LLC	1184425	Agent - Health	6/24/2022