DEPARTMENT OF INSURANCE
Affiliations
NameHazelbaker, Richard KeithDOIID384277NAIC NPN55108
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentPrepaid Dental Plan6/22/19981/24/2000 
Pending ReplacementResidentAgentLife1/22/1993 6/30/2024
Pending ReplacementResidentAgentHealth1/22/1993 6/30/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
License Renewal Information
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Agent04/15/202406/30/2024   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAF&L Insurance Company301582Agent - Health8/3/200012/1/2006
InactiveAccordia Life and Annuity Company502966Agent - Life8/26/20184/20/2020
Pending ReplacementAetna Health and Life Insurance Company300523Agent - Health6/2/2017 
InactiveAllianz Life Insurance Company of North America301791Agent - Health9/9/200512/27/2013
InactiveAllianz Life Insurance Company of North America301791Agent - Life9/9/200512/27/2013
InactiveAmerican Continental Insurance Company643130Agent - Health5/6/20112/17/2014
InactiveAmerican Continental Insurance Company643130Agent - Life6/2/20178/11/2021
Pending ReplacementAmerican Equity Investment Life Insurance Company300389Agent - Life8/2/2022 
Pending ReplacementAmerican General Life Insurance Company301585Agent - Health4/8/2022 
Pending ReplacementAmerican General Life Insurance Company301585Agent - Life4/8/2022 
InactiveAmerican Investors Life Insurance Company, Inc.301358Agent - Life10/3/20089/30/2009
InactiveAmerico Financial Life and Annuity Insurance Company300869Agent - Health3/4/20118/27/2013
InactiveAmerico Financial Life and Annuity Insurance Company300869Agent - Life3/4/20118/27/2013
InactiveAthene Annuity & Life Assurance Company301798Agent - Life1/8/20128/10/2015
InactiveAthene Annuity and Life Company301893Agent - Life9/1/20216/9/2023
Pending ReplacementAtlantic Coast Life Insurance Company642114Agent - Life3/1/2023 
Pending ReplacementAugustar Life Insurance Company301816Agent - Life9/20/2023 
InactiveBaltimore Life Insurance Company300286Agent - Health12/14/20019/25/2003
InactiveBaltimore Life Insurance Company300286Agent - Life12/14/20019/25/2003
InactiveBankers Fidelity Assurance Company554627Agent - Health5/17/201711/12/2020
InactiveBankers Fidelity Assurance Company554627Agent - Life5/17/201711/12/2020
InactiveBankers Fidelity Life Insurance Company300193Agent - Health5/17/201711/12/2020
InactiveBankers Fidelity Life Insurance Company300193Agent - Life5/17/201711/12/2020
Pending ReplacementClear Spring Life and Annuity Company300919Agent - Life8/28/2023 
InactiveContinental Casualty Company301019Agent - Health7/1/200211/29/2004
Pending ReplacementContinental Life Insurance Company of Brentwood Tennessee301526Agent - Health5/6/2011 
InactiveContinental Life Insurance Company of Brentwood Tennessee301526Agent - Life5/6/20114/26/2016
InactiveDental Plan Managers Inc.300547Agent - Prepaid Dental Plan6/22/19981/24/2000
InactiveEquiTrust Life Insurance Company502870Agent - Life4/25/20131/6/2018
InactiveEssence Healthcare, Inc.657425Agent - Health12/17/20083/31/2011
Pending ReplacementFidelity & Guaranty Life Insurance Company301359Agent - Life1/2/2014 
InactiveGenworth Life Insurance Company300623Agent - Health12/17/20091/7/2014
InactiveGenworth Life Insurance Company300623Agent - Life12/17/20091/7/2014
InactiveGerber Life Insurance Company300529Agent - Health7/6/201712/14/2020
InactiveGerber Life Insurance Company300529Agent - Life7/6/201712/14/2020
InactiveGuaranty Income Life Insurance Company552451Agent - Health7/16/20147/1/2019
InactiveGuaranty Income Life Insurance Company552451Agent - Life7/16/20147/1/2019
InactiveIndianapolis Life Insurance Company301381Agent - Life7/11/200810/1/2008
InactiveInvestors Life Insurance Company of North America301660Agent - Life8/7/20073/1/2008
InactiveJohn Hancock Life Insurance Company300821Agent - Health6/26/200312/30/2009
InactiveJohn Hancock Life Insurance Company300821Agent - Life6/26/200312/30/2009
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Health9/19/20084/2/2013
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Life9/19/20084/2/2013
InactiveLiberty Bankers Life Insurance Company542461Agent - Life5/10/201712/20/2022
InactiveLife Investors Insurance Company of America301793Agent - Health1/22/19933/26/2003
InactiveLife Investors Insurance Company of America301793Agent - Life1/22/19933/26/2003
InactiveLincoln National Life Insurance Company (The)301382Agent - Health8/21/20099/28/2021
InactiveLincoln National Life Insurance Company (The)301382Agent - Life8/21/20099/28/2021
InactiveMassMutual Ascend Life Insurance Company300320Agent - Life9/20/201712/10/2022
InactiveMedico Insurance Company301559Agent - Health9/22/202112/21/2022
InactiveMedico Insurance Company301559Agent - Life9/22/202112/21/2022
InactiveMedico Life and Health Insurance Company907406Agent - Health1/3/201912/28/2020
InactiveMedico Life and Health Insurance Company907406Agent - Life1/3/201912/28/2020
InactiveMinnesota Life Insurance Company300488Agent - Health10/21/20143/7/2018
InactiveMinnesota Life Insurance Company300488Agent - Life10/21/20143/7/2018
InactiveMutual of Omaha Insurance Company301012Agent - Health3/10/200810/22/2014
Pending ReplacementNassau Life and Annuity Company513671Agent - Life3/4/2024 
InactiveNational Western Life Insurance Company301515Agent - Health7/27/20052/14/2007
InactiveNational Western Life Insurance Company301515Agent - Life10/16/20128/9/2017
InactiveNationwide Life and Annuity Insurance Company300714Agent - Health12/27/201612/10/2018
InactiveNationwide Life and Annuity Insurance Company300714Agent - Life12/27/201612/10/2018
InactiveNorth American Company for Life and Health Insurance300291Agent - Life11/28/20104/23/2019
Pending ReplacementOceanview Life and Annuity Company301868Agent - Life8/13/2020 
InactivePenn Treaty Network America Insurance Company301297Agent - Health4/23/200711/27/2008
InactivePenn Treaty Network America Insurance Company301297Agent - Life4/23/200711/27/2008
InactiveProtective Life Insurance Company300638Agent - Health4/23/201511/23/2017
InactiveProtective Life Insurance Company300638Agent - Life4/23/201511/23/2017
InactiveProvident Life and Accident Insurance Company301525Agent - Health4/11/200311/10/2004
InactiveProvident Life and Accident Insurance Company301525Agent - Life4/11/200311/10/2004
InactivePruco Life Insurance Company300954Agent - Health12/3/201012/23/2014
InactivePruco Life Insurance Company300954Agent - Life12/3/201012/23/2014
InactivePrudential Insurance Company of America300784Agent - Health4/4/200712/23/2014
InactivePrudential Insurance Company of America300784Agent - Life4/4/200712/23/2014
Pending ReplacementReliance Standard Life Insurance Company300584Agent - Life5/20/2017 
InactiveSILAC Insurance Company300535Agent - Health4/29/200912/8/2010
Pending ReplacementSILAC Insurance Company300535Agent - Life11/12/2019 
InactiveSagicor Life Insurance Company300459Agent - Life6/19/20183/8/2023
InactiveSecurity Life of Denver Insurance Company300648Agent - Health10/15/20142/27/2016
InactiveSecurity Life of Denver Insurance Company300648Agent - Life10/15/20142/27/2016
InactiveSenior Health Insurance Company of Pennsylvania300251Agent - Health4/20/19939/17/2003
InactiveSenior Health Insurance Company of Pennsylvania300251Agent - Life4/20/19939/17/2003
Pending ReplacementSentinel Security Life Insurance Company935789Agent - Life8/1/2022 
InactiveStandard Insurance Company300185Agent - Health7/12/201712/5/2022
InactiveStandard Insurance Company300185Agent - Life7/12/201712/5/2022
InactiveState Life Insurance Company301497Agent - Health5/3/201712/4/2023
InactiveState Life Insurance Company301497Agent - Life5/3/201712/4/2023
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Health8/15/200612/11/2009
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Life8/15/200612/11/2009
InactiveTransamerica Life Insurance Company300571Agent - Health8/13/20198/28/2019
InactiveTransamerica Life Insurance Company300571Agent - Life8/13/20198/28/2019
InactiveU.S. Financial Life Insurance Company301812Agent - Life9/14/20049/27/2007
InactiveUNUM Life Insurance Company of America300817Agent - Health4/11/200311/10/2004
InactiveUNUM Life Insurance Company of America300817Agent - Life4/11/200311/10/2004
InactiveUnited Home Life Insurance Company300421Agent - Life1/20/201311/26/2014
InactiveUnited World Life Insurance Company300532Agent - Health3/10/200812/15/2010
InactiveUnited of Omaha Life Insurance Company300156Agent - Health7/26/20136/23/2014
InactiveUnited of Omaha Life Insurance Company300156Agent - Life7/26/20136/23/2014
InactiveVenerable Insurance and Annuity Company301006Agent - Life9/8/200512/5/2015
InactiveWest Coast Life Insurance Company301607Agent - Health2/17/20109/18/2012
InactiveWest Coast Life Insurance Company301607Agent - Life2/17/20109/18/2012
Inactive300277Agent - Life8/13/20041/1/2007
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
Pending ReplacementDesignated Agent Company Inc.681257Agent - Life12/16/2013 
Pending ReplacementDesignated Agent Company Inc.681257Agent - Health12/16/2013 
InactiveFundamental Insurance and Retirement Planning675147Agent - Life10/10/20113/31/2018
InactiveFundamental Insurance and Retirement Planning675147Agent - Health10/10/20113/31/2018
Pending ReplacementNorth American Life Plans LLC645076Agent - Life9/22/2010 
Pending ReplacementNorth American Life Plans LLC645076Agent - Health9/22/2010 
Pending ReplacementR. Keith Hazelbaker Enterprises610026Agent - Life6/23/2023 
Pending ReplacementR. Keith Hazelbaker Enterprises610026Agent - Health6/23/2023 

© Commonwealth of Kentucky. All rights reserved.