DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Physicians Planning Service Corporation Of Connecticut	DOIID	398049	NAIC NPN	660752

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	11/19/2015	4/1/2024
Inactive	Non Resident	Agent	Health	9/13/1993	4/1/2024
Inactive	Non Resident	Agent	Life	9/13/1993	4/1/2024
* 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	Hartford Life and Accident Insurance Company	300878	Agent - Health	10/7/1999	6/6/2017
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	10/7/1999	6/6/2017
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	10/7/1999	6/6/2017
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	10/7/1999	6/6/2017
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	9/13/1993	3/16/2004
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	9/13/1993	3/16/2004

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arden, George Justin	514352	Administrator - Not Applicable	10/9/2000	6/30/2003
Inactive	Butler, Jill Michele	383929	Agent - Health	9/13/1997	1/16/2002
Inactive	Butler, Jill Michele	383929	Agent - Life	9/13/1997	1/16/2002
Active	Dioses, Marisol	868863	Administrator - Not Applicable	11/19/2015
Inactive	Dioses, Marisol	868863	Agent - Health	7/6/2015	4/1/2024
Inactive	Dioses, Marisol	868863	Agent - Life	7/6/2015	4/1/2024
Inactive	Glenn, Robert L	390209	Agent - Health	9/13/1993	6/1/1997
Inactive	Glenn, Robert L	390209	Agent - Life	9/13/1993	6/1/1997
Inactive	Haggerty, Michael Thomas	580594	Administrator - Not Applicable	1/7/2005	6/3/2015
Inactive	Haggerty, Michael Thomas	580594	Agent - Health	6/2/2004	7/6/2015
Inactive	Haggerty, Michael Thomas	580594	Agent - Life	6/2/2004	7/6/2015
Inactive	White, Stephen Elbert	357760	Agent - Health	7/24/1997	2/14/2003
Inactive	White, Stephen Elbert	357760	Agent - Life	7/24/1997	2/14/2003
Inactive	Young, Barbara Lydia	516976	Agent - Health	2/24/2004	5/12/2004
Inactive	Young, Barbara Lydia	516976	Agent - Life	2/24/2004	5/12/2004