DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bluegrass Benefits Group LLC	DOIID	399883	NAIC NPN	7222017

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	2/8/2007	3/31/2013
Inactive	Resident	Agent	Life	2/8/2007	3/31/2013
Inactive	Resident	Agent	Health Maintenance Organization	7/6/1999	3/1/2001
* 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	Baptist Health Plan, Inc.	300157	Agent - Health	2/16/2007	3/31/2013
Inactive	Dearborn Life Insurance Company	300401	Agent - Health	12/28/2009	12/19/2011
Inactive	Dearborn Life Insurance Company	300401	Agent - Life	12/28/2009	12/19/2011
Inactive	DentiCare, Inc.	300655	Agent - Health	9/23/2002	11/1/2005
Inactive	Union Security Insurance Company	301844	Agent - Health	11/1/2005	1/1/2007
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	2/4/2005	1/1/2007
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/1/2001	1/1/2007
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health Maintenance Organization	7/6/1999	3/1/2001

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Phelps, Derek Brian	385962	Agent - Health	2/8/2007	3/31/2013
Inactive	Phelps, Derek Brian	385962	Agent - Health Maintenance Organization	7/6/1999	3/1/2001
Inactive	Phelps, Derek Brian	385962	Agent - Life	2/8/2007	3/31/2013
Inactive	Wesley, Rodney Stuart	341804	Agent - Health	3/1/2001	3/4/2003
Inactive	Wesley, Rodney Stuart	341804	Agent - Health Maintenance Organization	7/6/1999	3/1/2001