DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Provider Benefit Plans Inc.	DOIID	401311	NAIC NPN	7084178

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	8/24/1998	3/31/2010
Inactive	Resident	Agent	Life	9/3/1999	3/31/2008
Inactive	Resident	Agent	Health	9/3/1999	3/31/2008
* 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	ACE American Insurance Company	300625	Agent - Health	1/3/2004	2/26/2007
Inactive	Aetna Health Inc.	300694	Agent - Health	2/13/2004	12/31/2007
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007	3/31/2008
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/13/2004	3/31/2008
Inactive	Aetna Life Insurance Company	301140	Agent - Life	2/13/2004	3/31/2008
Inactive	American National Insurance Company	301861	Agent - Health	9/25/2001	3/31/2008
Inactive	American National Insurance Company	301861	Agent - Life	9/25/2001	3/31/2008
Inactive	American United Life Insurance Company	300498	Agent - Health	6/28/2006	3/31/2008
Inactive	American United Life Insurance Company	300498	Agent - Life	6/28/2006	3/31/2008
Inactive	HCC Life Insurance Company	301827	Agent - Health	7/15/2004	3/31/2008
Inactive	HCC Life Insurance Company	301827	Agent - Life	7/15/2004	3/31/2008
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	3/18/2002	5/16/2005
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	3/18/2002	5/16/2005
Inactive	Protective Life Insurance Company	300638	Agent - Health	9/3/1999	3/31/2008
Inactive	Protective Life Insurance Company	300638	Agent - Life	9/3/1999	3/31/2008
Inactive	Time Insurance Company	300683	Agent - Health	3/8/2002	3/31/2008
Inactive	Time Insurance Company	300683	Agent - Life	3/8/2002	3/31/2008

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Altier, Frank J	352738	Administrator - Not Applicable	8/24/1998	3/31/1999
Inactive	Barbour, Jessica Anne	537154	Administrator - Not Applicable	9/5/2001	8/31/2003
Inactive	Childers, Frank Randall	390690	Administrator - Not Applicable	8/24/1998	3/31/2010
Inactive	Childers, Frank Randall	390690	Agent - Health	9/3/1999	3/31/2008
Inactive	Childers, Frank Randall	390690	Agent - Life	9/3/1999	3/31/2008
Inactive	Fox, Alan Lynn	596113	Administrator - Not Applicable	9/23/2004	12/31/2006
Inactive	Hendrix, Billie Ivie	596112	Administrator - Not Applicable	9/23/2004	6/30/2006
Inactive	Holton, William O	521096	Administrator - Not Applicable	1/24/2001	8/21/2002
Inactive	Martinez Bello, Myriam Adriana	596110	Administrator - Not Applicable	9/23/2004	9/6/2005
Inactive	McDonald, Barbara Jean	537149	Administrator - Not Applicable	9/5/2001	8/19/2009
Inactive	Poppe, Kimberly Ann	596111	Administrator - Not Applicable	9/23/2004	7/31/2007
Inactive	Proctor, Myra D	557310	Administrator - Not Applicable	10/30/2002	6/17/2005
Inactive	Susemichel, Laura Ann	537152	Administrator - Not Applicable	9/5/2001	6/30/2005