DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Chupack, Nick D	DOIID	562225	NAIC NPN	2968523

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	6/20/2018		2/28/2027
Active	Non Resident	Agent	Life	6/20/2018		2/28/2027
* 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	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Active	Accendo Insurance Company	300312	Agent - Life	2/24/2022
Active	Aetna Health Inc. (PA)	660717	Agent - Health	10/8/2021
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	2/24/2022
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	10/8/2021
Active	Aetna Life Insurance Company	301140	Agent - Health	10/8/2021
Active	Aetna Life Insurance Company	301140	Agent - Life	10/8/2021
Inactive	American General Life Insurance Company	301585	Agent - Health	1/5/2020	6/10/2022
Inactive	American General Life Insurance Company	301585	Agent - Life	1/5/2020	6/10/2022
Inactive	American-Amicable Life Insurance Co. of Texas	300257	Agent - Life	12/23/2002	3/31/2005
Active	CareSource Kentucky Co.	838179	Agent - Health	5/2/2023
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	2/24/2022
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	2/24/2022
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	7/15/2019	10/5/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	7/15/2019	10/5/2021
Active	Principal National Life Insurance Company	301926	Agent - Life	5/21/2021
Active	SilverScript Insurance Company	663526	Agent - Health	10/8/2021
Inactive	United Home Life Insurance Company	300421	Agent - Life	3/24/2019	4/17/2020
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	3/14/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Hylant Group, Inc.	523019	Agent - Life	4/15/2019
Active	Hylant Group, Inc.	523019	Agent - Health	7/15/2019