DEPARTMENT OF INSURANCE

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		2/28/2025
Active	Non Resident	Agent	Life	6/20/2018		2/28/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	12/15/2024	02/28/2025

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