DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Peterson, Jane Marie	DOIID	601846	NAIC NPN	7567293

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	7/11/2022		7/31/2026
Inactive	Non Resident	Agent	Health	1/26/2005	7/31/2012
Inactive	Non Resident	Agent	Life	1/26/2005	7/31/2012
* 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
Administrator	05/15/2024	07/31/2024	06/14/2024	06/14/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	2/1/2005	7/31/2012
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	2/1/2005	7/31/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Health	1/26/2005	7/31/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Life	1/26/2005	7/31/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Community Insurance Company (TPA)	395826	Administrator - Not Applicable	7/12/2022