DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Kiley Ann	DOIID	641586	NAIC NPN	7078163

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	7/6/2021	11/30/2026
Active	Non Resident	Agent	Life	7/6/2021	11/30/2026
* 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	09/15/2024	11/30/2024	11/08/2024	11/08/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	7/25/2014	11/30/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Health	7/25/2014	11/30/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Life	7/25/2014	11/30/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Health	11/24/2015	3/29/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Life	11/24/2015	3/29/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/24/2015	3/29/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/24/2015	3/29/2016
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	6/22/2015	11/30/2016
Inactive	HCC Life Insurance Company	301827	Agent - Health	7/6/2015	10/3/2016
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	6/24/2015	3/29/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	6/24/2015	3/29/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/24/2015	3/29/2016
Inactive	Humana Insurance Company	301104	Agent - Health	6/24/2015	3/29/2016
Inactive	Humana Insurance Company	301104	Agent - Life	6/24/2015	3/29/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/24/2015	3/29/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/24/2015	3/29/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	6/24/2015	3/29/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	6/24/2015	11/3/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	6/24/2015	11/3/2015
Inactive	Time Insurance Company	300683	Agent - Health	11/2/2012	7/15/2015
Inactive	Time Insurance Company	300683	Agent - Life	11/2/2012	7/15/2015
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	7/13/2015	1/5/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	7/13/2015	1/5/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/13/2015	1/5/2016
Active	Vision Service Plan Insurance Company	300526	Agent - Health	12/1/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	6/24/2015	3/29/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	6/24/2015	3/29/2016
Inactive	Healthcompare Ins Services Inc	708319	Agent - Health	7/27/2015	4/12/2016
Inactive	Healthcompare Ins Services Inc	708319	Agent - Life	7/27/2015	4/12/2016