DEPARTMENT OF INSURANCE

Affiliations

Name	Pacific Benefits Group NW LLC	DOIID	650001	NAIC NPN	1916108

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	8/14/2024	3/31/2025
Active	Non Resident	Agent	Life	3/5/2007	3/31/2025
Active	Non Resident	Agent	Casualty	8/14/2024	3/31/2025
Active	Non Resident	Agent	Health	3/5/2007	3/31/2025
* 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	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Accendo Insurance Company	300312	Agent - Life	6/10/2020
Inactive	Aetna Health Inc.	300694	Agent - Health	9/4/2007	12/31/2007
Active	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/6/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	9/4/2007
Active	Aetna Life Insurance Company	301140	Agent - Life	9/4/2007
Active	American General Life Insurance Company	301585	Agent - Health	3/15/2011
Active	American General Life Insurance Company	301585	Agent - Life	3/15/2011
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/30/2009
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	11/30/2009	10/16/2012
Active	Anthem Life Insurance Company	301209	Agent - Health	11/30/2009
Active	Anthem Life Insurance Company	301209	Agent - Life	11/30/2009
Inactive	Assurity Life Insurance Company	301099	Agent - Health	3/4/2011	12/20/2018
Inactive	Assurity Life Insurance Company	301099	Agent - Life	3/4/2011	12/20/2018
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	9/5/2007	3/1/2011
Active	Banner Life Insurance Company	301696	Agent - Life	5/16/2013
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	8/3/2018
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022
Inactive	Catlin Insurance Company, Inc.	300979	Agent - Health	3/30/2015	1/14/2020
Active	Chesapeake Life Insurance Company (The)	301017	Agent - Health	7/26/2012
Active	Chesapeake Life Insurance Company (The)	301017	Agent - Life	7/26/2012
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/8/2009	3/14/2019
Inactive	CompBenefits Insurance Company	301864	Agent - Health	6/23/2009	7/2/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Life	6/23/2009	7/2/2013
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	3/6/2018
Active	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009
Inactive	Federal Insurance Company	301144	Agent - Health	6/20/2019	12/29/2021
Active	Golden Rule Insurance Company	301943	Agent - Health	3/14/2007
Active	Golden Rule Insurance Company	301943	Agent - Life	3/14/2007
Inactive	HCC Life Insurance Company	301827	Agent - Health	11/3/2016	6/12/2017
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	7/10/2013	2/23/2018
Active	Humana Health Plan, Inc.	300142	Agent - Health	1/30/2008
Active	Humana Insurance Company	301104	Agent - Health	1/30/2008
Active	Humana Insurance Company	301104	Agent - Life	1/30/2008
Active	Humana Insurance Company of Kentucky	300826	Agent - Health	1/30/2008
Active	Humana Insurance Company of Kentucky	300826	Agent - Life	1/30/2008
Inactive	HumanaDental Insurance Company	301457	Agent - Health	1/30/2008	2/23/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	1/30/2008	2/23/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	10/22/2015
Inactive	Security Life Insurance Company of America	300936	Agent - Health	8/2/2007	3/24/2009
Inactive	Security Life Insurance Company of America	300936	Agent - Life	8/2/2007	3/24/2009
Active	SilverScript Insurance Company	663526	Agent - Health	1/2/2020
Active	Southern Financial Life Insurance Company	300664	Agent - Health	5/24/2013
Active	Southern Financial Life Insurance Company	300664	Agent - Life	5/24/2013
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	4/10/2017	12/27/2018
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	4/10/2017	12/27/2018
Inactive	Starr Indemnity and Liability Company	301685	Agent - Health	4/16/2012	8/16/2018
Inactive	Time Insurance Company	300683	Agent - Health	3/11/2007	11/15/2019
Inactive	Time Insurance Company	300683	Agent - Life	3/11/2007	11/15/2019
Inactive	Unified Life Insurance Company	543169	Agent - Health	8/10/2015	4/6/2018
Active	United States Fire Insurance Company	582240	Agent - Health	4/4/2018
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	4/21/2008
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	4/21/2008
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/16/2016	12/20/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/5/2019	12/22/2022
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Health	11/11/2015	11/4/2016
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Life	11/11/2015	11/4/2016
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	12/23/2021
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	4/21/2008	11/29/2016
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/13/2015
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	10/25/2023
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	10/25/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Klemin, John R	812275	Agent - Health	12/3/2013
Active	Klemin, John R	812275	Agent - Life	12/3/2013
Active	Kobbe, Eric Scot	603781	Agent - Casualty	8/14/2024
Active	Kobbe, Eric Scot	603781	Agent - Property	8/14/2024
Inactive	Nichols, Shane Reed	639287	Agent - Health	10/20/2012	12/31/2014
Inactive	Nichols, Shane Reed	639287	Agent - Life	3/5/2007	12/31/2014