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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
Inactive 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
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