DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kelsey, Van Rensselaer	DOIID	655670	NAIC NPN	1006611

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Casualty	5/29/2014	12/1/2021
Inactive	Non Resident	Agent	Health	5/29/2007	12/1/2021
Inactive	Non Resident	Agent	Property	5/29/2014	12/1/2021
Inactive	Non Resident	Agent	Life	5/29/2007	12/1/2021
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	2/10/2012	5/20/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	11/23/2010	5/20/2014
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/12/2012	2/23/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/23/2010	6/8/2018
Inactive	Humana Insurance Company	301104	Agent - Health	11/23/2010	6/8/2018
Inactive	Humana Insurance Company	301104	Agent - Life	11/23/2010	6/8/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/14/2011	6/8/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/10/2012	6/8/2018
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	12/15/2010	8/24/2011
Inactive	SilverScript Insurance Company	663526	Agent - Health	11/19/2010	12/1/2021
Inactive	Time Insurance Company	300683	Agent - Health	8/8/2014	11/22/2019
Inactive	Time Insurance Company	300683	Agent - Life	8/8/2014	11/22/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/3/2011	11/7/2016
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/16/2016	11/7/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/3/2011	11/7/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/13/2015	11/7/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Kelsey National Corporation	398031	Agent - Health	11/27/2013	12/1/2021
Inactive	Kelsey National Corporation	398031	Agent - Life	11/27/2013	11/22/2019