DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ross, Mataia Nicolle	DOIID	816692	NAIC NPN	16974892

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/11/2017	2/28/2019
* 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	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	9/29/2017	6/8/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/29/2017	6/8/2018
Inactive	Humana Insurance Company	301104	Agent - Health	9/29/2017	6/8/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/29/2017	6/8/2018
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	9/29/2017	6/8/2018
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	9/29/2017	6/8/2018
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/7/2013	11/27/2013
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/7/2013	11/27/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Alorica Customer Care, Inc.	800938	Agent - Health