DEPARTMENT OF INSURANCE

Affiliations

Name	Derico, Tony Randall	DOIID	817002	NAIC NPN	17026337

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/9/2013	5/31/2019
Pending Replacement	Non Resident	Staff Adjuster	Property & Casualty	8/26/2022		5/31/2025
* 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
Staff Adjuster	03/15/2025	05/31/2025

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	10/10/2014	4/20/2018
Inactive	Aetna Health Insurance Company	301583	Agent - Health	10/10/2014	4/20/2018
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/10/2014	4/20/2018
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	1/20/2017	10/25/2018
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	12/8/2014	11/7/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/20/2013	9/25/2013
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/20/2013	9/25/2013
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	10/10/2014	4/20/2018
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/18/2016	2/6/2018
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/18/2016	2/6/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/18/2016	2/6/2018
Inactive	Humana Insurance Company	301104	Agent - Health	10/18/2016	2/6/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/26/2014	3/23/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/18/2016	2/6/2018
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/18/2016	2/6/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	8/20/2013	9/25/2013
Inactive	Omaha Insurance Company	751908	Agent - Health	2/24/2016	1/23/2017
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/9/2016	2/6/2018
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/16/2016	2/6/2018
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/9/2016	12/5/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/9/2016	2/6/2018

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	1/20/2017	10/25/2018
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	3/4/2016	5/24/2016