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
Active	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.

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