DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Gootz, Terry Ann	DOIID	849010	NAIC NPN	6719253

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/7/2022		7/31/2024
* 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	05/15/2024	07/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	10/14/2022
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	10/14/2022
Active	Aetna Life Insurance Company	301140	Agent - Health	10/14/2022
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	10/10/2022	7/27/2023
Active	SilverScript Insurance Company	663526	Agent - Health	10/14/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/10/2022	7/27/2023
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	10/10/2022	12/22/2022
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/21/2014	12/11/2015
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	10/10/2022	7/27/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Assurance IQ, LLC	919554	Agent - Health	3/28/2023	5/15/2024