DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Dombchik, David Adam	DOIID	924260	NAIC NPN	15948175

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/11/2016	1/31/2024
* 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	8/22/2019	1/31/2024
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	10/26/2020	1/31/2024
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/22/2019	1/31/2024
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/16/2020	10/21/2021
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/23/2021	10/21/2021
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/23/2021	10/21/2021
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	9/26/2017	11/29/2018
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/23/2021	10/21/2021
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	4/24/2017	1/31/2024
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/26/2020	1/31/2024
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/14/2021	2/21/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/14/2021	2/21/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	8/14/2021	12/23/2021
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/14/2021	2/21/2022
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	12/7/2020	12/29/2021
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	12/7/2020	12/30/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Core V Solutions, Inc.	636365	Agent - Health	11/9/2022	1/31/2024