DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Moss, Justin Shane	DOIID	930232	NAIC NPN	16792362

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/22/2016	1/31/2018
Inactive	Non Resident	Agent	Life	9/22/2016	1/31/2018
* 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	Anthem Life Insurance Company	301209	Agent - Health	10/6/2016	12/4/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/6/2016	12/4/2017
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/7/2016	6/21/2017
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/7/2016	6/21/2017
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	2/11/2017	11/29/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	2/11/2017	11/29/2017
Inactive	Humana Insurance Company	301104	Agent - Health	2/11/2017	11/29/2017
Inactive	Humana Insurance Company	301104	Agent - Life	2/11/2017	11/29/2017
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	2/11/2017	11/29/2017
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	2/11/2017	11/29/2017
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	2/6/2017	1/31/2018
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	2/6/2017	1/31/2018

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 - Life	10/6/2016	12/3/2017
Inactive	Designated Agent Company Inc.	681257	Agent - Health	10/6/2016	12/3/2017