DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Rebaza, Carlos	DOIID	931333	NAIC NPN	16154550

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/29/2016	9/30/2022
Inactive	Non Resident	Agent	Life	9/29/2016	9/30/2022
* 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	9/10/2019	9/30/2022
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/17/2020	9/30/2022
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/10/2019	9/30/2022
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	6/21/2022	9/30/2022
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	6/21/2022	9/30/2022
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	2/11/2017	4/10/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	2/11/2017	4/10/2018
Inactive	Humana Insurance Company	301104	Agent - Health	2/11/2017	4/10/2018
Inactive	Humana Insurance Company	301104	Agent - Life	2/11/2017	4/10/2018
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	2/11/2017	4/10/2018
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	2/11/2017	4/10/2018
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	8/27/2019	9/30/2022
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	8/27/2019	9/30/2022
Inactive	SilverScript Insurance Company	663526	Agent - Health	8/23/2019	9/30/2022
Inactive	Starmount Life Insurance Company	628031	Agent - Health	8/27/2019	9/30/2022
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	8/27/2019	9/30/2022
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	8/27/2019	9/30/2022
Inactive	Unum Insurance Company	301499	Agent - Health	8/27/2019	9/30/2022
Inactive	Unum Insurance Company	301499	Agent - Life	8/27/2019	9/30/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Optavise, LLC	671337	Agent - Life	10/14/2020	9/30/2022
Inactive	Optavise, LLC	671337	Agent - Health	10/14/2020	9/30/2022