DEPARTMENT OF INSURANCE

Affiliations

Name	Fornos, Raul	DOIID	962515	NAIC NPN	18487577

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	8/3/2017		7/31/2026
* 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	06/25/2024	06/25/2024	Yes

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	8/23/2017	6/3/2018
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	10/19/2017
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/23/2017	6/3/2018
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/19/2017	5/25/2018
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	5/8/2018	6/11/2019
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/21/2022
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	5/8/2018	12/10/2018
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	8/23/2017	6/3/2018
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	5/8/2018	6/11/2019
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/8/2018	12/10/2018
Inactive	Humana Insurance Company	301104	Agent - Health	5/8/2018	6/11/2019
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	5/8/2018	12/10/2018
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	5/8/2018	6/11/2019
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	5/8/2018	12/10/2018
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	7/16/2020
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/28/2017	5/3/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/16/2020	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/16/2020	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/16/2020
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	10/25/2017	12/29/2021

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	8/19/2017	5/24/2018
Inactive	TZ Insurance Solutions LLC	727470	Agent - Health	6/1/2018	4/18/2019
Inactive	eHealthInsurance Services Inc.	514105	Agent - Health	8/19/2017	5/2/2018