DEPARTMENT OF INSURANCE

Affiliations

Name	Collins, Domenique	DOIID	968189	NAIC NPN	18091267

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	9/17/2017	9/30/2026
Active	Non Resident	Agent	Health	9/17/2017	9/30/2026
* 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	07/15/2024	09/30/2024	07/15/2024	07/15/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Life	6/10/2020	7/26/2024
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	10/6/2017	7/8/2021
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	12/12/2017	6/22/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/6/2017	7/8/2021
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/6/2017	7/8/2021
Inactive	American Continental Insurance Company	643130	Agent - Life	6/22/2019	8/11/2021
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	8/20/2020	10/23/2023
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	11/21/2023
Inactive	CompBenefits Insurance Company	301864	Agent - Health	8/20/2020	10/23/2023
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	12/12/2017	6/22/2019
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/6/2020	10/23/2023
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	10/6/2017	7/8/2021
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/6/2020	10/23/2023
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/6/2020	10/23/2023
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/6/2020	10/23/2023
Inactive	Humana Insurance Company	301104	Agent - Health	8/20/2020	10/23/2023
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/6/2020	10/23/2023
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/6/2020	10/23/2023
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/6/2020	10/23/2023
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/6/2020	10/23/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Life	3/30/2021	4/8/2024
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	3/30/2021	10/23/2023