DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Poulin, Thomas Michel	DOIID	991810	NAIC NPN	16565921

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	10/23/2025		4/30/2027
Active	Non Resident	Agent	Health	10/23/2025		4/30/2027
* 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	02/15/2027	04/30/2027

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	1/11/2024	4/30/2025
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	11/1/2025	6/15/2026
Inactive	Aetna Life Insurance Company	301140	Agent - Health	11/1/2025	6/15/2026
Inactive	Aetna Life Insurance Company	301140	Agent - Life	7/23/2018	4/30/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	5/25/2018	4/30/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	5/25/2018	4/30/2021
Inactive	CMFG Life Insurance Company	300929	Agent - Life	10/29/2024	3/22/2025
Inactive	MEMBERS Life Insurance Company	301289	Agent - Life	1/3/2025	3/22/2025
Inactive	Pruco Life Insurance Company	300954	Agent - Life	10/16/2024	4/30/2025
Inactive	SilverScript Insurance Company	663526	Agent - Health	11/1/2025	6/15/2026
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	5/2/2020	4/30/2021
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	5/2/2020	4/30/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Connected Benefits LLC	922924	Agent - Health	5/25/2018	4/30/2021
Inactive	Connected Benefits LLC	922924	Agent - Life	5/25/2018	4/30/2021
Inactive	Designated Agent Company Inc.	681257	Agent - Health	5/25/2018	4/30/2021
Inactive	Designated Agent Company Inc.	681257	Agent - Life	5/25/2018	4/30/2021