DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Medina Mancisidor, Juan Carlos	DOIID	1050789	NAIC NPN	16790621

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	4/10/2024		11/30/2027
Active	Non Resident	Agent	Life	4/10/2024		11/30/2027
* 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
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	7/2/2024
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	7/2/2024
Active	ReliaStar Life Insurance Company	301712	Agent - Health	4/19/2024
Active	ReliaStar Life Insurance Company	301712	Agent - Life	4/19/2024
Active	Starmount Life Insurance Company	628031	Agent - Health	7/2/2024
Active	UNUM Life Insurance Company of America	300817	Agent - Health	7/2/2024
Active	UNUM Life Insurance Company of America	300817	Agent - Life	7/2/2024
Active	Unum Insurance Company	301499	Agent - Health	7/2/2024
Active	Unum Insurance Company	301499	Agent - Life	7/2/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Hodges-Mace LLC	1059189	Agent - Life	1/14/2025
Active	Hodges-Mace LLC	1059189	Agent - Health	1/14/2025