DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mutual Med Insurance Services LLC	DOIID	1105629	NAIC NPN	13733306

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/20/2020		3/31/2028
Active	Non Resident	Agent	Life	10/20/2020		3/31/2028
* 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	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Inactive	Accendo Insurance Company	300312	Agent - Life	11/23/2023	9/20/2025
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	11/23/2023	9/20/2025
Active	All Savers Insurance Company	301940	Agent - Health	10/8/2021
Active	All Savers Insurance Company	301940	Agent - Life	10/8/2021
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022	7/18/2025
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	11/23/2023	9/20/2025
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	11/23/2023	9/20/2025
Active	Tier One Insurance Company	301056	Agent - Health	4/19/2023
Active	Tier One Insurance Company	301056	Agent - Life	4/19/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	5/14/2026
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	10/8/2021
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	10/4/2021	12/22/2022
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	5/14/2026
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Life	5/14/2026
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	5/14/2026
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Life	5/14/2026
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	10/4/2021	7/18/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bender, Janson J	1105300	Agent - Health	10/20/2020	12/31/2022
Inactive	Bender, Janson J	1105300	Agent - Life	10/20/2020	12/31/2022
Active	Edel, Robert D	1127077	Agent - Health	3/14/2023
Active	Edel, Robert D	1127077	Agent - Life	3/14/2023
Denied	Johnston, Phyllis M	1109541	Agent - Health
Denied	Johnston, Phyllis M	1109541	Agent - Life