DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mutual Med Insurance Services Southeast LLC	DOIID	1110230	NAIC NPN	19567194

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	4/12/2023		3/31/2028
Active	Non Resident	Agent	Life	11/12/2020		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
Active	All Savers Insurance Company	301940	Agent - Health	4/8/2024
Active	All Savers Insurance Company	301940	Agent - Life	4/8/2024
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/12/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	12/7/2020
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/12/2023
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Life	12/7/2020
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/12/2023
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Life	12/7/2020

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bender, Janson J	1105300	Agent - Health	11/12/2020	12/31/2022
Inactive	Bender, Janson J	1105300	Agent - Life	11/12/2020	12/31/2022
Active	Edel, Robert D	1127077	Agent - Health	4/12/2023
Active	Edel, Robert D	1127077	Agent - Life	3/14/2023
Denied	Johnston, Phyllis M	1109541	Agent - Health
Denied	Johnston, Phyllis M	1109541	Agent - Life