DEPARTMENT OF INSURANCE

Affiliations

Name	Petersen, Jacob	DOIID	1137204	NAIC NPN	19929113

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	6/1/2021		10/31/2025
* 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	08/15/2025	10/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE Property and Casualty Insurance Company	300520	Agent - Health	9/10/2023
Inactive	Accendo Insurance Company	300312	Agent - Health	11/10/2021	11/17/2023
Active	Aetna Health Inc. (PA)	660717	Agent - Health	6/3/2021
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	6/14/2021
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	6/3/2021
Active	Aetna Life Insurance Company	301140	Agent - Health	6/3/2021
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	6/8/2021
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/26/2021	12/19/2024
Active	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/26/2021
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	2/15/2022
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	2/17/2024
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/21/2022
Inactive	CareSource Kentucky Co.	838179	Agent - Health	6/3/2022	12/8/2022
Active	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/26/2021
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	6/14/2021
Active	Devoted Health Insurance Company of Kentucky, Inc.	1306593	Agent - Health	9/23/2024
Active	HealthSpring Life and Health Insurance Company, Inc.	684899	Agent - Health	11/15/2024
Active	Healthspring Healthcare of Colorado, Inc.	1098153	Agent - Health	2/17/2024
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/16/2021
Active	Humana Insurance Company	301104	Agent - Health	10/25/2021
Active	Humana Medical Plan, Inc.	801568	Agent - Health	11/22/2023
Active	Medco Containment Life Insurance Company	301557	Agent - Health	2/25/2024
Active	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	10/8/2021
Active	SilverScript Insurance Company	663526	Agent - Health	6/3/2021
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/1/2021
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	6/1/2021	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/1/2021	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	6/1/2021
Active	Vision Service Plan Insurance Company	300526	Agent - Health	10/31/2024
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	10/27/2021	3/4/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	eHealthInsurance Services Inc.	514105	Agent - Health	6/14/2021