DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Tibisay	DOIID	1192785	NAIC NPN	17073949

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	5/9/2025		10/31/2026
Active	Non Resident	Agent	Health	3/10/2022		10/31/2026
* 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	08/15/2026	10/31/2026

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	5/29/2024	10/30/2024
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	5/18/2024	12/19/2025
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	5/29/2024	10/30/2024
Inactive	Aetna Life Insurance Company	301140	Agent - Health	5/29/2024	10/30/2024
Active	American General Life Insurance Company	301585	Agent - Health	4/29/2024
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/14/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	6/4/2024	1/13/2026
Inactive	Arcadian Health Plan, Inc.	728196	Agent - Health	2/17/2025	10/15/2025
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	10/10/2025	12/5/2025
Inactive	CareSource Kentucky Co.	838179	Agent - Health	10/31/2022	12/26/2025
Active	Colonial Penn Life Insurance Company	300491	Agent - Life	5/28/2025
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	6/4/2024	1/13/2026
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	5/18/2024	12/19/2025
Active	Devoted Health Insurance Company of Kentucky, Inc.	1306593	Agent - Health	10/4/2024
Active	EMC National Life Company	300388	Agent - Life	12/31/2025
Inactive	Sierra Health and Life Insurance Company Inc.	300357	Agent - Health	10/21/2024	10/10/2025
Inactive	SilverScript Insurance Company	663526	Agent - Health	5/29/2024	10/30/2024
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/10/2025	12/5/2025
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	10/10/2025	12/5/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Gohealth LLC	691445	Agent - Health	2/17/2025