DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Van Den Berg, Raymond	DOIID	1300619	NAIC NPN	20838372

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	1/13/2025		4/30/2027
Active	Non Resident	Agent	Health	9/24/2023		4/30/2027
* 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	02/15/2025	04/30/2025	04/04/2025	04/04/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	1/23/2024
Active	Colonial Penn Life Insurance Company	300491	Agent - Life	1/23/2025
Active	Humana Health Plan of Ohio Inc.	301565	Agent - Health	5/28/2024
Active	Humana Insurance Company	301104	Agent - Health	12/4/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	TZ Insurance Solutions LLC	727470	Agent - Health	2/18/2025
Active	TZ Insurance Solutions LLC	727470	Agent - Life	2/18/2025
Inactive	Trubridge Inc	717747	Agent - Health	3/25/2024	2/18/2025