DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Medicare Complete	DOIID	1342029	NAIC NPN	20468236

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/24/2024		3/31/2026
Active	Non Resident	Agent	Life	5/24/2024		3/31/2026
* 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	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	8/3/2024
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/3/2024
Active	Aetna Life Insurance Company	301140	Agent - Health	8/3/2024
Active	SilverScript Insurance Company	663526	Agent - Health	8/3/2024
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	9/23/2024
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	9/23/2024

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	David, Jeremiah Alan	913330	Agent - Health	5/24/2024
Active	David, Jeremiah Alan	913330	Agent - Life	5/24/2024