DEPARTMENT OF INSURANCE
Affiliations
NameKelsey National CorporationDOIID398031NAIC NPN720533
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
ActiveNon ResidentAdministratorNot Applicable6/1/1994 3/31/2026
ActiveNon ResidentAgentHealth2/18/2005 3/31/2026
ActiveNon ResidentAgentLife2/18/2005 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
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Administrator01/15/202603/31/2026   
Agent01/15/202603/31/2026   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAetna Health Inc.300694Agent - Health10/11/200612/31/2007
ActiveAetna Health Inc. (PA)660717Agent - Health12/31/2007 
ActiveAetna Health of Ohio Inc.1065035Agent - Health8/6/2020 
ActiveAetna Life Insurance Company301140Agent - Health10/11/2006 
ActiveAetna Life Insurance Company301140Agent - Life10/11/2006 
InactiveAmerican General Assurance Company300586Agent - Health8/14/20097/25/2011
InactiveAmerican General Assurance Company300586Agent - Life8/14/20097/25/2011
ActiveAmerican General Life Insurance Company301585Agent - Health12/31/2012 
ActiveAmerican General Life Insurance Company301585Agent - Life12/31/2012 
InactiveAmerican General Life Insurance Company of Delaware301057Agent - Health4/27/200912/31/2012
InactiveAmerican General Life Insurance Company of Delaware301057Agent - Life4/27/200912/31/2012
ActiveAmerican National Life Insurance Company of Texas300912Agent - Health8/21/2007 
ActiveAmerican National Life Insurance Company of Texas300912Agent - Life8/21/2007 
ActiveAmeritas Life Insurance Corporation300126Agent - Health10/25/2005 
ActiveAmeritas Life Insurance Corporation300126Agent - Life10/25/2005 
ActiveAnthem Health Plans of Kentucky, Inc.300999Agent - Health9/2/2005 
InactiveAnthem Insurance Companies, Inc.300941Agent - Health9/2/200510/16/2012
InactiveAnthem Life Insurance Company301209Agent - Health9/1/20054/15/2025
InactiveAnthem Life Insurance Company301209Agent - Life9/1/20054/15/2025
InactiveBerkshire Life Insurance Company of America300983Agent - Health6/13/201910/5/2021
InactiveBerkshire Life Insurance Company of America300983Agent - Life6/13/201910/5/2021
ActiveCIGNA Health & Life Insurance Company301783Agent - Health9/14/2014 
ActiveCIGNA Health & Life Insurance Company301783Agent - Life9/14/2014 
InactiveCare Improvement Plus South Central Insurance Company799697Agent - Health7/20/20225/26/2025
InactiveCompBenefits Dental, Inc.591692Agent - Health7/7/20053/14/2019
InactiveCompBenefits Insurance Company301864Agent - Health2/24/20107/2/2013
InactiveCompBenefits Insurance Company301864Agent - Life2/24/20107/2/2013
ActiveCompanion Life Insurance Company300191Agent - Health5/23/2023 
ActiveCompanion Life Insurance Company300191Agent - Life5/23/2023 
InactiveConnecticut General Life Insurance Company301333Agent - Health12/26/20086/11/2014
ActiveCoventry Health and Life Insurance Company301771Agent - Health4/30/2014 
ActiveCoventry Health and Life Insurance Company301771Agent - Life4/30/2014 
ActiveDental Concern Inc. (The)301641Agent - Health3/21/2009 
ActiveFirst Health Life & Health Insurance Company301735Agent - Health3/17/2011 
InactiveGolden Rule Insurance Company301943Agent - Health8/4/200611/2/2017
InactiveGolden Rule Insurance Company301943Agent - Life8/4/200611/2/2017
ActiveGuardian Insurance & Annuity Company Inc. (The)301920Agent - Health12/30/2024 
ActiveGuardian Insurance & Annuity Company Inc. (The)301920Agent - Life12/30/2024 
ActiveGuardian Life Insurance Company of America301316Agent - Health6/13/2019 
ActiveGuardian Life Insurance Company of America301316Agent - Life6/13/2019 
InactiveHCC Life Insurance Company301827Agent - Health1/27/20166/20/2017
InactiveHartford Life Group Insurance Company301708Agent - Health9/26/200512/31/2006
InactiveHartford Life Group Insurance Company301708Agent - Life9/26/200512/31/2006
ActiveHartford Life and Accident Insurance Company300878Agent - Health9/26/2005 
ActiveHartford Life and Accident Insurance Company300878Agent - Life9/26/2005 
ActiveHumana Health Plan, Inc.300142Agent - Health9/18/2007 
ActiveHumana Insurance Company301104Agent - Health9/18/2007 
ActiveHumana Insurance Company301104Agent - Life9/18/2007 
ActiveHumana Insurance Company of Kentucky300826Agent - Health9/18/2007 
ActiveHumana Insurance Company of Kentucky300826Agent - Life9/18/2007 
InactiveHumanaDental Insurance Company301457Agent - Health9/18/20072/23/2012
InactiveHumanaDental Insurance Company301457Agent - Life9/18/20072/23/2012
ActiveMetropolitan Life Insurance Company301948Agent - Health10/28/2019 
ActiveMetropolitan Life Insurance Company301948Agent - Life10/28/2019 
ActiveNational Health Insurance Company300554Agent - Health5/31/2024 
ActiveNational Health Insurance Company300554Agent - Life5/31/2024 
InactivePacifiCare Life and Health Insurance Company301304Agent - Health1/25/20108/25/2011
InactivePennsylvania Life Insurance Company301321Agent - Health6/17/20093/31/2013
InactivePennsylvania Life Insurance Company301321Agent - Life6/17/20093/31/2013
InactiveRevol One Insurance Company300681Agent - Life7/28/201112/28/2012
InactiveSecurity Life Insurance Company of America300936Agent - Health8/12/200812/31/2016
InactiveSecurity Life Insurance Company of America300936Agent - Life8/12/200812/31/2016
ActiveSilverScript Insurance Company663526Agent - Health3/13/2015 
ActiveStandard Insurance Company300185Agent - Health1/5/2025 
ActiveStandard Insurance Company300185Agent - Life1/5/2025 
InactiveStandard Security Life Insurance Company of NY301487Agent - Health2/7/20071/20/2010
InactiveStandard Security Life Insurance Company of NY301487Agent - Life2/7/20071/20/2010
InactiveStarmount Life Insurance Company628031Agent - Health3/15/201611/30/2023
InactiveStarmount Life Insurance Company628031Agent - Life3/15/201611/30/2023
InactiveStonebridge Life Insurance Company301614Agent - Health1/31/201210/1/2015
InactiveStonebridge Life Insurance Company301614Agent - Life1/31/201210/1/2015
InactiveSymetra Life Insurance Company301691Agent - Health9/19/20059/12/2014
InactiveSymetra Life Insurance Company301691Agent - Life9/19/20059/12/2014
InactiveTime Insurance Company300683Agent - Health4/1/201411/15/2019
InactiveTime Insurance Company300683Agent - Life4/1/201411/15/2019
ActiveTransamerica Life Insurance Company300571Agent - Health8/20/2015 
ActiveTransamerica Life Insurance Company300571Agent - Life8/20/2015 
InactiveUnited American Insurance Company300910Agent - Health10/27/200612/28/2006
InactiveUnited American Insurance Company300910Agent - Life10/27/200612/28/2006
ActiveUnited States Life Insurance Company in the City of New York301126Agent - Health7/18/2013 
ActiveUnited States Life Insurance Company in the City of New York301126Agent - Life7/18/2013 
InactiveUnitedHealthcare Insurance Company300946Agent - Health12/18/20195/26/2025
InactiveUnitedHealthcare Insurance Company of America301552Agent - Health9/16/201612/20/2018
InactiveUnitedHealthcare Insurance Company of the River Valley1027817Agent - Health12/18/201912/22/2022
InactiveUnitedHealthcare Life Insurance Company301517Agent - Health11/11/201511/4/2016
InactiveUnitedHealthcare Life Insurance Company301517Agent - Life11/11/201511/4/2016
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health12/18/201912/23/2021
InactiveUnitedHealthcare of Ohio, Inc.300493Agent - Health8/18/201112/5/2016
InactiveUnitedHealthcare of Wisconsin, Inc.871491Agent - Health12/18/20195/26/2025
InactiveWellCare Health Insurance Company of Kentucky, Inc.301478Agent - Health4/6/20223/1/2025
InactiveWellCare Health Insurance of Arizona, Inc.501692Agent - Health10/28/20084/29/2010
InactiveWellCare Health Insurance of Arizona, Inc.501692Agent - Life10/28/20084/29/2010
InactiveWellCare Prescription Insurance Inc.654329Agent - Health4/6/20223/1/2025
ActiveWellpoint Life and Health Insurance Company300469Agent - Health11/14/2006 
ActiveWellpoint Life and Health Insurance Company300469Agent - Life11/14/2006 
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveBrown, Samuel Martin 636000Agent - Health6/2/20215/12/2022
InactiveBrown, Samuel Martin 636000Agent - Life6/2/20215/12/2022
ActiveKelsey, Mark R 368341Administrator - Not Applicable6/1/1994 
ActiveKelsey, Mark R 368341Agent - Health2/18/2005 
ActiveKelsey, Mark R 368341Agent - Life2/18/2005 
InactiveKelsey, Van Rensselaer 655670Agent - Health11/27/201312/1/2021
InactiveKelsey, Van Rensselaer 655670Agent - Life11/27/201311/22/2019
DeniedOrtega, Jesus Hector 692204Agent - Health  
DeniedOrtega, Jesus Hector 692204Agent - Life  
DeniedSmith, Avery Akwasi 973627Agent - Health  
InactiveSmith, Avery Akwasi 973627Agent - Life8/16/20182/21/2020

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