DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Beller, Douglas	DOIID	873901	NAIC NPN	6373116

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/2/2015	12/31/2019
Inactive	Non Resident	Agent	Life	4/2/2015	12/31/2019
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/8/2019	12/31/2019
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/8/2019	12/31/2019
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	3/8/2019	12/31/2019
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	3/8/2019	12/31/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	7/1/2015	12/1/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	7/1/2015	12/1/2016
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/1/2015	12/31/2019
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	7/1/2015	4/30/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	7/9/2015	1/10/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	7/9/2015	12/1/2016
Inactive	Usi Insurance Services LLC	669260	Agent - Health	12/27/2018	1/10/2019
Inactive	Usi Insurance Services LLC	669260	Agent - Life	3/8/2019	12/31/2019