TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
TPL Insuring Organization Address City State Zip CODE 136 ACADEMY LIFE INSURANCE COMPANY P O BOX 3074 SOUTHEASTERN PA 19398 903 ACCIDENTAL DEATH & DISMEMBER 001 AETNA P O BOX 981107 EL PASO TX 79998 036 AETNA/PRUDENTIAL HEALTH PLANS P O BOX 981107 EL PASO TX 79998 149 ALLMERICA 440 LINCOLN ST N365 WORCESTER MA 01653 048 ALLSTATE LIFE INSURANCE ALLSTATE PLAZA NORTHBROOK IL 60062 144 ALLSTATE WORKPLACE DIVISION 1776 AMERICAN HERITAGE LIFE DRIVE JACKSONVILLE FL 32224 002 AMALGAMATED LIFE & HEALTH CO 333 SOUTH ASHLAND BOULEVARD CHICAGO IL 60607 041 AMALGAMATED LIFE INSURANCE CO 333 WESTCHESTER AVENUE - SUITE N101 WHITE PLAINS NY 10604 061 AMER FAMILY/AMER REPUBLIC INS PO BOX 21801 EAGAN MN 55121 475 AMERICAN FEDERATION GOVT EMPL 80 F STREET NW WASHINGTON DC 20001 042 AMERICAN FIDELITY ASSURANCE 2000 CLASSEN CENTER OKLAHOMA CITY OK 73106 103 AMERICAN GEN LIFE & ACCIDENT P O BOX 1500 HEALTH CLAIMS NASHVILLE TN 37202 105 AMERICAN INCOME LIFE INS CO P O BOX 2608 WACO TX 73702 098 AMERICAN INDEPENDENCE LIFE INS 1867 AVENUE OF AMERICA MONROE LA 71201 062 AMERICAN INTEGRITY--NOLHGA P O BOX 834 HORSHAM PA 19044 161 AMERICAN INTERNATIONAL LIFE P O BOX 727 WALL STREET STATION NEW YORK NY 10268 063 AMERICAN LIBERTY LIFE INS CO P O BOX 1568 BIRMINGHAM AL 35201 064 AMERICAN LIFE & ACCIDENT INS P O BOX 1600 DALLAS TX 75221 065 AMERICAN LIFE INS CO 208 S LASALLE ST - SUITE 1440 CHICAGO IL 60604 066 AMERICAN MUTUAL LIFE INS CO 611 5TH AVE DES MOINES IA 50309 056 AMERICAN NATIONAL INSURANCE CO P O BOX 10546 SPRINGFIELD MO 65808 053 AMERICAN REPUBLIC INS CO P O BOX 21670 EAGAN MN 55121 068 AMERICAN UNITED LIFE INS CO P O BOX 368 INDIANAPOLIS IN 46206 453 APWU HEALTH PLAN P O BOX 1358 GLEN BURNIE MD 21060 130 ASSURANT HEALTH P O BOX 2806 CLINTON IA 52733 187 ASSURANT HEALTH - JOHN ALDEN P O BOX 2806 CLINTON IA 52733 132 ASSURITY P O BOX 82533 LINCOLN NE 68501 485 ATKINSON TOPEKA & SANTA FE P O BOX 1979 TOPEKA KS 66601 486 AUTO MECHANICS LOCAL 701 361 S FRONTAGE RD - STE 100 BURR RIDGE IL 60527
1 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
430 AUTOMOTIVE WHOLESALERS OF ILL P O BOX 19252 ATTN: INSURANCE DEPT SPRINGFIELD IL 62794 460 BAKERY & CONFECTIONERY UNION 10401 CONNECTICUT AV -ATTN INS DEPT KENSINGTON MD 20895 003 BANKERS LIFE & CASUALTY CO P O BOX 1935 CARMEL IN 46082 086 BANNER LIFE INSURANCE CO 1701 RESEARCH BLVD ROCKVILLE MD 20850 480 BC/BS IL- FED EMPLOYEE PROGRAM P O BOX 805107 CHICAGO IL 60680 070 BENEFICIAL STANDARD LIFE INS 3700 WILSHIRE BLVD LOS ANGELES CA 90010 044 BLUE CROSS BLUE SHIELD OUT OF STATE BCBS VARIES MD 00000 433 BLUE CROSS BLUE SHIELD 600 E LAFAYETTE-P O BOX 1088 DETROIT MI 48226 006 BLUE CROSS BLUE SHIELD/HCSC 300 EAST RANDOLPH CHICAGO IL 60601 462 BOILERMAKER'S HEALTH & WELFARE 522 BROTHERHOOD BLDG - ATTN INS DEPT KANSAS CITY KS 66101 469 BRICKLAYER'S BENEFIT FUND 124 SOUTHWEST ADAMS STREET- SUITE 430 PEORIA IL 61602 919 BTS 007 BUSINESS MEN'S ASSURANCE CO BMA TOWER - PENN VALLEY PARK KANSAS CITY MO 64108 008 CAPITOL LIFE INSURANCE CO P O BOX 1200 DENVER CO 80201 448 CARPENTERS H & W TRUST FUND 12 E. ERIE, ATTN: CLAIMS CHICAGO IL 60611 080 CENTRAL LIFE ASSURANCE CO P O BOX 5620 MADISON WI 53705 072 CENTRAL STATES HEALTH & LIFE P O BOX 34350 OMAHA NE 68134 443 CENTRAL STATES JOINT BOARD 245 FENCL LN HILLSIDE IL 60162 452 CENTRAL STATES SE & SW FUND 9377 W HIGGINS ROAD ROSEMONT IL 60018 035 CIGNA HEALTH CARE 7555 GOODWIN ROAD CHATTANOOGA TN 37421 015 CIGNA/GREAT WEST HEALTHCARE P O BOX 188061 CHATTANOOGA TN 37422 073 COLONIAL LIFE & ACCIDENT INS P O BOX 1365 COLUMBIA SC 29202 051 COLUMBIA UNIVERSAL P O BOX 19085 GREENVILLE SC 29602 084 COMBINED INSURANCE CO OF AMERI P O BOX 981625 EL PASO TX 79998 047 COMBINED INSURANCE COMPANY P O BOX 981625 EL PASO TX 79998 076 COMMONWEALTH LIFE & ACCIDENT P O BOX 9000 LEAGUE CITY TX 77573 180 COMMUNITY HEALTH PLAN P O BOX 372 MATTOON IL 61938 077 CONFEDERATION LIFE INS CO ONE MOUNT PLEASANT ROAD TORONTO, ONTARIO M4Y 2Y5 CA 00000 010 CONNECTICUT GENERAL LIFE INS P O BOX 188021 CHATTANOOGA TN 37422 074 CONSECO 11825 N PENNSYLVANIA AVENUE CARMEL IN 46032 033 CONSTITUTION LIFE/PENN LIFE P O BOX 130 PENSACOLA FL 32591 011 CONTINENTAL CASUALTY P O BOX 64912 ST PAUL MN 55164 916 COPAYMENT - ADJUSTMENT
2 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
915 COPAYMENT - RECIPIENT PAID 108 CORESOURCE P O BOX 2920 CLINTON IA 52733 012 COUNTRY LIFE INSURANCE COMPANY P O BOX 10870 CLEARWATER FL 33757 156 CUNA MUTUAL INSURANCE SOCIETY 5910 MINERAL POINT RD MADISON WI 53705 911 ENROLLED MEDICARE PART A & B 013 EQUITABLE LIFE ASSURANCE 3 TRIAD CENTER - SUITE 200 SALT LAKE CITY UT 84180 078 EQUITY NATIONAL LIFE INS. CO P O BOX 8063 LITTLE ROCK AR 72203 171 FARMLAND INDUSTRIES 103 WEST 26TH AVENUE KANSAS CITY MO 64116 163 FEDERAL HOME LIFE INS CO P O BOX 10821- MEDICARE CLAIMS CENTER CLEARWATER FL 33757 079 FEDERAL LIFE INSURANCE 3750 W DEERFIELD RD RIVERWOODS IL 60015 183 FEDERATED MUTUAL INSURANCE 129 EAST BROADWAY OWATONNA MN 55060 082 FIDELITY NATIONAL LIFE P O BOX 8067 DALLAS TX 75205 431 FORD MOTOR COMPANY 1000 LINCOLN HWY - ATTN EMP BENEFITS CHICAGO HEIGHTS IL 60411 197 GE FINANCIAL ASSURANCE/PHOENIX ONE AMERICAN ROW HARTFORD CT 06115 014 GENAM BENEFIT/GREAT WEST LIFE 13045 TESSON FERRY RD-CLAIMS ST LOUIS MO 63128 437 GENERAL ELECTRIC CO P O BOX 414 MILWAUKEE WI 53201 432 GENERAL MOTORS CORPORATION 1500 E ROUTE A WENTZVILLE MO 63385 461 GLAZIERS UNION LOCAL 27 4225 LAWNDALE AVENUE LYONS IL 60534 083 GLOBE LIFE & ACCIDENT INS CO 14000 PARKWAY PLAZA OKLAHOMA CITY OK 73184 085 GOLDEN RULE INSURANCE COMPANY 712 ELEVENTH STREET LAWRENCEVILLE IL 62439 459 GOVERNMENT EMPLOYEES HOSP ASSN P O BOX 4665 INDEPENDENCE MO 64051 088 GUARANTEE TRUST LIFE 1275 MILWAUKEE AVE GLENVIEW IL 60025 089 GUARDIAN LIFE INSURANCE CO DO NOT USE NO PLACE IL 00000 169 HARRINGTON BENEFIT 675 BROOKSEDGE BLVD WESTERVILLE OH 43081 016 HARTFORD LIFE/MASS MUTUAL HARTFORD PLAZA HARTFORD CT 06115 196 HEALTH PARTNERS P O BOX 1289 MINNEAPOLIS MN 55440 090 HOLY FAMILY SOCIETY OF USA P O BOX 2909 - CLAIM DEPT JOLIET IL 60434 017 HOME LIFE INSURANCE CO CN1367/NERGC PISCATAWAY NJ 08854 018 HORACE MANN INSURANCE COMPANY 1 HORACE MANN PLAZA SPRINGFIELD IL 62701 075 HUMANA HEALTH PLANS HMO P O BOX 14601 LEXINGTON KY 40512 182 HUMANA INSURANCE COMPANY P O BOX 14610 LEXINGTON KY 40512 043 ILL HOSPITAL & HEALTH SERVICES 308 WEST STATE ST ROCKFORD IL 61101 019 ILL MUTUAL LIFE & CASUALTY CO 300 SW ADAMS - BENEFITS DEPT. PEORIA IL 61602
3 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
434 ILLINOIS BELL-BENEFIT DEPT 300 EAST RANDOLPH CHICAGO IL 60601 474 ILLINOIS CENTRAL HOSPITAL ASSN 2024 HICKORY ROAD HOMEWOOD IL 60430 445 INDIANA LABORERS & HOD CARRIER P O BOX 1587 TERRE HAUTE IN 47808 092 INDUSTRIAL LIFE INS CO 2727 TURTLE CREEK BLVD DALLAS TX 75219 441 INTERNATIONAL FUNDS 711 N COMMONS DR AURORA IL 60504 467 INTERNTL LONGSHOREMAN'S ASSN 3631 MARINE AVE - ATTN INS DEPT ST LOUIS MO 63118 093 INTER-OCEAN INSURANCE COMPANY P O BOX 145497 CINCINNATI OH 45250 470 IRON WORKERS H & W FUND 5640 SOCKNESS DR ATTN INS DEPT ROCKFORD IL 61109 446 J C PENNEY COMPANY INC P O BOX 869090 PLANO TX 75086 145 JEFFERSON PILOT INS CO P O BOX 21008 GREENSBORO NC 27420 071 JOHN DEERE LIFE INS CO. 110 NORTH EAST STREET JACKSONVILLE IL 62651 020 JOHN HANCOCK LIFE INSURANCE P O BOX 852 - LTC DEPT BOSTON MA 02117 190 KAISER FOUNDATION HEALTH PLAN P O BOX 12923 OAKLAND CA 94604 162 KEY BENEFIT ADMINISTRATORS P O BOX 55210 INDIANAPOLIS IN 46205 451 LABORERS WELFARE FUND 11465 WEST CERMAK ROAD WESTCHESTER IL 60154 021 LIBERTY LIFE ASSURANCE CO 100 LINCOLN WAY WEST MISHAWAKA IN 46544 095 LIBERTY NATIONAL LIFE INS CO 2001 THIRD AVENUE SOUTH BIRMINGHAM AL 35233 097 LIFE INVESTORS INSURANCE CO P O BOX 39119 PHOENIX AZ 85069 022 LINCOLN NATIONAL LIFE INS CO P O BOX 7807 FORT WAYNE IN 46801 473 MAIL HANDLERS BENEFIT PLAN P O BOX 8402 LONDON KY 40742 917 MANDATORY IDPA RECIPIENT COPAY 099 MARQUETTE NATIONAL LIFE 4800 N KENNETH AVENUE CHICAGO IL 60630 024 MASSACHUSETTS MUTUAL/UNICARE 4747 LINCOLN MALL DR-SUITE 500 MATTESON IL 60443 444 MEATCUTTERS & BUTCHERS #100 1649 W ADAMS ST - ATTN HEALTH FUND CHICAGO IL 60612 914 MEDICARE A & B & OTHER TPL 912 MEDICARE A & OTHER TPL PAYOR 920 MEDICARE ADVANTAGE PLANS 913 MEDICARE B & OTHER TPL PAYOR 918 MEDICARE COB - DMERC 140 MEDICO P O BOX 10386 DES MOINES IA 50306 146 MENNONITE MUTUAL AID ASSN P O BOX 483 GOSHEN IN 46527 025 METRAHEALTH/UNITED HEALTHCARE P O BOX 500 TULSA OK 74101 457 MIDWESTERN TEAMSTERS H & W 18861 90TH AV. STE A MOKENA IL 60442
4 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
994 MISCELLANEOUS TPL SOURCE 995 MISCELLANEOUS TPL SOURCE 996 MISCELLANEOUS TPL SOURCE 997 MISCELLANEOUS TPL SOURCE 998 MISCELLANEOUS TPL SOURCE 999 MISCELLANEOUS TPL SOURCE 888 MULTIPLE TPL SOURCES 058 MUTUAL BENEFIT LIFE P O BOX 419876 KANSAS CITY MO 64141 455 NATIONAL ASSOC LETTER CARRIERS 20547 WAVERLY COURT ASHBURN VA 20149 101 NATIONAL BENEFIT LIFE INS CO P O BOX 2800 AUSTIN TX 78768 104 NATIONAL LIBERTY LIFE INS CO LIBERTY PARK FRAZER PA 19355 106 NATIONAL STATES INS CO 1830 CRAIG PARK CT ST LOUIS MO 63146 107 NATIONWIDE LIFE INS CO P O BOX 2399 COLUMBUS OH 43216 458 NECA-IBEW WELFARE TRUST FUND 2120 HUBBARD AVENUE DECATUR IL 62526 057 NEW ENGLAND MUTUAL LIFE INS CO 501 BOYLSTON STREET BOSTON MA 02117 029 NEW YORK LIFE INSURANCE CO 3316 FARNAM STREET OMAHA NE 68175 122 NORTH AMERICAN BENEFIT NETWORK P O BOX 94928 CLEVELAND OH 44101 139 NORTH AMERICAN CO LIFE&HEALTH P O BOX 466 CHICAGO IL 60690 150 NORTH AMERICAN INSURANCE CO 1232 FOURIER DRIVE MADISON WI 53717 030 NORTHWESTERN MUTUAL LIFE 720 EAST WISCONSIN AVE MILWAUKEE WI 53202 109 OLD AMERICAN INSURANCE CO P O BOX 418573 KANSAS CITY MO 64141 168 OLD REPUBLIC LIFE INS 307 NORTH MICHIGAN AVE CHICAGO IL 60601 027 OMAHA HEALTH CARE/MUTUAL MUTUAL OF OMAHA PLAZA OMAHA NE 68175 456 OPERATING ENGINEERS H & W FUND 10 EXECUTIVE WOODS COURT - ROUTE 159 BELLEVILLE IL 62221 905 OTHER FEDERAL PROGRAM 904 OTHER STATE PROGRAM 032 PACIFIC MUTUAL LIFE INS P O BOX 34799 PHOENIX AZ 85067 450 PAINTERS HEALTH & WELFARE 3100 BROADWAY ST #511 KANSAS CITY MO 64111 110 PAN-AMERICAN LIFE INSURANCE CO P O BOX 981644 EL PASO TX 79998 909 PART A MEDICARE 910 PART B MEDICARE 906 PATIENT PAID 111 PAUL REVERE LIFE INSURANCE CO 18 CHESTNUT STREET WORCESTER MA 01608
5 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
112 PEKIN LIFE INSURANCE CO 2505 COURT STREET PEKIN IL 61558 113 PENN MUTUAL LIFE INS CO INDEPENDENCE SQUARE PHILADELPHIA PA 19172 902 PERSONAL INJURY SETTLEMENT 195 PHILADELPHIA AMERICAN LIFE P O BOX 4884 HOUSTON TX 77210 158 PHILADELPHIA LIFE INS CO P O BOX 4884 HOUSTON TX 77210 034 PHYSICIANS MUTUAL LIFE INS 2600 DODGE STREET-P O BOX 2018 OMAHA NE 68103 198 PILGRIM INSURANCE COMPANY 1037 CHICAGO AVENUE OAK PARK IL 60302 060 PIONEER LIFE INSURANCE P O BOX 6275 CAROL STREAM IL 60197 463 PIPEFITTER'S HEALTH & WELFARE 12385 LARIMORE RD - ATTN INS DEPT ST LOUIS MO 63138 465 PLASTERS & CEMENT MASONS P O BOX 50440-LOCAL 692 INDIANAPOLIS IN 46250 466 PLUMBERS & PIPEFITTERS 7130 COLUMBIA GATEWAY DRIVE - SUITE A COLUMBIA MD 21046 478 POSTMASTERS BENEFIT PLAN P O BOX 9554 SALT LAKE CITY UT 84109 004 PRINCIPAL LIFE INSURANCE CO P O BOX 10357 DES MOINES IA 50306 147 PROTECTIVE LIFE INS CO P O BOX 2606 BIRMINGHAM AL 35202 157 PROVIDENT MUTUAL INS OF PHIL P O BOX 7378 PHILADELPHIA PA 19101 188 QUAL MED INSURANCE WEST 201 N RIVER SUITE 300 SPOKANE WA 99201 482 QUALITY CARE HEALTH PLAN P O BOX 188021 CHATTANOOGA TN 37422 059 RELIABLE LIFE INSURANCE CO P O BOX 46955 ST LOUIS MO 63146 175 RELIABLE LIFE INSURANCE CO P O BOX 46955 ST LOUIS MO 63146 908 REPLACED BLOOD 115 RESERVE NATIONAL INSURANCE CO P O BOX 26620 OKLAHOMA CITY OK 73126 907 RESPONSIBLE RELATIVE PAID 477 RURAL CARRIER BENEFIT PLAN P O BOX 7404 LONDON KY 40742 055 SAFECO LIFE INSURANCE 5069 154TH PLACE NE REDMOND WA 98052 148 SECURITY BENEFIT LIFE INS CO 700 HARRISON TOPEKA KS 66636 471 SEIU HEALTHCARE 2229 S HALSTED, STE 122 CHICAGO IL 60608 037 SENTRY LIFE INSURANCE P O BOX 8888 STEVENS POINT WI 54481 464 SHEET METAL WORKER HEALTH FUND 601 N FAIRFAX ST - SUITE 500 ALEXANDRIA VA 22314 116 SOUTHLAND LIFE INSURANCE CO P O BOX 2220 DALLAS TX 75221 439 ST CLAIR COUNTY HEALTH PLAN 10 PUBLIC SQUARE-ROOM B-580 BELLEVILLE IL 62220 117 STANDARD LIFE INSURANCE CO P O BOX 10546 SPRINGFIELD MO 65808 119 STANDARD OF AMERICA LIFE INS 100 SOUTH WACKER DR - SUITE 834 CHICAGO IL 60606 052 STATE FARM HEALTH INS CO P O BOX 3070 NEWARK OH 43058
6 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
049 STONEBRIDGE LIFE P O BOX 869090 PLANO TX 75086 160 SUPREME LIFE INSURANCE CO 819 S. WABASH AVE #202 CHICAGO IL 60605 142 THRIVENT FINANCIAL - LUTHERANS 4321 NORTH BALLARD ROAD APPLETON WI 54919 026 TRANSAMERICA/MONUMENTAL LIFE 300 EAGLEVIEW BLVD EXTON PA 19341 046 TRANSAMERICA/MONUMENTAL LIFE 300 EAGLEVIEW BLVD EXTON PA 19341 191 TRANSPORT LIFE INS CO P O BOX 1982 CARMEL IN 46082 038 TRAVELERS INSURANCE CO P O BOX 3039 -CHGO TRANSIT AUTHORITY NAPERVILLE IL 60566 009 TRICARE FOR LIFE P O BOX 7890 MADISON WI 53707 005 TRUSTMARK P O BOX 2942 CLINTON IA 52733 192 TUFTS HEALTH PLAN 705 MOUNT AUBURN STREET WATERTOWN MA 02471 193 U S HEALTHCARE 980 JOLLY ROAD P O BOX 1109 BLUE BELL PA 19422 050 UMR - WAUSAU P O BOX 30541 SALT LAKE CITY UT 84130 186 UNICARE P O BOX 4458 CHICAGO IL 60680 141 UNION BANKERS INSURANCE CO P O BOX 130 PENSACOLA FL 32591 100 UNION FIDELITY P O BOX 8121 FORT WASHINGTON PA 19034 123 UNION FIDELITY LIFE INS CO P O BOX 5008 BRENTWOOD TN 37024 039 UNION LABOR LIFE INS CO P O BOX 130 PENSACOLA FL 32591 173 UNION MUTUAL LIFE INS CO 2211 CONGRESS STREET PORTLAND ME 04122 124 UNITED AMERICAN INSURANCE CO 3700 S STONEBRIDGE DRIVE-P O BOX 8080 MCKINNEY TX 75070 125 UNITED BENEFIT LIFE INS CO DODGE AT 33RD STREET OMAHA NE 68131 442 UNITED FOOD & COMM WORKERS 9801 W. HIGGINS RD, STE 500 DES PLAINES IL 60018 454 UNITED FOOD & COMM WORKERS P O BOX 42669 INDIANAPOLIS IN 46242 170 UNITED FOUNDERS LIFE INS CO P O BOX 12686 BIRMINGHAM AL 35202 468 UNITED FURNITURE WORKERS PO BOX 100037 NASHVILLE TN 37224 189 UNITED HEALTHCARE P O BOX 740800 ATLANTA GA 30374 449 UNITED HEALTHCARE P O BOX 740800 ATLANTA GA 30374 447 UNITED HEALTHCARE RIVER VALLEY P O BOX 5230 KINGSTON NY 12402 127 UNITED INS CO OF AMERICA ONE EAST WACKER DRIVE CHICAGO IL 60601 436 UNITED MINE WORKERS OF AMERICA P O BOX 99002 LUBBOCK TX 79490 174 UNITED STATES LIFE INS CO 125 MAIDEN LANE NEW YORK NY 10038 166 UNITED TEACHER ASSOCIATES INS P O BOX 30010 AUSTIN TX 78755 950 UNNAMED CREDIT 479 UPREHS P O BOX 161020 SALT LAKE CITY UT 84116
7 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
476 WABASH MEMORIAL HOSPITAL ASSN P O BOX 1340 DECATUR IL 62525 040 WASHINGTON NATIONAL INSURANCE P O BOX 2034 CARMEL IN 46082 131 WESTERN SOUTHERN LIFE 400 BROADWAY CINCINNATI OH 45202 901 WORKMEN'S COMPENSATION 133 WORLD INSURANCE COMPANY P O BOX 1 DES MOINES IA 50334 045 WORLD INSURANCE/BANKERS MULTI P O BOX 3160 OMAHA NE 68103 135 ZURICH AMERICAN LIFE INS CO 1375 EAST WOODFIELD RD SCHAUMBURG IL 60173
8 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
TPL Insuring Organization Address City State Zip CODE 001 AETNA P O BOX 981107 EL PASO TX 79998 002 AMALGAMATED LIFE & HEALTH CO 333 SOUTH ASHLAND BOULEVARD CHICAGO IL 60607 003 BANKERS LIFE & CASUALTY CO P O BOX 1935 CARMEL IN 46082 004 PRINCIPAL LIFE INSURANCE CO P O BOX 10357 DES MOINES IA 50306 005 TRUSTMARK P O BOX 2942 CLINTON IA 52733 006 BLUE CROSS BLUE SHIELD/HCSC 300 EAST RANDOLPH CHICAGO IL 60601 007 BUSINESS MEN'S ASSURANCE CO BMA TOWER - PENN VALLEY PARK KANSAS CITY MO 64108 008 CAPITOL LIFE INSURANCE CO P O BOX 1200 DENVER CO 80201 009 TRICARE FOR LIFE P O BOX 7890 MADISON WI 53707 010 CONNECTICUT GENERAL LIFE INS P O BOX 188021 CHATTANOOGA TN 37422 011 CONTINENTAL CASUALTY P O BOX 64912 ST PAUL MN 55164 012 COUNTRY LIFE INSURANCE COMPANY P O BOX 10870 CLEARWATER FL 33757 013 EQUITABLE LIFE ASSURANCE 3 TRIAD CENTER - SUITE 200 SALT LAKE CITY UT 84180 014 GENAM BENEFIT/GREAT WEST LIFE 13045 TESSON FERRY RD-CLAIMS ST LOUIS MO 63128 015 CIGNA/GREAT WEST HEALTHCARE P O BOX 188061 CHATTANOOGA TN 37422 016 HARTFORD LIFE/MASS MUTUAL HARTFORD PLAZA HARTFORD CT 06115 017 HOME LIFE INSURANCE CO CN1367/NERGC PISCATAWAY NJ 08854 018 HORACE MANN INSURANCE COMPANY 1 HORACE MANN PLAZA SPRINGFIELD IL 62701 019 ILL MUTUAL LIFE & CASUALTY CO 300 SW ADAMS - BENEFITS DEPT. PEORIA IL 61602 020 JOHN HANCOCK LIFE INSURANCE P O BOX 852 - LTC DEPT BOSTON MA 02117 021 LIBERTY LIFE ASSURANCE CO 100 LINCOLN WAY WEST MISHAWAKA IN 46544 022 LINCOLN NATIONAL LIFE INS CO P O BOX 7807 FORT WAYNE IN 46801 024 MASSACHUSETTS MUTUAL/UNICARE 4747 LINCOLN MALL DR-SUITE 500 MATTESON IL 60443 025 METRAHEALTH/UNITED HEALTHCARE P O BOX 500 TULSA OK 74101 026 TRANSAMERICA/MONUMENTAL LIFE 300 EAGLEVIEW BLVD EXTON PA 19341 027 OMAHA HEALTH CARE/MUTUAL MUTUAL OF OMAHA PLAZA OMAHA NE 68175 029 NEW YORK LIFE INSURANCE CO 3316 FARNAM STREET OMAHA NE 68175 030 NORTHWESTERN MUTUAL LIFE 720 EAST WISCONSIN AVE MILWAUKEE WI 53202 032 PACIFIC MUTUAL LIFE INS P O BOX 34799 PHOENIX AZ 85067 033 CONSTITUTION LIFE/PENN LIFE P O BOX 130 PENSACOLA FL 32591 034 PHYSICIANS MUTUAL LIFE INS 2600 DODGE STREET-P O BOX 2018 OMAHA NE 68103
9 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
035 CIGNA HEALTH CARE 7555 GOODWIN ROAD CHATTANOOGA TN 37421 036 AETNA/PRUDENTIAL HEALTH PLANS P O BOX 981107 EL PASO TX 79998 037 SENTRY LIFE INSURANCE P O BOX 8888 STEVENS POINT WI 54481 038 TRAVELERS INSURANCE CO P O BOX 3039 -CHGO TRANSIT AUTHORITY NAPERVILLE IL 60566 039 UNION LABOR LIFE INS CO P O BOX 130 PENSACOLA FL 32591 040 WASHINGTON NATIONAL INSURANCE P O BOX 2034 CARMEL IN 46082 041 AMALGAMATED LIFE INSURANCE CO 333 WESTCHESTER AVENUE - SUITE N101 WHITE PLAINS NY 10604 042 AMERICAN FIDELITY ASSURANCE 2000 CLASSEN CENTER OKLAHOMA CITY OK 73106 043 ILL HOSPITAL & HEALTH SERVICES 308 WEST STATE ST ROCKFORD IL 61101 044 BLUE CROSS BLUE SHIELD OUT OF STATE BCBS VARIES MD 00000 045 WORLD INSURANCE/BANKERS MULTI P O BOX 3160 OMAHA NE 68103 046 TRANSAMERICA/MONUMENTAL LIFE 300 EAGLEVIEW BLVD EXTON PA 19341 047 COMBINED INSURANCE COMPANY P O BOX 981625 EL PASO TX 79998 048 ALLSTATE LIFE INSURANCE ALLSTATE PLAZA NORTHBROOK IL 60062 049 STONEBRIDGE LIFE P O BOX 869090 PLANO TX 75086 050 UMR - WAUSAU P O BOX 30541 SALT LAKE CITY UT 84130 051 COLUMBIA UNIVERSAL P O BOX 19085 GREENVILLE SC 29602 052 STATE FARM HEALTH INS CO P O BOX 3070 NEWARK OH 43058 053 AMERICAN REPUBLIC INS CO P O BOX 21670 EAGAN MN 55121 055 SAFECO LIFE INSURANCE 5069 154TH PLACE NE REDMOND WA 98052 056 AMERICAN NATIONAL INSURANCE CO P O BOX 10546 SPRINGFIELD MO 65808 057 NEW ENGLAND MUTUAL LIFE INS CO 501 BOYLSTON STREET BOSTON MA 02117 058 MUTUAL BENEFIT LIFE P O BOX 419876 KANSAS CITY MO 64141 059 RELIABLE LIFE INSURANCE CO P O BOX 46955 ST LOUIS MO 63146 060 PIONEER LIFE INSURANCE P O BOX 6275 CAROL STREAM IL 60197 061 AMER FAMILY/AMER REPUBLIC INS PO BOX 21801 EAGAN MN 55121 062 AMERICAN INTEGRITY--NOLHGA P O BOX 834 HORSHAM PA 19044 063 AMERICAN LIBERTY LIFE INS CO P O BOX 1568 BIRMINGHAM AL 35201 064 AMERICAN LIFE & ACCIDENT INS P O BOX 1600 DALLAS TX 75221 065 AMERICAN LIFE INS CO 208 S LASALLE ST - SUITE 1440 CHICAGO IL 60604 066 AMERICAN MUTUAL LIFE INS CO 611 5TH AVE DES MOINES IA 50309 068 AMERICAN UNITED LIFE INS CO P O BOX 368 INDIANAPOLIS IN 46206 070 BENEFICIAL STANDARD LIFE INS 3700 WILSHIRE BLVD LOS ANGELES CA 90010
10 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
071 JOHN DEERE LIFE INS CO. 110 NORTH EAST STREET JACKSONVILLE IL 62651 072 CENTRAL STATES HEALTH & LIFE P O BOX 34350 OMAHA NE 68134 073 COLONIAL LIFE & ACCIDENT INS P O BOX 1365 COLUMBIA SC 29202 074 CONSECO 11825 N PENNSYLVANIA AVENUE CARMEL IN 46032 075 HUMANA HEALTH PLANS HMO P O BOX 14601 LEXINGTON KY 40512 076 COMMONWEALTH LIFE & ACCIDENT P O BOX 9000 LEAGUE CITY TX 77573 077 CONFEDERATION LIFE INS CO ONE MOUNT PLEASANT ROAD TORONTO, ONTARIO M4Y 2Y5 CA 00000 078 EQUITY NATIONAL LIFE INS. CO P O BOX 8063 LITTLE ROCK AR 72203 079 FEDERAL LIFE INSURANCE 3750 W DEERFIELD RD RIVERWOODS IL 60015 080 CENTRAL LIFE ASSURANCE CO P O BOX 5620 MADISON WI 53705 082 FIDELITY NATIONAL LIFE P O BOX 8067 DALLAS TX 75205 083 GLOBE LIFE & ACCIDENT INS CO 14000 PARKWAY PLAZA OKLAHOMA CITY OK 73184 084 COMBINED INSURANCE CO OF AMERI P O BOX 981625 EL PASO TX 79998 085 GOLDEN RULE INSURANCE COMPANY 712 ELEVENTH STREET LAWRENCEVILLE IL 62439 086 BANNER LIFE INSURANCE CO 1701 RESEARCH BLVD ROCKVILLE MD 20850 088 GUARANTEE TRUST LIFE 1275 MILWAUKEE AVE GLENVIEW IL 60025 089 GUARDIAN LIFE INSURANCE CO DO NOT USE NO PLACE IL 00000 090 HOLY FAMILY SOCIETY OF USA P O BOX 2909 - CLAIM DEPT JOLIET IL 60434 092 INDUSTRIAL LIFE INS CO 2727 TURTLE CREEK BLVD DALLAS TX 75219 093 INTER-OCEAN INSURANCE COMPANY P O BOX 145497 CINCINNATI OH 45250 095 LIBERTY NATIONAL LIFE INS CO 2001 THIRD AVENUE SOUTH BIRMINGHAM AL 35233 097 LIFE INVESTORS INSURANCE CO P O BOX 39119 PHOENIX AZ 85069 098 AMERICAN INDEPENDENCE LIFE INS 1867 AVENUE OF AMERICA MONROE LA 71201 099 MARQUETTE NATIONAL LIFE 4800 N KENNETH AVENUE CHICAGO IL 60630 100 UNION FIDELITY P O BOX 8121 FORT WASHINGTON PA 19034 101 NATIONAL BENEFIT LIFE INS CO P O BOX 2800 AUSTIN TX 78768 103 AMERICAN GEN LIFE & ACCIDENT P O BOX 1500 HEALTH CLAIMS NASHVILLE TN 37202 104 NATIONAL LIBERTY LIFE INS CO LIBERTY PARK FRAZER PA 19355 105 AMERICAN INCOME LIFE INS CO P O BOX 2608 WACO TX 73702 106 NATIONAL STATES INS CO 1830 CRAIG PARK CT ST LOUIS MO 63146 107 NATIONWIDE LIFE INS CO P O BOX 2399 COLUMBUS OH 43216 108 CORESOURCE P O BOX 2920 CLINTON IA 52733 109 OLD AMERICAN INSURANCE CO P O BOX 418573 KANSAS CITY MO 64141
11 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
110 PAN-AMERICAN LIFE INSURANCE CO P O BOX 981644 EL PASO TX 79998 111 PAUL REVERE LIFE INSURANCE CO 18 CHESTNUT STREET WORCESTER MA 01608 112 PEKIN LIFE INSURANCE CO 2505 COURT STREET PEKIN IL 61558 113 PENN MUTUAL LIFE INS CO INDEPENDENCE SQUARE PHILADELPHIA PA 19172 115 RESERVE NATIONAL INSURANCE CO P O BOX 26620 OKLAHOMA CITY OK 73126 116 SOUTHLAND LIFE INSURANCE CO P O BOX 2220 DALLAS TX 75221 117 STANDARD LIFE INSURANCE CO P O BOX 10546 SPRINGFIELD MO 65808 119 STANDARD OF AMERICA LIFE INS 100 SOUTH WACKER DR - SUITE 834 CHICAGO IL 60606 122 NORTH AMERICAN BENEFIT NETWORK P O BOX 94928 CLEVELAND OH 44101 123 UNION FIDELITY LIFE INS CO P O BOX 5008 BRENTWOOD TN 37024 124 UNITED AMERICAN INSURANCE CO 3700 S STONEBRIDGE DRIVE-P O BOX 8080 MCKINNEY TX 75070 125 UNITED BENEFIT LIFE INS CO DODGE AT 33RD STREET OMAHA NE 68131 127 UNITED INS CO OF AMERICA ONE EAST WACKER DRIVE CHICAGO IL 60601 130 ASSURANT HEALTH P O BOX 2806 CLINTON IA 52733 131 WESTERN SOUTHERN LIFE 400 BROADWAY CINCINNATI OH 45202 132 ASSURITY P O BOX 82533 LINCOLN NE 68501 133 WORLD INSURANCE COMPANY P O BOX 1 DES MOINES IA 50334 135 ZURICH AMERICAN LIFE INS CO 1375 EAST WOODFIELD RD SCHAUMBURG IL 60173 136 ACADEMY LIFE INSURANCE COMPANY P O BOX 3074 SOUTHEASTERN PA 19398 139 NORTH AMERICAN CO LIFE&HEALTH P O BOX 466 CHICAGO IL 60690 140 MEDICO P O BOX 10386 DES MOINES IA 50306 141 UNION BANKERS INSURANCE CO P O BOX 130 PENSACOLA FL 32591 142 THRIVENT FINANCIAL - LUTHERANS 4321 NORTH BALLARD ROAD APPLETON WI 54919 144 ALLSTATE WORKPLACE DIVISION 1776 AMERICAN HERITAGE LIFE DRIVE JACKSONVILLE FL 32224 145 JEFFERSON PILOT INS CO P O BOX 21008 GREENSBORO NC 27420 146 MENNONITE MUTUAL AID ASSN P O BOX 483 GOSHEN IN 46527 147 PROTECTIVE LIFE INS CO P O BOX 2606 BIRMINGHAM AL 35202 148 SECURITY BENEFIT LIFE INS CO 700 HARRISON TOPEKA KS 66636 149 ALLMERICA 440 LINCOLN ST N365 WORCESTER MA 01653 150 NORTH AMERICAN INSURANCE CO 1232 FOURIER DRIVE MADISON WI 53717 156 CUNA MUTUAL INSURANCE SOCIETY 5910 MINERAL POINT RD MADISON WI 53705 157 PROVIDENT MUTUAL INS OF PHIL P O BOX 7378 PHILADELPHIA PA 19101 158 PHILADELPHIA LIFE INS CO P O BOX 4884 HOUSTON TX 77210
12 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
160 SUPREME LIFE INSURANCE CO 819 S. WABASH AVE #202 CHICAGO IL 60605 161 AMERICAN INTERNATIONAL LIFE P O BOX 727 WALL STREET STATION NEW YORK NY 10268 162 KEY BENEFIT ADMINISTRATORS P O BOX 55210 INDIANAPOLIS IN 46205 163 FEDERAL HOME LIFE INS CO P O BOX 10821- MEDICARE CLAIMS CENTER CLEARWATER FL 33757 166 UNITED TEACHER ASSOCIATES INS P O BOX 30010 AUSTIN TX 78755 168 OLD REPUBLIC LIFE INS 307 NORTH MICHIGAN AVE CHICAGO IL 60601 169 HARRINGTON BENEFIT 675 BROOKSEDGE BLVD WESTERVILLE OH 43081 170 UNITED FOUNDERS LIFE INS CO P O BOX 12686 BIRMINGHAM AL 35202 171 FARMLAND INDUSTRIES 103 WEST 26TH AVENUE KANSAS CITY MO 64116 173 UNION MUTUAL LIFE INS CO 2211 CONGRESS STREET PORTLAND ME 04122 174 UNITED STATES LIFE INS CO 125 MAIDEN LANE NEW YORK NY 10038 175 RELIABLE LIFE INSURANCE CO P O BOX 46955 ST LOUIS MO 63146 180 COMMUNITY HEALTH PLAN P O BOX 372 MATTOON IL 61938 182 HUMANA INSURANCE COMPANY P O BOX 14610 LEXINGTON KY 40512 183 FEDERATED MUTUAL INSURANCE 129 EAST BROADWAY OWATONNA MN 55060 186 UNICARE P O BOX 4458 CHICAGO IL 60680 187 ASSURANT HEALTH - JOHN ALDEN P O BOX 2806 CLINTON IA 52733 188 QUAL MED INSURANCE WEST 201 N RIVER SUITE 300 SPOKANE WA 99201 189 UNITED HEALTHCARE P O BOX 740800 ATLANTA GA 30374 190 KAISER FOUNDATION HEALTH PLAN P O BOX 12923 OAKLAND CA 94604 191 TRANSPORT LIFE INS CO P O BOX 1982 CARMEL IN 46082 192 TUFTS HEALTH PLAN 705 MOUNT AUBURN STREET WATERTOWN MA 02471 193 U S HEALTHCARE 980 JOLLY ROAD P O BOX 1109 BLUE BELL PA 19422 195 PHILADELPHIA AMERICAN LIFE P O BOX 4884 HOUSTON TX 77210 196 HEALTH PARTNERS P O BOX 1289 MINNEAPOLIS MN 55440 197 GE FINANCIAL ASSURANCE/PHOENIX ONE AMERICAN ROW HARTFORD CT 06115 198 PILGRIM INSURANCE COMPANY 1037 CHICAGO AVENUE OAK PARK IL 60302 430 AUTOMOTIVE WHOLESALERS OF ILL P O BOX 19252 ATTN: INSURANCE DEPT SPRINGFIELD IL 62794 431 FORD MOTOR COMPANY 1000 LINCOLN HWY - ATTN EMP BENEFITS CHICAGO HEIGHTS IL 60411 432 GENERAL MOTORS CORPORATION 1500 E ROUTE A WENTZVILLE MO 63385 433 BLUE CROSS BLUE SHIELD 600 E LAFAYETTE-P O BOX 1088 DETROIT MI 48226 434 ILLINOIS BELL-BENEFIT DEPT 300 EAST RANDOLPH CHICAGO IL 60601 436 UNITED MINE WORKERS OF AMERICA P O BOX 99002 LUBBOCK TX 79490
13 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
437 GENERAL ELECTRIC CO P O BOX 414 MILWAUKEE WI 53201 439 ST CLAIR COUNTY HEALTH PLAN 10 PUBLIC SQUARE-ROOM B-580 BELLEVILLE IL 62220 441 INTERNATIONAL FUNDS 711 N COMMONS DR AURORA IL 60504 442 UNITED FOOD & COMM WORKERS 9801 W. HIGGINS RD, STE 500 DES PLAINES IL 60018 443 CENTRAL STATES JOINT BOARD 245 FENCL LN HILLSIDE IL 60162 444 MEATCUTTERS & BUTCHERS #100 1649 W ADAMS ST - ATTN HEALTH FUND CHICAGO IL 60612 445 INDIANA LABORERS & HOD CARRIER P O BOX 1587 TERRE HAUTE IN 47808 446 J C PENNEY COMPANY INC P O BOX 869090 PLANO TX 75086 447 UNITED HEALTHCARE RIVER VALLEY P O BOX 5230 KINGSTON NY 12402 448 CARPENTERS H & W TRUST FUND 12 E. ERIE, ATTN: CLAIMS CHICAGO IL 60611 449 UNITED HEALTHCARE P O BOX 740800 ATLANTA GA 30374 450 PAINTERS HEALTH & WELFARE 3100 BROADWAY ST #511 KANSAS CITY MO 64111 451 LABORERS WELFARE FUND 11465 WEST CERMAK ROAD WESTCHESTER IL 60154 452 CENTRAL STATES SE & SW FUND 9377 W HIGGINS ROAD ROSEMONT IL 60018 453 APWU HEALTH PLAN P O BOX 1358 GLEN BURNIE MD 21060 454 UNITED FOOD & COMM WORKERS P O BOX 42669 INDIANAPOLIS IN 46242 455 NATIONAL ASSOC LETTER CARRIERS 20547 WAVERLY COURT ASHBURN VA 20149 456 OPERATING ENGINEERS H & W FUND 10 EXECUTIVE WOODS COURT - ROUTE 159 BELLEVILLE IL 62221 457 MIDWESTERN TEAMSTERS H & W 18861 90TH AV. STE A MOKENA IL 60442 458 NECA-IBEW WELFARE TRUST FUND 2120 HUBBARD AVENUE DECATUR IL 62526 459 GOVERNMENT EMPLOYEES HOSP ASSN P O BOX 4665 INDEPENDENCE MO 64051 460 BAKERY & CONFECTIONERY UNION 10401 CONNECTICUT AV -ATTN INS DEPT KENSINGTON MD 20895 461 GLAZIERS UNION LOCAL 27 4225 LAWNDALE AVENUE LYONS IL 60534 462 BOILERMAKER'S HEALTH & WELFARE 522 BROTHERHOOD BLDG - ATTN INS DEPT KANSAS CITY KS 66101 463 PIPEFITTER'S HEALTH & WELFARE 12385 LARIMORE RD - ATTN INS DEPT ST LOUIS MO 63138 464 SHEET METAL WORKER HEALTH FUND 601 N FAIRFAX ST - SUITE 500 ALEXANDRIA VA 22314 465 PLASTERS & CEMENT MASONS P O BOX 50440-LOCAL 692 INDIANAPOLIS IN 46250 466 PLUMBERS & PIPEFITTERS 7130 COLUMBIA GATEWAY DRIVE - SUITE A COLUMBIA MD 21046 467 INTERNTL LONGSHOREMAN'S ASSN 3631 MARINE AVE - ATTN INS DEPT ST LOUIS MO 63118 468 UNITED FURNITURE WORKERS PO BOX 100037 NASHVILLE TN 37224 469 BRICKLAYER'S BENEFIT FUND 124 SOUTHWEST ADAMS STREET- SUITE 430 PEORIA IL 61602 470 IRON WORKERS H & W FUND 5640 SOCKNESS DR ATTN INS DEPT ROCKFORD IL 61109 471 SEIU HEALTHCARE 2229 S HALSTED, STE 122 CHICAGO IL 60608
14 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
473 MAIL HANDLERS BENEFIT PLAN P O BOX 8402 LONDON KY 40742 474 ILLINOIS CENTRAL HOSPITAL ASSN 2024 HICKORY ROAD HOMEWOOD IL 60430 475 AMERICAN FEDERATION GOVT EMPL 80 F STREET NW WASHINGTON DC 20001 476 WABASH MEMORIAL HOSPITAL ASSN P O BOX 1340 DECATUR IL 62525 477 RURAL CARRIER BENEFIT PLAN P O BOX 7404 LONDON KY 40742 478 POSTMASTERS BENEFIT PLAN P O BOX 9554 SALT LAKE CITY UT 84109 479 UPREHS P O BOX 161020 SALT LAKE CITY UT 84116 480 BC/BS IL- FED EMPLOYEE PROGRAM P O BOX 805107 CHICAGO IL 60680 482 QUALITY CARE HEALTH PLAN P O BOX 188021 CHATTANOOGA TN 37422 485 ATKINSON TOPEKA & SANTA FE P O BOX 1979 TOPEKA KS 66601 486 AUTO MECHANICS LOCAL 701 361 S FRONTAGE RD - STE 100 BURR RIDGE IL 60527 888 MULTIPLE TPL SOURCES 901 WORKMEN'S COMPENSATION 902 PERSONAL INJURY SETTLEMENT 903 ACCIDENTAL DEATH & DISMEMBER 904 OTHER STATE PROGRAM 905 OTHER FEDERAL PROGRAM 906 PATIENT PAID 907 RESPONSIBLE RELATIVE PAID 908 REPLACED BLOOD 909 PART A MEDICARE 910 PART B MEDICARE 911 ENROLLED MEDICARE PART A & B 912 MEDICARE A & OTHER TPL PAYOR 913 MEDICARE B & OTHER TPL PAYOR 914 MEDICARE A & B & OTHER TPL 915 COPAYMENT - RECIPIENT PAID 916 COPAYMENT - ADJUSTMENT 917 MANDATORY IDPA RECIPIENT COPAY 918 MEDICARE COB - DMERC 919 BTS 920 MEDICARE ADVANTAGE PLANS 950 UNNAMED CREDIT
15 TPL Code Directory Posted August 2016 Illinois Department of Healthcare and Family Services
994 MISCELLANEOUS TPL SOURCE 995 MISCELLANEOUS TPL SOURCE 996 MISCELLANEOUS TPL SOURCE 997 MISCELLANEOUS TPL SOURCE 998 MISCELLANEOUS TPL SOURCE 999 MISCELLANEOUS TPL SOURCE
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