TPL Code Directory - Illinois.gov

1 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20161 TPL code Insuring OrganizationAddressCityStateZip136 ACADEMY LIFE INSURANCE COMPANYP O BOX 3074 SOUTHEASTERNPA19398903 ACCIDENTAL DEATH & DISMEMBER001 AETNAP O BOX 981107EL PASOTX79998036 AETNA/PRUDENTIAL HEALTH PLANSP O BOX 981107EL PASOTX79998149 ALLMERICA440 LINCOLN ST N365 WORCESTERMA01653048 ALLSTATE LIFE INSURANCEALLSTATE PLAZANORTHBROOKIL60062144 ALLSTATE WORKPLACE DIVISION1776 AMERICAN HERITAGE LIFE DRIVEJACKSONVILLEFL32224002 AMALGAMATED LIFE & HEALTH CO333 SOUTH ASHLAND BOULEVARDCHICAGOIL60607041 AMALGAMATED LIFE INSURANCE CO333 WESTCHESTER AVENUE - SUITE N101 WHITE PLAINSNY10604061 AMER FAMILY/AMER REPUBLIC INSPO BOX 21801 EAGANMN55121475 AMERICAN FEDERATION GOVT EMPL80 F STREET NWWASHINGTONDC20001042 AMERICAN FIDELITY ASSURANCE2000 CLASSEN CENTEROKLAHOMA CITYOK73106103 AMERICAN GEN LIFE & ACCIDENTP O BOX 1500 HEALTH CLAIMSNASHVILLETN37202105 AMERICAN INCOME LIFE INS COP O BOX 2608 WACOTX73702098 AMERICAN INDEPENDENCE LIFE INS1867 AVENUE OF AMERICAMONROELA71201062 AMERICAN INTEGRITY--NOLHGAP O BOX 834 HORSHAMPA19044161 AMERICAN INTERNATIONAL LIFEP O BOX 727 WALL STREET STATIONNEW YORKNY10268063 AMERICAN LIBERTY LIFE INS COP O BOX 1568 BIRMINGHAMAL35201064 AMERICAN LIFE & ACCIDENT INSP O BOX 1600 DALLASTX75221065 AMERICAN LIFE INS CO208 S LASALLE ST - SUITE 1440 CHICAGOIL60604066 AMERICAN MUTUAL LIFE INS CO611 5TH AVEDES MOINESIA50309056 AMERICAN NATIONAL INSURANCE COP O BOX 10546 SPRINGFIELDMO65808053 AMERICAN REPUBLIC INS COP O BOX 21670 EAGANMN55121068 AMERICAN UNITED LIFE INS COP O BOX 368 INDIANAPOLISIN46206453 APWU HEALTH PLANP O BOX 1358 GLEN BURNIEMD21060130 ASSURANT HEALTHP O BOX 2806 CLINTONIA52733187 ASSURANT HEALTH - JOHN ALDENP O BOX 2806 CLINTONIA52733132 ASSURITYP O BOX 82533 LINCOLNNE68501485 ATKINSON TOPEKA & SANTA FEP O BOX 1979 TOPEKAKS66601486 AUTO MECHANICS LOCAL 701361 S FRONTAGE RD - STE 100 BURR

2 RIDGEIL60527 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20162430 AUTOMOTIVE WHOLESALERS OF ILLP O BOX 19252 ATTN: INSURANCE DEPTSPRINGFIELDIL62794460 BAKERY & CONFECTIONERY UNION10401 CONNECTICUT AV -ATTN INS DEPTKENSINGTONMD20895003 BANKERS LIFE & CASUALTY COP O BOX 1935 CARMELIN46082086 BANNER LIFE INSURANCE CO1701 RESEARCH BLVDROCKVILLEMD20850480BC/BS IL- FED EMPLOYEE PROGRAMP O BOX 805107 CHICAGOIL60680070 BENEFICIAL STANDARD LIFE INS3700 WILSHIRE BLVDLOS ANGELESCA90010044 BLUE CROSS BLUE SHIELDOUT OF STATE BCBSVARIESMD00000433 BLUE CROSS BLUE SHIELD600 E LAFAYETTE-P O BOX 1088 DETROITMI48226006 BLUE CROSS BLUE SHIELD/HCSC300 EAST RANDOLPHCHICAGOIL60601462 BOILERMAKER'S HEALTH & WELFARE522 BROTHERHOOD BLDG - ATTN INS DEPTKANSAS CITYKS66101469 BRICKLAYER'S BENEFIT FUND124 SOUTHWEST ADAMS STREET- SUITE 430 PEORIAIL61602919 BTS007 BUSINESS MEN'S ASSURANCE COBMA TOWER - PENN VALLEY PARKKANSAS CITYMO64108008 CAPITOL LIFE INSURANCE COP O BOX 1200 DENVERCO80201448 CARPENTERS H & W TRUST FUND12 E.

3 ERIE, ATTN: CLAIMSCHICAGOIL60611080 CENTRAL LIFE ASSURANCE COP O BOX 5620 MADISONWI53705072 CENTRAL STATES HEALTH & LIFEP O BOX 34350 OMAHANE68134443 CENTRAL STATES JOINT BOARD245 FENCL LNHILLSIDEIL60162452 CENTRAL STATES SE & SW FUND9377 W HIGGINS ROADROSEMONTIL60018035 CIGNA HEALTH CARE7555 GOODWIN ROADCHATTANOOGATN37421015 CIGNA/GREAT WEST HEALTHCAREP O BOX 188061 CHATTANOOGATN37422073 COLONIAL LIFE & ACCIDENT INSP O BOX 1365 COLUMBIASC29202051 COLUMBIA UNIVERSALP O BOX 19085 GREENVILLESC29602084 COMBINED INSURANCE CO OF AMERIP O BOX 981625EL PASOTX79998047 COMBINED INSURANCE COMPANYP O BOX 981625EL PASOTX79998076 COMMONWEALTH LIFE & ACCIDENTP O BOX 9000 LEAGUE CITYTX77573180 COMMUNITY HEALTH PLANP O BOX 372 MATTOONIL61938077 CONFEDERATION LIFE INS COONE MOUNT PLEASANT ROADTORONTO, ONTARIO M4Y 2Y5CA00000010 CONNECTICUT GENERAL LIFE INSP O BOX 188021 CHATTANOOGATN37422074 CONSECO11825 N PENNSYLVANIA AVENUECARMELIN46032033 CONSTITUTION LIFE/PENN LIFEP O BOX 130 PENSACOLAFL32591011 CONTINENTAL CASUALTYP O BOX 64912ST PAULMN55164916 COPAYMENT - ADJUSTMENTTPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20163915 COPAYMENT - RECIPIENT PAID108 CORESOURCEP O BOX 2920 CLINTONIA52733012 COUNTRY LIFE INSURANCE COMPANYP O BOX 10870 CLEARWATERFL33757156 CUNA MUTUAL INSURANCE SOCIETY5910 MINERAL POINT RDMADISONWI53705911 ENROLLED MEDICARE PART A & B013 EQUITABLE LIFE ASSURANCE3 TRIAD CENTER - SUITE 200 SALT LAKE CITYUT84180078 EQUITY NATIONAL LIFE INS.

4 COP O BOX 8063 LITTLE ROCKAR72203171 FARMLAND INDUSTRIES103 WEST 26TH AVENUEKANSAS CITYMO64116163 FEDERAL HOME LIFE INS COP O BOX 10821- MEDICARE CLAIMS CENTERCLEARWATERFL33757079 FEDERAL LIFE INSURANCE3750 W DEERFIELD RDRIVERWOODSIL60015183 FEDERATED MUTUAL INSURANCE129 EAST BROADWAYOWATONNAMN55060082 FIDELITY NATIONAL LIFEP O BOX 8067 DALLASTX75205431 FORD MOTOR COMPANY1000 LINCOLN HWY - ATTN EMP BENEFITSCHICAGO HEIGHTSIL60411197GE FINANCIAL ASSURANCE/PHOENIXONE AMERICAN ROWHARTFORDCT06115014 GENAM BENEFIT/GREAT WEST LIFE13045 TESSON FERRY RD-CLAIMSST LOUISMO63128437 GENERAL ELECTRIC COP O BOX 414 MILWAUKEEWI53201432 GENERAL MOTORS CORPORATION1500 E ROUTE AWENTZVILLEMO63385461 GLAZIERS UNION LOCAL 274225 LAWNDALE AVENUELYONSIL60534083 GLOBE LIFE & ACCIDENT INS CO14000 PARKWAY PLAZAOKLAHOMA CITYOK73184085 GOLDEN RULE INSURANCE COMPANY712 ELEVENTH STREETLAWRENCEVILLEIL62439459 GOVERNMENT EMPLOYEES HOSP ASSNP O BOX 4665 INDEPENDENCEMO64051088 GUARANTEE TRUST LIFE1275 MILWAUKEE AVEGLENVIEWIL60025089 GUARDIAN LIFE INSURANCE CODO NOT USENO PLACEIL00000169 HARRINGTON BENEFIT675 BROOKSEDGE BLVDWESTERVILLEOH43081016 HARTFORD LIFE/MASS MUTUALHARTFORD PLAZAHARTFORDCT06115196 HEALTH PARTNERSP O BOX 1289 MINNEAPOLISMN55440090 HOLY FAMILY SOCIETY OF USAP O BOX 2909 - CLAIM DEPTJOLIETIL60434017 HOME LIFE INSURANCE COCN1367/NERGCPISCATAWAYNJ08854018 HORACE MANN INSURANCE COMPANY1 HORACE MANN PLAZASPRINGFIELDIL62701075 HUMANA HEALTH PLANS HMOP O BOX 14601 LEXINGTONKY40512182 HUMANA INSURANCE COMPANYP O BOX 14610 LEXINGTONKY40512043 ILL HOSPITAL & HEALTH SERVICES308 WEST STATE STROCKFORDIL61101019 ILL MUTUAL LIFE & CASUALTY CO300 SW ADAMS - BENEFITS code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20164434 illinois BELL-BENEFIT DEPT300 EAST RANDOLPHCHICAGOIL60601474 illinois CENTRAL HOSPITAL ASSN2024 HICKORY ROADHOMEWOODIL60430445 INDIANA LABORERS & HOD CARRIERP O BOX 1587 TERRE HAUTEIN47808092

5 INDUSTRIAL LIFE INS CO2727 TURTLE CREEK BLVDDALLASTX75219441 INTERNATIONAL FUNDS711 N COMMONS DRAURORAIL60504467 INTERNTL LONGSHOREMAN'S ASSN3631 MARINE AVE - ATTN INS DEPTST LOUISMO63118093 INTER-OCEAN INSURANCE COMPANYP O BOX 145497 CINCINNATIOH45250470 IRON WORKERS H & W FUND5640 SOCKNESS DR ATTN INS DEPTROCKFORDIL61109446J C PENNEY COMPANY INCP O BOX 869090 PLANOTX75086145 JEFFERSON PILOT INS COP O BOX 21008 GREENSBORONC27420071 JOHN DEERE LIFE INS NORTH EAST STREETJACKSONVILLEIL62651020 JOHN HANCOCK LIFE INSURANCEP O BOX 852 - LTC DEPTBOSTONMA02117190 KAISER FOUNDATION HEALTH PLANP O BOX 12923 OAKLANDCA94604162 KEY BENEFIT ADMINISTRATORSP O BOX 55210 INDIANAPOLISIN46205451 LABORERS WELFARE FUND11465 WEST CERMAK ROADWESTCHESTERIL60154021 LIBERTY LIFE ASSURANCE CO100 LINCOLN WAY WESTMISHAWAKAIN46544095 LIBERTY NATIONAL LIFE INS CO2001 THIRD AVENUE SOUTHBIRMINGHAMAL35233097 LIFE INVESTORS INSURANCE COP O BOX 39119 PHOENIXAZ85069022 LINCOLN NATIONAL LIFE INS COP O BOX 7807 FORT WAYNEIN46801473 MAIL HANDLERS BENEFIT PLANP O BOX 8402 LONDONKY40742917 MANDATORY IDPA RECIPIENT COPAY099 MARQUETTE NATIONAL LIFE4800 N KENNETH AVENUECHICAGOIL60630024 MASSACHUSETTS MUTUAL/UNICARE4747 LINCOLN MALL DR-SUITE 500 MATTESONIL60443444 MEATCUTTERS & BUTCHERS #1001649 W ADAMS ST - ATTN HEALTH FUNDCHICAGOIL60612914 MEDICARE A & B & OTHER TPL912 MEDICARE A & OTHER TPL PAYOR920 MEDICARE ADVANTAGE PLANS913 MEDICARE B & OTHER TPL PAYOR918 MEDICARE COB - DMERC140 MEDICOP O BOX 10386 DES MOINESIA50306146 MENNONITE MUTUAL AID ASSNP O BOX 483 GOSHENIN46527025 METRAHEALTH/UNITED HEALTHCAREP O BOX 500 TULSAOK74101457 MIDWESTERN TEAMSTERS H & W18861 90TH AV.

6 STE AMOKENAIL60442 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20165994 MISCELLANEOUS TPL SOURCE995 MISCELLANEOUS TPL SOURCE996 MISCELLANEOUS TPL SOURCE997 MISCELLANEOUS TPL SOURCE998 MISCELLANEOUS TPL SOURCE999 MISCELLANEOUS TPL SOURCE888 MULTIPLE TPL SOURCES058 MUTUAL BENEFIT LIFEP O BOX 419876 KANSAS CITYMO64141455 NATIONAL ASSOC LETTER CARRIERS20547 WAVERLY COURTASHBURNVA20149101 NATIONAL BENEFIT LIFE INS COP O BOX 2800 AUSTINTX78768104 NATIONAL LIBERTY LIFE INS COLIBERTY PARKFRAZERPA19355106 NATIONAL STATES INS CO1830 CRAIG PARK CTST LOUISMO63146107 NATIONWIDE LIFE INS COP O BOX 2399 COLUMBUSOH43216458 NECA-IBEW WELFARE TRUST FUND2120 HUBBARD AVENUEDECATURIL62526057 NEW ENGLAND MUTUAL LIFE INS CO501 BOYLSTON STREETBOSTONMA02117029 NEW YORK LIFE INSURANCE CO3316 FARNAM STREETOMAHANE68175122 NORTH AMERICAN BENEFIT NETWORKP O BOX 94928 CLEVELANDOH44101139 NORTH AMERICAN CO LIFE&HEALTHP O BOX 466 CHICAGOIL60690150 NORTH AMERICAN INSURANCE CO1232 FOURIER DRIVEMADISONWI53717030 NORTHWESTERN MUTUAL LIFE720 EAST WISCONSIN AVEMILWAUKEEWI53202109 OLD AMERICAN INSURANCE COP O BOX 418573 KANSAS CITYMO64141168 OLD REPUBLIC LIFE INS307 NORTH MICHIGAN AVECHICAGOIL60601027 OMAHA HEALTH CARE/MUTUALMUTUAL OF OMAHA PLAZAOMAHANE68175456 OPERATING ENGINEERS H & W FUND10 EXECUTIVE WOODS COURT - ROUTE 159 BELLEVILLEIL62221905 OTHER FEDERAL PROGRAM904 OTHER STATE PROGRAM032 PACIFIC MUTUAL LIFE INSP O BOX 34799 PHOENIXAZ85067450 PAINTERS HEALTH & WELFARE3100 BROADWAY ST #511 KANSAS CITYMO64111110 PAN-AMERICAN LIFE INSURANCE COP O BOX 981644EL PASOTX79998909 PART A MEDICARE910 PART B MEDICARE906 PATIENT PAID111 PAUL REVERE LIFE INSURANCE CO18 CHESTNUT STREETWORCESTERMA01608 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20166112 PEKIN LIFE INSURANCE CO2505 COURT STREETPEKINIL61558113 PENN MUTUAL LIFE INS COINDEPENDENCE SQUAREPHILADELPHIAPA19172902 PERSONAL INJURY

7 SETTLEMENT195 PHILADELPHIA AMERICAN LIFEP O BOX 4884 HOUSTONTX77210158 PHILADELPHIA LIFE INS COP O BOX 4884 HOUSTONTX77210034 PHYSICIANS MUTUAL LIFE INS2600 DODGE STREET-P O BOX 2018 OMAHANE68103198 PILGRIM INSURANCE COMPANY1037 CHICAGO AVENUEOAK PARKIL60302060 PIONEER LIFE INSURANCEP O BOX 6275 CAROL STREAMIL60197463 PIPEFITTER'S HEALTH & WELFARE12385 LARIMORE RD - ATTN INS DEPTST LOUISMO63138465 PLASTERS & CEMENT MASONSP O BOX 50440-LOCAL 692 INDIANAPOLISIN46250466 PLUMBERS & PIPEFITTERS7130 COLUMBIA GATEWAY DRIVE - SUITE ACOLUMBIAMD21046478 POSTMASTERS BENEFIT PLANP O BOX 9554 SALT LAKE CITYUT84109004 PRINCIPAL LIFE INSURANCE COP O BOX 10357 DES MOINESIA50306147 PROTECTIVE LIFE INS COP O BOX 2606 BIRMINGHAMAL35202157 PROVIDENT MUTUAL INS OF PHILP O BOX 7378 PHILADELPHIAPA19101188 QUAL MED INSURANCEWEST 201 N RIVER SUITE 300 SPOKANEWA99201482 QUALITY CARE HEALTH PLANP O BOX 188021 CHATTANOOGATN37422059 RELIABLE LIFE INSURANCE COP O BOX 46955ST LOUISMO63146175 RELIABLE LIFE INSURANCE COP O BOX 46955ST LOUISMO63146908 REPLACED BLOOD115 RESERVE NATIONAL INSURANCE COP O BOX 26620 OKLAHOMA CITYOK73126907 RESPONSIBLE RELATIVE PAID477 RURAL CARRIER BENEFIT PLANP O BOX 7404 LONDONKY40742055 SAFECO LIFE INSURANCE5069 154TH PLACE NEREDMONDWA98052148 SECURITY BENEFIT LIFE INS CO700 HARRISONTOPEKAKS66636471 SEIU HEALTHCARE2229 S HALSTED.

8 STE 122 CHICAGOIL60608037 SENTRY LIFE INSURANCEP O BOX 8888 STEVENS POINTWI54481464 SHEET METAL WORKER HEALTH FUND601 N FAIRFAX ST - SUITE 500 ALEXANDRIAVA22314116 SOUTHLAND LIFE INSURANCE COP O BOX 2220 DALLASTX75221439ST CLAIR COUNTY HEALTH PLAN10 PUBLIC SQUARE-ROOM B-580 BELLEVILLEIL62220117 STANDARD LIFE INSURANCE COP O BOX 10546 SPRINGFIELDMO65808119 STANDARD OF AMERICA LIFE INS100 SOUTH WACKER DR - SUITE 834 CHICAGOIL60606052 STATE FARM HEALTH INS COP O BOX 3070 NEWARKOH43058 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20167049 STONEBRIDGE LIFEP O BOX 869090 PLANOTX75086160 SUPREME LIFE INSURANCE CO819 S. WABASH AVE #202 CHICAGOIL60605142 THRIVENT FINANCIAL - LUTHERANS4321 NORTH BALLARD ROADAPPLETONWI54919026 TRANSAMERICA/MONUMENTAL LIFE300 EAGLEVIEW BLVDEXTONPA19341046 TRANSAMERICA/MONUMENTAL LIFE300 EAGLEVIEW BLVDEXTONPA19341191 TRANSPORT LIFE INS COP O BOX 1982 CARMELIN46082038 TRAVELERS INSURANCE COP O BOX 3039 -CHGO TRANSIT AUTHORITYNAPERVILLEIL60566009 TRICARE FOR LIFEP O BOX 7890 MADISONWI53707005 TRUSTMARKP O BOX 2942 CLINTONIA52733192 TUFTS HEALTH PLAN705 MOUNT AUBURN STREETWATERTOWNMA02471193U S HEALTHCARE980 JOLLY ROAD P O BOX 1109 BLUE BELLPA19422050 UMR - WAUSAUP O BOX 30541 SALT LAKE CITYUT84130186 UNICAREP O BOX 4458 CHICAGOIL60680141 UNION BANKERS INSURANCE COP O BOX 130 PENSACOLAFL32591100 UNION FIDELITYP O BOX 8121 FORT WASHINGTONPA19034123 UNION FIDELITY LIFE INS COP O BOX 5008 BRENTWOODTN37024039 UNION LABOR LIFE INS COP O BOX 130 PENSACOLAFL32591173 UNION MUTUAL LIFE INS CO2211 CONGRESS STREETPORTLANDME04122124 UNITED AMERICAN INSURANCE CO3700

9 S STONEBRIDGE DRIVE-P O BOX 8080 MCKINNEYTX75070125 UNITED BENEFIT LIFE INS CODODGE AT 33RD STREETOMAHANE68131442 UNITED FOOD & COMM WORKERS9801 W. HIGGINS RD, STE 500 DES PLAINESIL60018454 UNITED FOOD & COMM WORKERSP O BOX 42669 INDIANAPOLISIN46242170 UNITED FOUNDERS LIFE INS COP O BOX 12686 BIRMINGHAMAL35202468 UNITED FURNITURE WORKERSPO BOX 100037 NASHVILLETN37224189 UNITED HEALTHCAREP O BOX 740800 ATLANTAGA30374449 UNITED HEALTHCAREP O BOX 740800 ATLANTAGA30374447 UNITED HEALTHCARE RIVER VALLEYP O BOX 5230 KINGSTONNY12402127 UNITED INS CO OF AMERICAONE EAST WACKER DRIVECHICAGOIL60601436 UNITED MINE WORKERS OF AMERICAP O BOX 99002 LUBBOCKTX79490174 UNITED STATES LIFE INS CO125 MAIDEN LANENEW YORKNY10038166 UNITED TEACHER ASSOCIATES INSP O BOX 30010 AUSTINTX78755950 UNNAMED CREDIT479 UPREHSP O BOX 161020 SALT LAKE CITYUT84116 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20168476 WABASH MEMORIAL HOSPITAL ASSNP O BOX 1340 DECATURIL62525040 WASHINGTON NATIONAL INSURANCEP O BOX 2034 CARMELIN46082131 WESTERN SOUTHERN LIFE400 BROADWAYCINCINNATIOH45202901 WORKMEN'S COMPENSATION133

10 WORLD INSURANCE COMPANYP O BOX 1 DES MOINESIA50334045 WORLD INSURANCE/BANKERS MULTIP O BOX 3160 OMAHANE68103135 ZURICH AMERICAN LIFE INS CO1375 EAST WOODFIELD RDSCHAUMBURGIL60173 TPL code DirectoryIllinois Department of Healthcare and Family ServicesPosted August 20169 TPL code Insuring OrganizationAddressCityStateZip001 AETNAP O BOX 981107EL PASOTX79998002 AMALGAMATED LIFE & HEALTH CO333 SOUTH ASHLAND BOULEVARDCHICAGOIL60607003 BANKERS LIFE & CASUALTY COP O BOX 1935 CARMELIN46082004 PRINCIPAL LIFE I