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

2 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 RIDGEIL60527 TPL code DirectoryIllinois Department of Healthcare and family ServicesPosted

3 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

4 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. 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

5 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

6 INSURANCE SOCIETY5910 MINERAL POINT RDMADISONWI53705911 ENROLLED MEDICARE PART A & B013 EQUITABLE LIFE ASSURANCE3 TRIAD CENTER - SUITE 200 SALT LAKE CITYUT84180078 EQUITY NATIONAL LIFE INS. 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

7 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

8 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 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

9 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