TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
1
TPL
CODE
Insuring Organization Address City State Zip
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
2
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
3
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
4
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
5
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
6
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
7
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
8
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
9
TPL
CODE
Insuring Organization Address City State Zip
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
10
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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
11
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
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Illinois Department of Healthcare and Family Services
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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
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Illinois Department of Healthcare and Family Services
Posted August 2016
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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
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Illinois Department of Healthcare and Family Services
Posted August 2016
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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
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Illinois Department of Healthcare and Family Services
Posted August 2016
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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
TPL Code Directory
Illinois Department of Healthcare and Family Services
Posted August 2016
16
994 MISCELLANEOUS TPL SOURCE
995 MISCELLANEOUS TPL SOURCE
996 MISCELLANEOUS TPL SOURCE
997 MISCELLANEOUS TPL SOURCE
998 MISCELLANEOUS TPL SOURCE
999 MISCELLANEOUS TPL SOURCE
