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Billing Information
Title
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Last
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Mr.
Mrs
Ms.
Miss
Mstr
Dr.
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Address
City
State
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
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OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Home Phone:
Work Phone:
Primary
Insurance Information
Insurance Name:
None
AARP Medicare Advantage
AARP Medicare Supplemental
Accident fund Insurance Company of America
ACE
Ace Medicare Supplement
Admiral Life Ins Comp Of America
Advantica Eye Care
Aetna
Aetna Medicare
AIG Property Casualty Inc
Allstate
Allwell From Home State
Ambetter From Home State Health
AMCO
America's Choice Healthplans
American Continental Insurance Company
American Family Insurance
American Healthcare Alliance
American Medical Security
American National
American Pioneer
American Republic Insurance
Americas Choice
Americo
Ameritas Life Ins
Arkansas Blue Cross BlueShield
Assurant
Atlantic Coast Life
Avesis
AVMA Group Health & Life
Bankers Fidelity
Bankers Life and Casualty
BC/BS Medicare PLUS Blue Group PPO
Bearskin Healthcare & Wellness Center
Benchmark Insurance Co.
BLUE CROSS / BLUE SHIELD FED
Blue Cross BlueShield
BMI Health Plans
Boilmakers Nat Health & Welfare Fund
Bridge Pointe
Bright HealthCare
Care Improvement Plus
Care To Learn
Caremark Claims Dept
Carpenters Health & Welfare Trust Fund
CCO, Inc
Celtic Individual Health
CENTRAL STATES
Central United Life Ins
CHAMPVA
Childrens Miracle Network
Christian Brothers
Christian Fidelity
Cigna (Chattanooga, TN)
Cigna Medicare
Cigna Medicare Supplement Solutions
CNA
Cole Managed Vision
Colonial Penn Life Insurance
Combined Insurance Company of America
Companion Life
COMPNAME
Connecticut General Life
Conseco Ins Company
Consolidated Group Claims
Constitution Life Ins Comp
Construction Industy laborers Welfare Fund
Continental Assurance Co.
Continental Life Insurance
Cooperative Benefit Center
CorVel
Cox Health Plans
CRA Managed Care, Inc.
Dakotas & Western Benefits Admin
Davis Vision
Definity Health
Disability Determinations
Division of Family Services
EFCO Corporation
Elips Life Ins
Envision Insurance Company
Epoch Group,LC
Equicor, Inc.
Equitable Life & Casualty
Esis
Essence Healthcare
Evercare
Everence
Everest
Eye Care Specialists, LLC
Eyeconic
EyeMed
EyeQuest
Family Support Division
Farmers Insurance Exchange
Federated Mutual Insurance Co.
First Choice Administrators
First Continental Life & Accident Insurance Co.
First Health
First Health Network / Starmark
First Health Part D / Medico
First Steps
Fiser V Health
Floricda Medicaid
FMH Benefit Services
FMH/Heath Link
Foreign Mission Board
Fortis Benefits Ins Co.
Freedom Blue PPO
Freedom Network Select
Gallagher Bassett
GBS (Group Benefit Service)
GE Medicare Benefit Plans
GEHA
General American Life
General Casualty
GENEX
Golden Rule Ins Co
Gov't Employees Health Assc
GPM Life
Great West (Kennett, MO)
Greene County Children's Division
Grinnell Mutual Reinsurance Co.
Group Health Plan
Guarantee Trust Life Ins. Company
Guardian
GWH- Cigna
Harden & Company
Harrington Southwest
HCH Administrators
Health Insurance Innovations Co-Ord Ben Plans
Health Link Open Access
Health Link/Freedom (PO Box 419104)
Health Link/HSB
HEALTH MATCHING ACCOUNT SERVICES
HealthCare Solutions Group
HealthChoice
HealthFlex
Healthlink/ Christian Brothers
HealthScope
HealthSmart Benefit Solutions
Healthsmart Preferred Care, Inc.
Healthy Alliance Life Ins. Co.
Healthy Blue (MCD)
Highmark / Freedom Blue PPO
Hillcrest Benefit Administrator
HIP
HMO Missouri Inc
Home State Health Care (MCD)
HSI Benefit Systems
Humana Medicare Advantage
Humana, Inc.
IAC
IMG
Indiana Laboreres Welfare Fund
Insurance Admin Solutions
Insurance Managemant Admin
John Alden Life Insurance Co.
Laborers Health & Welfare
LaHood and Associates
Liberty Mutual
Liberty National
Life Investors Insurance
LIFESHIELD NATIONAL INS
Lions Club
Logisticare
Loren Cook Group Health Plan
Loyal American Life
LUMICO
Mail Handlers Benefit Plan
Manhattan Life Ins
Marathon Electric
Marquette National
Mass Mutual
Mattax-Neu-Prater
Med Pay
Med Plans 2000
Medica
Medical-Cigna Healthcare
Medical Mutual
Medical Review Team
MEDICARE / RAILROAD RETIREMENT BOARD
Medicare Supplement Operations
Medico
Medifit Insurance
Medishare
Medivest
MedMutual PROTECT
Meeks Building-Med Pay
Mercer
Mercy Workers Compensation
Meritain Health ( Minneapolis, MN)
Metropolitan Life Insurance
Missouri Employee Mutual Ins
Missouri Eye Institute
Missouri Healthnet
Missouri Valley
Missouri WGS
Mo-Kan Sheet Metal Workers Welfare Fund
MODA MEDICARE SUPPLEMENT
MoDOT/MSHP Medical & Life Ins
Molina Healthcare
Monumental Life
Mosers/Humana
MSC
MSTA Claims Unit
Municipal Health Benefit Fund
Mutual Assurance Adninistrators
Mutual of Omaha
NALC
National Automatic Sprinkler Industry
National General
National Travelers Life
Nationwide Specialty Health Claims
NEI
New Era Life Insurance Company
New Insurance
NHP Group Limited Benefit Claims
Nordian Administrative Services
North American Ins. Co.
NVA
OACAC Greene County Cneter
Oklahoma Healthcare Authority
Oklahoma State & Education Employees
Old Surety Life Ins Comp
Omaha Insurance Company
OptumHealth Vision Claims Dept
Oxford Life Ins
Ozark Health Plan
Painters District Council #2 Welfare Plan
Paradigm
PEKIN LIFE INS
Pension Associates
PHCS
Physicians Mutual
Pioneer Life
Preferred Health Professionals
Premier Eye Care
Prevention of Blindness
Principal (Clearwater, FL)
Principal Financial Group
Principal Health Care, Inc.
Principal Life Ins Dental/Vision
Principal LIfe Insurance Co. (Colorado Springs)
Principal Mutual Group
Principal Mutual Insurance Co.
Principal Mutual Life
Principle Health Care, Inc-PPO
Professional Benefit Admin.
Progressive
Prosperity Life Group
Provident Insurance Co.
Provident Life and Accident
Provident Life and Accident
Provider Partners Health Plan of Missouri
Prudential Custom Care
Pyramid Claims
QBE
Qual Choice
RCBA/Healthlink
Rehab Services F/T Blind
Reserve National Insurance Co.
Restat
Roebuck Administrators, Inc.
Royal Neighbors of America
SAFETY NATIONAL CASUALTY CORP
Sanford Health Plan
Santa Fe Employees
Seabright Insurance
SECURA
Secure Horizons
Security Life InsuranceCo.
Sedgwick
Sheet Metals Workers Local 104
Show Me Healthy Kids (MCD)
SILAC Ins Comp
SilverScript Ins Com[
Spectera
St Johns Claims Admin
Standard Life & Accident Ins
Starmark
State Farm Health Insurance
State Fund - Claims Processing C
State Mutual Life Assurance
Sterling Investors Life Ins Comp
Stonebridge Life
Superior Vision
SXC Health Solutions
TCS
Team Care
The Federated Insurance Co.
The Guardian Insurance Co.
The Hartford
The Principal Financial Group
The Principal Financial Group
The Principal Mutual Group
The Travelers-P-C Claim Dept
The Travelers Consolidated
The Travelers Insurance Co.
Thrivent Financial for Lutherans
TIC International Corp
Time Ins Co
Time Insurance Co.
Today's Options / Pyramid Life
Trans American Life
Traveler's (Work Comp)
Travelers Insurance
Tricare For Life
Tricare West Region Claims
Triune Health Group
TriWest Healthcare Alliance
UFCW Food Trades & Indust. Health & Welfare
UGS- Global Care, Inc.
UHC (Commercial plan)
UHC Community Plan (MCD)
UHC Dual Complete Medicare Adv
UHC Medicare Advantage
UMR
Unicare
Union Bankers
United American Insurance Company
United Health Care
United Heartland
United Teacher Assc.(Austin, TX)
United World LIfe Ins
USA MCO H&W Network
USAA Life Insurance Company
USAble Life Group Health
VA COMMUNITY CARE
Veterans Administration / VISN 16 Consolidated Fee Unit
Vision Care Direct
Vision USA
VisionUSA
Vocational Rehabilitation
VSP
VSP/ ASPEX FRAME CLAIMS
Wakely & Associates, Inc.
Washington National Insurance Company (Carmel, IN)
Wausau Insurance Co.
WellCare Health Plans
Wellcare of South Carolina
Western Teamsters Welfare Trust
Westport Benefits(St.Loius)
Worldwide Insurance
WPS Medicare Part B
Zurich North America
Insurance Plan:
Insurance ID:
Insurance Policy Group:
Not Primary on Account:
Not Primary
Primary on Account
Name:
Last, First, MI
Relationship to Insured:
Spouse
Child
Other
Sex:
Male
Female
Address:
City:
State:
Zip:
Phone Number:
Birthday:
SSN:
Employer/School:
Secondary
Insurance Information
Insurance Name:
None
AARP Medicare Advantage
AARP Medicare Supplemental
Accident fund Insurance Company of America
ACE
Ace Medicare Supplement
Admiral Life Ins Comp Of America
Advantica Eye Care
Aetna
Aetna Medicare
AIG Property Casualty Inc
Allstate
Allwell From Home State
Ambetter From Home State Health
AMCO
America's Choice Healthplans
American Continental Insurance Company
American Family Insurance
American Healthcare Alliance
American Medical Security
American National
American Pioneer
American Republic Insurance
Americas Choice
Americo
Ameritas Life Ins
Arkansas Blue Cross BlueShield
Assurant
Atlantic Coast Life
Avesis
AVMA Group Health & Life
Bankers Fidelity
Bankers Life and Casualty
BC/BS Medicare PLUS Blue Group PPO
Bearskin Healthcare & Wellness Center
Benchmark Insurance Co.
BLUE CROSS / BLUE SHIELD FED
Blue Cross BlueShield
BMI Health Plans
Boilmakers Nat Health & Welfare Fund
Bridge Pointe
Bright HealthCare
Care Improvement Plus
Care To Learn
Caremark Claims Dept
Carpenters Health & Welfare Trust Fund
CCO, Inc
Celtic Individual Health
CENTRAL STATES
Central United Life Ins
CHAMPVA
Childrens Miracle Network
Christian Brothers
Christian Fidelity
Cigna (Chattanooga, TN)
Cigna Medicare
Cigna Medicare Supplement Solutions
CNA
Cole Managed Vision
Colonial Penn Life Insurance
Combined Insurance Company of America
Companion Life
COMPNAME
Connecticut General Life
Conseco Ins Company
Consolidated Group Claims
Constitution Life Ins Comp
Construction Industy laborers Welfare Fund
Continental Assurance Co.
Continental Life Insurance
Cooperative Benefit Center
CorVel
Cox Health Plans
CRA Managed Care, Inc.
Dakotas & Western Benefits Admin
Davis Vision
Definity Health
Disability Determinations
Division of Family Services
EFCO Corporation
Elips Life Ins
Envision Insurance Company
Epoch Group,LC
Equicor, Inc.
Equitable Life & Casualty
Esis
Essence Healthcare
Evercare
Everence
Everest
Eye Care Specialists, LLC
Eyeconic
EyeMed
EyeQuest
Family Support Division
Farmers Insurance Exchange
Federated Mutual Insurance Co.
First Choice Administrators
First Continental Life & Accident Insurance Co.
First Health
First Health Network / Starmark
First Health Part D / Medico
First Steps
Fiser V Health
Floricda Medicaid
FMH Benefit Services
FMH/Heath Link
Foreign Mission Board
Fortis Benefits Ins Co.
Freedom Blue PPO
Freedom Network Select
Gallagher Bassett
GBS (Group Benefit Service)
GE Medicare Benefit Plans
GEHA
General American Life
General Casualty
GENEX
Golden Rule Ins Co
Gov't Employees Health Assc
GPM Life
Great West (Kennett, MO)
Greene County Children's Division
Grinnell Mutual Reinsurance Co.
Group Health Plan
Guarantee Trust Life Ins. Company
Guardian
GWH- Cigna
Harden & Company
Harrington Southwest
HCH Administrators
Health Insurance Innovations Co-Ord Ben Plans
Health Link Open Access
Health Link/Freedom (PO Box 419104)
Health Link/HSB
HEALTH MATCHING ACCOUNT SERVICES
HealthCare Solutions Group
HealthChoice
HealthFlex
Healthlink/ Christian Brothers
HealthScope
HealthSmart Benefit Solutions
Healthsmart Preferred Care, Inc.
Healthy Alliance Life Ins. Co.
Healthy Blue (MCD)
Highmark / Freedom Blue PPO
Hillcrest Benefit Administrator
HIP
HMO Missouri Inc
Home State Health Care (MCD)
HSI Benefit Systems
Humana Medicare Advantage
Humana, Inc.
IAC
IMG
Indiana Laboreres Welfare Fund
Insurance Admin Solutions
Insurance Managemant Admin
John Alden Life Insurance Co.
Laborers Health & Welfare
LaHood and Associates
Liberty Mutual
Liberty National
Life Investors Insurance
LIFESHIELD NATIONAL INS
Lions Club
Logisticare
Loren Cook Group Health Plan
Loyal American Life
LUMICO
Mail Handlers Benefit Plan
Manhattan Life Ins
Marathon Electric
Marquette National
Mass Mutual
Mattax-Neu-Prater
Med Pay
Med Plans 2000
Medica
Medical-Cigna Healthcare
Medical Mutual
Medical Review Team
MEDICARE / RAILROAD RETIREMENT BOARD
Medicare Supplement Operations
Medico
Medifit Insurance
Medishare
Medivest
MedMutual PROTECT
Meeks Building-Med Pay
Mercer
Mercy Workers Compensation
Meritain Health ( Minneapolis, MN)
Metropolitan Life Insurance
Missouri Employee Mutual Ins
Missouri Eye Institute
Missouri Healthnet
Missouri Valley
Missouri WGS
Mo-Kan Sheet Metal Workers Welfare Fund
MODA MEDICARE SUPPLEMENT
MoDOT/MSHP Medical & Life Ins
Molina Healthcare
Monumental Life
Mosers/Humana
MSC
MSTA Claims Unit
Municipal Health Benefit Fund
Mutual Assurance Adninistrators
Mutual of Omaha
NALC
National Automatic Sprinkler Industry
National General
National Travelers Life
Nationwide Specialty Health Claims
NEI
New Era Life Insurance Company
New Insurance
NHP Group Limited Benefit Claims
Nordian Administrative Services
North American Ins. Co.
NVA
OACAC Greene County Cneter
Oklahoma Healthcare Authority
Oklahoma State & Education Employees
Old Surety Life Ins Comp
Omaha Insurance Company
OptumHealth Vision Claims Dept
Oxford Life Ins
Ozark Health Plan
Painters District Council #2 Welfare Plan
Paradigm
PEKIN LIFE INS
Pension Associates
PHCS
Physicians Mutual
Pioneer Life
Preferred Health Professionals
Premier Eye Care
Prevention of Blindness
Principal (Clearwater, FL)
Principal Financial Group
Principal Health Care, Inc.
Principal Life Ins Dental/Vision
Principal LIfe Insurance Co. (Colorado Springs)
Principal Mutual Group
Principal Mutual Insurance Co.
Principal Mutual Life
Principle Health Care, Inc-PPO
Professional Benefit Admin.
Progressive
Prosperity Life Group
Provident Insurance Co.
Provident Life and Accident
Provident Life and Accident
Provider Partners Health Plan of Missouri
Prudential Custom Care
Pyramid Claims
QBE
Qual Choice
RCBA/Healthlink
Rehab Services F/T Blind
Reserve National Insurance Co.
Restat
Roebuck Administrators, Inc.
Royal Neighbors of America
SAFETY NATIONAL CASUALTY CORP
Sanford Health Plan
Santa Fe Employees
Seabright Insurance
SECURA
Secure Horizons
Security Life InsuranceCo.
Sedgwick
Sheet Metals Workers Local 104
Show Me Healthy Kids (MCD)
SILAC Ins Comp
SilverScript Ins Com[
Spectera
St Johns Claims Admin
Standard Life & Accident Ins
Starmark
State Farm Health Insurance
State Fund - Claims Processing C
State Mutual Life Assurance
Sterling Investors Life Ins Comp
Stonebridge Life
Superior Vision
SXC Health Solutions
TCS
Team Care
The Federated Insurance Co.
The Guardian Insurance Co.
The Hartford
The Principal Financial Group
The Principal Financial Group
The Principal Mutual Group
The Travelers-P-C Claim Dept
The Travelers Consolidated
The Travelers Insurance Co.
Thrivent Financial for Lutherans
TIC International Corp
Time Ins Co
Time Insurance Co.
Today's Options / Pyramid Life
Trans American Life
Traveler's (Work Comp)
Travelers Insurance
Tricare For Life
Tricare West Region Claims
Triune Health Group
TriWest Healthcare Alliance
UFCW Food Trades & Indust. Health & Welfare
UGS- Global Care, Inc.
UHC (Commercial plan)
UHC Community Plan (MCD)
UHC Dual Complete Medicare Adv
UHC Medicare Advantage
UMR
Unicare
Union Bankers
United American Insurance Company
United Health Care
United Heartland
United Teacher Assc.(Austin, TX)
United World LIfe Ins
USA MCO H&W Network
USAA Life Insurance Company
USAble Life Group Health
VA COMMUNITY CARE
Veterans Administration / VISN 16 Consolidated Fee Unit
Vision Care Direct
Vision USA
VisionUSA
Vocational Rehabilitation
VSP
VSP/ ASPEX FRAME CLAIMS
Wakely & Associates, Inc.
Washington National Insurance Company (Carmel, IN)
Wausau Insurance Co.
WellCare Health Plans
Wellcare of South Carolina
Western Teamsters Welfare Trust
Westport Benefits(St.Loius)
Worldwide Insurance
WPS Medicare Part B
Zurich North America
Insurance Plan:
Insurance ID:
Insurance Policy Group:
Not Primary on Account:
Not Primary
Primary on Account
Name:
Last, First, MI
Relationship to Insured:
Spouse
Child
Other
Sex:
Male
Female
Address:
City:
State:
Zip:
Phone Number:
Birthday:
SSN:
Employer/School:
Tertiary
Insurance Information
Insurance Name:
None
AARP Medicare Advantage
AARP Medicare Supplemental
Accident fund Insurance Company of America
ACE
Ace Medicare Supplement
Admiral Life Ins Comp Of America
Advantica Eye Care
Aetna
Aetna Medicare
AIG Property Casualty Inc
Allstate
Allwell From Home State
Ambetter From Home State Health
AMCO
America's Choice Healthplans
American Continental Insurance Company
American Family Insurance
American Healthcare Alliance
American Medical Security
American National
American Pioneer
American Republic Insurance
Americas Choice
Americo
Ameritas Life Ins
Arkansas Blue Cross BlueShield
Assurant
Atlantic Coast Life
Avesis
AVMA Group Health & Life
Bankers Fidelity
Bankers Life and Casualty
BC/BS Medicare PLUS Blue Group PPO
Bearskin Healthcare & Wellness Center
Benchmark Insurance Co.
BLUE CROSS / BLUE SHIELD FED
Blue Cross BlueShield
BMI Health Plans
Boilmakers Nat Health & Welfare Fund
Bridge Pointe
Bright HealthCare
Care Improvement Plus
Care To Learn
Caremark Claims Dept
Carpenters Health & Welfare Trust Fund
CCO, Inc
Celtic Individual Health
CENTRAL STATES
Central United Life Ins
CHAMPVA
Childrens Miracle Network
Christian Brothers
Christian Fidelity
Cigna (Chattanooga, TN)
Cigna Medicare
Cigna Medicare Supplement Solutions
CNA
Cole Managed Vision
Colonial Penn Life Insurance
Combined Insurance Company of America
Companion Life
COMPNAME
Connecticut General Life
Conseco Ins Company
Consolidated Group Claims
Constitution Life Ins Comp
Construction Industy laborers Welfare Fund
Continental Assurance Co.
Continental Life Insurance
Cooperative Benefit Center
CorVel
Cox Health Plans
CRA Managed Care, Inc.
Dakotas & Western Benefits Admin
Davis Vision
Definity Health
Disability Determinations
Division of Family Services
EFCO Corporation
Elips Life Ins
Envision Insurance Company
Epoch Group,LC
Equicor, Inc.
Equitable Life & Casualty
Esis
Essence Healthcare
Evercare
Everence
Everest
Eye Care Specialists, LLC
Eyeconic
EyeMed
EyeQuest
Family Support Division
Farmers Insurance Exchange
Federated Mutual Insurance Co.
First Choice Administrators
First Continental Life & Accident Insurance Co.
First Health
First Health Network / Starmark
First Health Part D / Medico
First Steps
Fiser V Health
Floricda Medicaid
FMH Benefit Services
FMH/Heath Link
Foreign Mission Board
Fortis Benefits Ins Co.
Freedom Blue PPO
Freedom Network Select
Gallagher Bassett
GBS (Group Benefit Service)
GE Medicare Benefit Plans
GEHA
General American Life
General Casualty
GENEX
Golden Rule Ins Co
Gov't Employees Health Assc
GPM Life
Great West (Kennett, MO)
Greene County Children's Division
Grinnell Mutual Reinsurance Co.
Group Health Plan
Guarantee Trust Life Ins. Company
Guardian
GWH- Cigna
Harden & Company
Harrington Southwest
HCH Administrators
Health Insurance Innovations Co-Ord Ben Plans
Health Link Open Access
Health Link/Freedom (PO Box 419104)
Health Link/HSB
HEALTH MATCHING ACCOUNT SERVICES
HealthCare Solutions Group
HealthChoice
HealthFlex
Healthlink/ Christian Brothers
HealthScope
HealthSmart Benefit Solutions
Healthsmart Preferred Care, Inc.
Healthy Alliance Life Ins. Co.
Healthy Blue (MCD)
Highmark / Freedom Blue PPO
Hillcrest Benefit Administrator
HIP
HMO Missouri Inc
Home State Health Care (MCD)
HSI Benefit Systems
Humana Medicare Advantage
Humana, Inc.
IAC
IMG
Indiana Laboreres Welfare Fund
Insurance Admin Solutions
Insurance Managemant Admin
John Alden Life Insurance Co.
Laborers Health & Welfare
LaHood and Associates
Liberty Mutual
Liberty National
Life Investors Insurance
LIFESHIELD NATIONAL INS
Lions Club
Logisticare
Loren Cook Group Health Plan
Loyal American Life
LUMICO
Mail Handlers Benefit Plan
Manhattan Life Ins
Marathon Electric
Marquette National
Mass Mutual
Mattax-Neu-Prater
Med Pay
Med Plans 2000
Medica
Medical-Cigna Healthcare
Medical Mutual
Medical Review Team
MEDICARE / RAILROAD RETIREMENT BOARD
Medicare Supplement Operations
Medico
Medifit Insurance
Medishare
Medivest
MedMutual PROTECT
Meeks Building-Med Pay
Mercer
Mercy Workers Compensation
Meritain Health ( Minneapolis, MN)
Metropolitan Life Insurance
Missouri Employee Mutual Ins
Missouri Eye Institute
Missouri Healthnet
Missouri Valley
Missouri WGS
Mo-Kan Sheet Metal Workers Welfare Fund
MODA MEDICARE SUPPLEMENT
MoDOT/MSHP Medical & Life Ins
Molina Healthcare
Monumental Life
Mosers/Humana
MSC
MSTA Claims Unit
Municipal Health Benefit Fund
Mutual Assurance Adninistrators
Mutual of Omaha
NALC
National Automatic Sprinkler Industry
National General
National Travelers Life
Nationwide Specialty Health Claims
NEI
New Era Life Insurance Company
New Insurance
NHP Group Limited Benefit Claims
Nordian Administrative Services
North American Ins. Co.
NVA
OACAC Greene County Cneter
Oklahoma Healthcare Authority
Oklahoma State & Education Employees
Old Surety Life Ins Comp
Omaha Insurance Company
OptumHealth Vision Claims Dept
Oxford Life Ins
Ozark Health Plan
Painters District Council #2 Welfare Plan
Paradigm
PEKIN LIFE INS
Pension Associates
PHCS
Physicians Mutual
Pioneer Life
Preferred Health Professionals
Premier Eye Care
Prevention of Blindness
Principal (Clearwater, FL)
Principal Financial Group
Principal Health Care, Inc.
Principal Life Ins Dental/Vision
Principal LIfe Insurance Co. (Colorado Springs)
Principal Mutual Group
Principal Mutual Insurance Co.
Principal Mutual Life
Principle Health Care, Inc-PPO
Professional Benefit Admin.
Progressive
Prosperity Life Group
Provident Insurance Co.
Provident Life and Accident
Provident Life and Accident
Provider Partners Health Plan of Missouri
Prudential Custom Care
Pyramid Claims
QBE
Qual Choice
RCBA/Healthlink
Rehab Services F/T Blind
Reserve National Insurance Co.
Restat
Roebuck Administrators, Inc.
Royal Neighbors of America
SAFETY NATIONAL CASUALTY CORP
Sanford Health Plan
Santa Fe Employees
Seabright Insurance
SECURA
Secure Horizons
Security Life InsuranceCo.
Sedgwick
Sheet Metals Workers Local 104
Show Me Healthy Kids (MCD)
SILAC Ins Comp
SilverScript Ins Com[
Spectera
St Johns Claims Admin
Standard Life & Accident Ins
Starmark
State Farm Health Insurance
State Fund - Claims Processing C
State Mutual Life Assurance
Sterling Investors Life Ins Comp
Stonebridge Life
Superior Vision
SXC Health Solutions
TCS
Team Care
The Federated Insurance Co.
The Guardian Insurance Co.
The Hartford
The Principal Financial Group
The Principal Financial Group
The Principal Mutual Group
The Travelers-P-C Claim Dept
The Travelers Consolidated
The Travelers Insurance Co.
Thrivent Financial for Lutherans
TIC International Corp
Time Ins Co
Time Insurance Co.
Today's Options / Pyramid Life
Trans American Life
Traveler's (Work Comp)
Travelers Insurance
Tricare For Life
Tricare West Region Claims
Triune Health Group
TriWest Healthcare Alliance
UFCW Food Trades & Indust. Health & Welfare
UGS- Global Care, Inc.
UHC (Commercial plan)
UHC Community Plan (MCD)
UHC Dual Complete Medicare Adv
UHC Medicare Advantage
UMR
Unicare
Union Bankers
United American Insurance Company
United Health Care
United Heartland
United Teacher Assc.(Austin, TX)
United World LIfe Ins
USA MCO H&W Network
USAA Life Insurance Company
USAble Life Group Health
VA COMMUNITY CARE
Veterans Administration / VISN 16 Consolidated Fee Unit
Vision Care Direct
Vision USA
VisionUSA
Vocational Rehabilitation
VSP
VSP/ ASPEX FRAME CLAIMS
Wakely & Associates, Inc.
Washington National Insurance Company (Carmel, IN)
Wausau Insurance Co.
WellCare Health Plans
Wellcare of South Carolina
Western Teamsters Welfare Trust
Westport Benefits(St.Loius)
Worldwide Insurance
WPS Medicare Part B
Zurich North America
Insurance Plan:
Insurance ID:
Insurance Policy Group:
Not Primary on Account:
Not Primary
Primary on Account
Name:
Last, First, MI
Relationship to Insured:
Spouse
Child
Other
Sex:
Male
Female
Address:
City:
State:
Zip:
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