File a Hospital Indemnity Claim

To begin your claim, contact Midwest Heritage at 515-343-5047 or [email protected]. A customer service representative will ask you for the following information to get the claim form started, and then mail the forms to you for completion.

• Employee name, social security number, and store location
• Current phone number, address and email address to contact claimant

 

When an employee receives the claim form from Midwest Heritage:

• Complete the statement of insured, answering all questions fully.
• Complete Authorization for Release of Information.
• Attach copies of itemized hospital billings. Billings must indicate date, place of service and diagnosis.

Send the completed claim form with the appropriate itemized bills to:
Midwest Heritage Insurance
1025 Braden Ave.
Chariton, Iowa 50049

Fax: 641-774-2022
Email: [email protected]

Depending on the facts and circumstances relating to your condition, additional information may be required to process your claim.