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1. Complete a Wellness Claim Form and mail or fax the completed form and a copy of the itemized bill indicating patient name, date of service, name of provider, type of service, and diagnosis code to Reserve National Insurance Company at the address or fax number indicated below. Paper claim forms submitted can take up to 10 business days for processing.
Reserve National Insurance CompanyP.O. Box 9988Austin, TX 78766-9988Fax: 844-473-8084
2. See a Midwest Heritage Representative during a store visit. For assistance in filing a claim or to inquire about your store’s next Midwest Heritage Representative store visit, please call 800-622-0057 or 515-343-5047 or email [email protected].According to the plan guidelines, a wellness benefit will be paid only one-time per year for each covered family member. Listed below are the common wellness screenings that can be considered for a wellness claim. (Full-time employees on Hy-Vee’s core medical plan can submit their biometric screening, which includes a lipid panel.)Abdominal aortic aneurysm ultrasoundBlood test for triglycerides Bone marrow testing Breast ultrasound CA 15-3 (blood test for breast cancer)CA 125 (blood test for ovarian cancer)Carotid ultrasound CEA (blood test for colon cancer)Chest x-ray Colonoscopy CT Angiography EKG Double contrast barium enema Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap Smear PSA (blood test for prostate cancer) Serum cholesterol HDL/LDL Serum protein electrophoresis (blood test for myeloma)Stress Test Thermography