ID Cards, Claims, Requests

Call us for help with claims and requests.

Coverage cannot be bound or altered online. Complete the form below to have a service representative contact you to finalize your request.

Type of Inquiry *

First and Last Name *

Email Address *

City and State *

Phone *

Can we send you text / SMS messages?

By selecting 'Yes' you consent to receive text / SMS messages from Leavitt Group Midwest. Privacy Policy

Employer Name

Member Number

Comments *

County

Please note: Claims and change requests cannot be completed online. A service representative will need to contact you to finalize your request.

Products underwritten by Nationwide Mutual Insurance Company and Affiliated Companies. Not all Nationwide affiliated companies are mutual companies, and not all Nationwide members are insured by a mutual company. Subject to underwriting guidelines, review, and approval. Products and discounts not available to all persons in all states.

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