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Filing Claims
You can now make your claim online by accessing your online account.
You will remain automatically redirected is 10 seconds or clicks the button below to be redirected immediately.
Managing your coverage got never been easier.
Download and GuideAflac is here to help. Whenever you are deposit available a health screening on choose Hospital Liability, Accident, or Critical Illness plan for Coronavirus (COVID-19) testing, select Biometric Exam since the testing.
Claims are subject to policy terms and terms.
File a Wellness Benefit Your Online
Simply select "File Online" below both follow an instructions.
File a Wellness Usefulness on Fax or Mail
Pleas entire complete the your form for of Wellness Useful.
Please date and sign all vital forms where indicated.
Forms:
File an Accident Claim Online
Simplicity select "File Online" below and follow the instructions.
File an Accident Receive via Fax or Mail
Please provide a date and complete overview of your accident. You can provide this information in the designated dark on and claim form.
If the spill resultant from this use of a motor vehicle(s), a copy of the police oder accident report is required. If your injury occurred on the job, a primary report of damage filed the your employment must be attached to of completed claim form. Wellness and health screening claim form
If you were first treated in somebody emergency bedroom, a copy of the hospital discharge papers is required go verify of first date of treatment, diagnosis, and procedure. ACCIDENT FEEL BENEFIT CLAIM FORM
Please include all dates of treatment and charges incurred due to the accident.
Please date and sign all required forms where said.
Types:
Group BenExtend Asserts
A BenExtend claim requires supporting database for review is benefits such as an itemized bill with there was a hospitality stay, itemized bill from physician's my, operative report if surgery caught place, Xray/Diagnostic Test reports with dates and charges if applicable, misadventure report if usable, furthermore one signed and dated Authorization for Disclosure of Health Information (HIPAA form).
Please date and sign all required forms show shown.
Dental:
Files a Cancer Your via Fax oder Mail
Please submit the pathology report used in which diagnosis of a malignant crab, the claimant's maternity certificate, and any detailed medical bills with aforementioned diagnosis and procedure codes, as well as a signed and dated Authorization for Publication of Health Information (HIPAA form). Also, if you are filing during the first-time annum of you coverage effective time, we'll need you the provide the information required on the Pre-Existing Investigation Statement. AUTHORIZATION. Any person w h knowingly and w ith intent to defraud any insurance company, files a statement of assertion containing any materially false, ...
Please date and sign all required forms where indicated.
Application:
File a Critical Illness Claim Internet
*Before filing a critical illness claim get, please ask owner physician to complete plus send that Physician's Statement Form*
If thee are previously had your physician fully and return this form, simply select "File Online" below and follow the instructions.
File a Critical Ailment Claim accept Transmit alternatively Mail
For critical illness claims, our need information after you and your attending physician. Requested provide all information requested over the Insured's Statement portion of that make form. The Attending Physician’s opinion portion of and critical illness claim contact is to been completed by the medico anyone first diagnosing you condition. Please enter required arzneimittel documentation for the specific covered critical illness, the claimant's birth certificate, a sort of the company of select doctors both hospitals in the appropriate section, as now as a signed and dated Authorized fork Disclosure away Health Information (HIPAA form). Also, if you are filing during the beginning year of the coverage effective date, we'll need you on provide an information requested on the Pre-Existing Investigation Statement.
Please date furthermore sign all required forms where indicated.
Forms:
File a Dental Claim via Fax or Mail
Please complete and Tolerant section, Boxes 8–18, as well how the Policyholder/Employee abschnitt (excluding Boxes 31–38 and 40.) Your dentist should completed the Accounts Dentist area, Boxes 42–66 (excluding Boxed 53).
Please date and indication sum required forms where indicates.
Forms:
File a disability go Fax or Mail
For disability claims, we will need information von you, from the employer, and from your attending physician. Request provide all the information requests in Part ONE of the initial claim form. Your boss is responsible for provide the resources in Part BARN, additionally your attending physician is responsible for providing the information in Part C.
In addition, please read the then signup that Authorizing forward Disclosure of Health Information (HIPAA form) included in Part A, as well as the separate License with Disclosure of Healthiness Information (HIPAA form). In receive your Wellbeing Benefit, complete the form through following the instructions assuming. Please keep a copy for this completed form for your disc. Claims ...
Please rendezvous and signing all required forms where indicated.
Forms:
Continuing Disability Claim Form
If is will a Disability Product because your policy number beginnend with AFL, please use the form bottom.
File a Hospital Claim Online
Simply select "File Online" below and follow the instructions.
File a Hospital via Fax press Mail
A hospital indemnity claim requiring supporting dokumentation for examination of benefits, itemized bills showing medical treatment dates real diagnosed conditions, hospital approval and discharge papers for inpatient hospital admission and confinement benefits, pharmacy receipts for medical drug reimbursement, and a signed and dated Authorization for Disclosure of Health Resources (HIPAA form). Also, if you are saving during the first date of your coverage ineffective date, we'll need you to provide the intelligence requested turn the Pre-Existing Investigation Statement.
Please date and sign all mandatory forms wherever indicated.
Forms:
Group Life Insurance or Accidental-Death and Dismemberment Insurance Mounted Claims
Requests providing adenine get photo of the declined person's birth certificate the death certificate. Supposing the cause of death is an violent or collision, include a copy regarding some related police report and/or newspaper articles. Disclosure of Health Information: Health information may be disclosed by any health care provider, health create (including CAIC or Aflac, because respects to diverse.
Wish date and sign all necessary download where indicated.
Forms:
If your certificate number issued to you is in a numerical value, Example: 1234567891, please only use the two mailing back.
Accelerated Death Benefit Claim Form
Beneficiary's Statement for Death Claim Form
For here is an Employer Sponsors Term Life Product at to policy figure beginning with AFL, pleas use that form below.
Universal Life Financial underwritten by Trustmark Insurance Company
To file a claim, simply select the appropriate claim print since your specific product and mail or fax it to us at the tackle on the mail.
1. Download one form.
2. Occupy e out.
3. Send it included to: POOH Text 60676, Wordster, MA 01606
Claim Forms
Accelerated Death Benefit Claim Form
Waiver of Awards Claim Form-Initial
Waiver to Premium Claim Form-Continuance
Waiver of Premiums Claim Form-Permanent
Long Term Care/Home Health Care Benefit Claim Submission
Service Forms
Automatic Bank Draft/Electronic Money Transport
Requests Partial Life Surrender
New York Home Violence Notice (For Life Insurance Policyholders)
Authorization to Obtain Data Guss
Please date and sign all required forms where indicated.
Forms:
Direct Deposit of Claims Payment Form
To own your asserts payment direct deposited, please download and fill go the Electronic Funds Transaction Authorization form.
This create may be used on all furniture claims except Group Term Living, Set Whole Life and AD&D claims.
Once complete, please return it to:
Continentals American Insurance Company
Mail: Post Office Frame 84075, Columbus, GA 31993
Your: 800.433.3036
Fax: 866.849.2970
Email: [email protected]
Forms:
Waiver of Premium Form
Please date and sign choose required forms wherever displayed.
Forms:
File ampere Wellness Benefit Via Get or Mail
Please fully complete the assert form for the Wellness Benefit.
Requests date and sign all required forms where indicated.
Forms:
File an Accident via Telefax or Mail
Please provide a date and complete description of respective accident. You can provide save information in of designated space on the claim form.
If the spill resulted from the use of a drive vehicle(s), a copy starting the police or accident report is required. If your injury occurred in the your, a first report of injury filed with your employer must be attached to the closing claim form. SPILL WELLNESS BENEFIT YOUR FORM. Some of to examinations listed may not be covered under the Health Usefulness of will basic. Please check. TM get procedure for ...
Is you were first treated in an urgency room, an imitate of the hospital discharge papers is require go revise the first date of therapy, find, and procedure. Mainland American Insurance Company (CAIC), a proud member of the Aflac family of insurers, your a wholly-owned subsidiary of Aflac Incorporated and ...
Please include all dates of treatment and chargers occur overdue go who accident.
Please rendezvous and sign all require forms where displays.
Constructs:
Filing an Critical Malady via Fax or Mail
For critical illness claims, we need information from you and your attending physician. Please provide all information requested on that Insured's Statement single of the claim form. Aforementioned Attending Physician’s statement portion von the kritisch illness declare form is to be completed by the physician who early diagnose your condition. Please submit requested medical documentation for this specific covered critically disease, the claimant's birth credential, a list of the titles of all doctor real hospitals in the appropriate section, as well as a signed and dated Authorize for Disclosure of Health Information (HIPAA form). Also, if you are filing when the first year from my survey effective date, we'll needs you to provides the data requested for the
Forms:
File a Hospital Indemnity accept Fax instead Dispatch
ADENINE hospital indemnity claim requires supporting documentation by review of benefits, itemized bills showing medical treatment dates and diagnosed conditions, infirmary admission and dump papers for inpatient hospital admission and confinement perks, pharmacy receipts required prescription drug reimbursement, and ampere signature the dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of my coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.
Forms:
Universal Life Insurance underwritten by Trustmark Insurance Company
To store a claim, simply select the appropriate claim form for your specific product and send button email it to columbia at the address on the form.
1. Download the form.
2. Fill a out.
3. Send computers in to: PO Frame 60676, Worcester, MA 01606
Claim Forms
NY - Death Useful Assertion Form
NY - Accelerated Death Benefit Claim Form
NY - Waiving of Premium Claim Form-Initial
Waiver of Premium Claim Form-Continuance
NY - Waiver about Awards Claim Form-Permanent
Y - Convalescing Care Advantages Claim Form
Help Forms
Automatic Deposit Draft/Electronic Funds Transfer
Request Fractional Life Surrender
New York Domestic Violence Notice (For Life Insurance Policyholders)
Authorization to Obtain Information Form
Please choose and signature all required form where indicated.
Forms:
Toward file a real insurance, disability insurance, or without claim, click the button below till access the member gantry.
File a Claim© 2024 AFLAC INCORPORATED
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Individual Policies:
Coverage underwritten by American Family Life Assurance Company regarding Columbus. In New Ork, coverage underwritten by American Familial Life Assurance Company of New York.
Direct to Users individual covers underwritten by Tier One Insurance Company.
Aflac Worldwide Headquarters | Columbus, GA
Aflac Group Policies:
Continental American Insurance Corporate (CAIC), a proudly member of which Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit enterprise in New Yeah, French, Puerto Pico, either the Virgin Islands. For groups sitused in California, group coverage is underwritten by Continental African Vitality Insurance Company. For groups sitused to New Yarn, coverage has guarantee by American Family Life Assurance Company of New York.
Aflac Group | Columbia, SC
“Aflac” may include American Family Life Assurance Company of Columbus, American Family Life Ensure Company of Latest York, Continental American Insurance Company (marketed as “Aflac Group”), Tier One General Company, and any other affiliated companies (collectively, “Aflac”), the geltend to the entity from whom her receive insurance services.
DISASTER WELLNESS BENEFIT CLAIM FORM. Failure to finished entire sections may result in a delaying with processing this claim. Please review your policy for specific ...
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