aflac accident wellness benefit claim form

Annual Physical Ultrasound PSA blood test for prostate cancer Pap Smear. You can provide this information in the designated space on the claim form.

Accident Wellness Benefit Claim Form Benefit Legal Forms Accident

ACCIDENT WELLNESS BENEFIT CLAIM FORM Some of the tests listed may not be covered under the Wellness Benefit of your policy.

. ZIP of mailing address. Z06197AD FL American Family Life Assurance Company of Columbus Aflac Attn. Z06197AD American Family Life Assurance Company of Columbus Aflac Attn. Please review your policy for specific benefits covered under your plan.

Complete the requested boxes they will be yellowish. Read more Aflac Cancer Screening Wellness Claim Form. FREE 8 Sample Aflac Claim Forms in PDF. ZIP of mailing address.

AUTHORIZATION Post Office Box 84075 Columbus GA. Ad Download Or Email Aflac Forms More Fillable Forms Register and Subscribe Now. Mail the completed form to the Aflac address shown below. Send all claims to.

You can sign up using either your Aflac insurance policy number or alternate personal information. Pick the document template you will need from the library of legal forms. Benefits are payable to you unless we receive written authorization from your provider to assign benefits to them or from you to pay your benefits elsewhere. ACCIDENT WELLNESS BENEFIT CLAIM FORM Failure to complete all sections may result in a delay in processing this claim.

9 Benefits are payable to you unless we receive written authorization from your provider to assign benefits to them or from you to pay your benefits elsewhere. Click the Get form key to open the document and start editing. Mail the completed form to the Aflac address shown below. Keep a copy of the supporting documentation and this completed form for your records.

Review your policy for specific benefits covered under your plan. If the accident resulted from the use of a motor vehicle s a copy of the police or accident report is required. Execute Aflac Accident Hospital Indemnity Wellness Benefit Claim Form in just several moments following the recommendations listed below. Please use black or blue ink only and print legibly when completing this form in its entirety.

ACCIDENT WELLNESS BENEFIT CLAIM FORM Failure to complete all sections may result in a delay in processing this claim. File an Accident Claim via Fax or Mail. Follow a few simple steps and your Aflac wellness claim is complete. PdfFiller allows users to Edit Sign Fill Share all type of documents online.

Your policy for a list of covered wellness procedures or call 1-800-99-AFLAC 1-800-992-3522 for a Wellness Form specifically tailored for your policy. Life claim forms for the state of Illinois must be obtained by contacting Aflac. Continental American Insurance Company Accident Processing Unit Post Office Box 427 Columbia South Carolina 29202 Fax 866 849-2970 POLICYHOLDERCLAIMANTS INFORMATION POLICYHOLDERS NAME POLICYCERTIFICATE NO. Please check TM your policy for a list of covered wellness procedures or call 1-800-99-AFLAC 1-800-992-3522 for a Wellness Form specifically tailored for your policy.

Please provide a date and complete description of your accident. You can also file a claim as a guest if you prefer not to register. Sign date and mail or fax the completed form to the addressnumber shown below. You can even track its progress online with the claims status tracker.

View Site AFLAC Forms Augusta University httpswwwaugustaeduhruniversityuniversity_benefitsaflacformsphp. Ad Download Or Email CW061999 More Fillable Forms Register and Subscribe Now. Please review your policy for specific benefits covered under your plan. Before filing a claim make sure you register online by creating a MyAflac account.

ACCIDENT WELLNESS BENEFIT CLAIM FORM. Your policy for a list of covered wellness procedures or call 1-800-99-AFLAC 1-800-992-3522 for a.

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