Accidental Aflac Printable Claim Forms Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac ACCIDENT CLAIM FORM INSTRUCTIONS
File a Dental Claim via Fax or Mail Please complete the Patient section Boxes 8 18 as well as the Policyholder Employee section excluding Boxes 31 38 and 40 Your dentist should complete the Billing Dentist section Boxes 42 66 excluding Box 53 Please date and sign all required forms where indicated Accident Claims Checklist Z2201218R1 Policy number Policyholder s name Policyholder s date of birth Identify your policy Policyholder s address Date and description of injury Location of the injury Patient s name and date of birth Patient s relationship to policyholder What you need to file a claim HCFA 1500 non hospital bill
Accidental Aflac Printable Claim Forms
Accidental Aflac Printable Claim Forms
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For information or help filing your claim please call toll free 1 800 99 AFLAC 1 800 992 3522 or visit our Web site at aflac Toll free fax number 1 877 44 AFLAC 1 877 442 3522 Any person who knowingly and with intent to defraud any insurance company or other person files an Fax 888 659 1023 Mail Aflac Claims Appeals PO Box 84065 Columbus GA 31908 9998 Please use the claim appeal form to organize your request Please be sure to explain why you disagree with Aflac s decision and include any additional supporting documentation You have the right to appeal a decision up to a maximum of three times per claim
ACCIDENT WELLNESS BENEFIT CLAIM FORM Wellness Form specifically tailored for your policy Pdicfiolder First Name Please use black or blue ink only and print legibly when completing this form in its entirety Keep a Aflac Attn Claims Department 1932 Wynnton Road Columbus GA 31999 7251 1 800 99 AFLAC 1 800 992 3522 aflac Please do not fax this completed form to Aflac Mark only wellness exam box es for test s that you had performed American Family Life Assurance Company of Columbus Aflac Attn Claims Department 1932 Wynnton Road Columbus GA 31999 7251 1 800 99 AFLAC 1 800 992 3522 aflac 1 800 SI AFLAC 1 800 742 3522 en espa ol
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His total medical expenses came out to 7 274 2 After filing a claim with his initial insurance he still owes over 2 910 3 With Aflac s accident plan Monte receives 2 435 in cash benefits to help lower that burden 3 Aflac s personal injury insurance helps Monte keep his rainy day fund looking sunny File a Claim Claim Status Step 3 Then go to File a Claim and follow the steps Step 4 There s no uploading required All you need is your doctor s contact information date of your visit and the health exam performed Step 5 Follow a few simple steps and your Aflac wellness claim is complete You can even track its progress online with
American Family Life Assurance Company of Columbus Aflac ATTN Claims Appeals PO Box 84065 Columbus GA 31908 For information or to check claim status visit aflac Appeals may be faxed to 1 888 659 1023 Page 1 of 3 HC0021 06 19 CLAIM APPEAL FORM Today s Date Thank you for trusting Aflac with your supplemental insurance needs Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac WELLNESS AND HEALTHSCREENING CLAIM FORM
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Injury Claim Aflac Printable Claim Forms TUTORE ORG Master Of Documents
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Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac ACCIDENT CLAIM FORM INSTRUCTIONS
https://www.aflacgroupinsurance.com/customer-service/file-a-claim.aspx
File a Dental Claim via Fax or Mail Please complete the Patient section Boxes 8 18 as well as the Policyholder Employee section excluding Boxes 31 38 and 40 Your dentist should complete the Billing Dentist section Boxes 42 66 excluding Box 53 Please date and sign all required forms where indicated
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Accidental Aflac Printable Claim Forms - ACCIDENT WELLNESS BENEFIT CLAIM FORM Wellness Form specifically tailored for your policy Pdicfiolder First Name Please use black or blue ink only and print legibly when completing this form in its entirety Keep a Aflac Attn Claims Department 1932 Wynnton Road Columbus GA 31999 7251 1 800 99 AFLAC 1 800 992 3522 aflac
