Aflac Printable Wellness Benefit Claim Forms Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac WELLNESS AND HEALTHSCREENING CLAIM FORM
Page 1 of 2 02 14 American Family Life Assurance Company of Columbus Aflac ATTN Claims Department 1932 Wynnton Road Columbus GA 31999 For information or to check claim status visit aflac or call 1 800 99 AFLAC 1 800 992 3522 Claims may be faxed to 1 877 44 AFLAC 1 877 442 3522 Accident Hospital Indemnity Wellness Benefit Claims are subject to policy terms and conditions File a Wellness Benefit Claim Online Simply select File Online below and follow the instructions File Online File a Wellness Benefit via Fax or Mail Please fully complete the claim form for the Wellness Benefit Please date and sign all required forms where indicated
Aflac Printable Wellness Benefit Claim Forms
Aflac Printable Wellness Benefit Claim Forms
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CANCERSCREENINGBENEFITCLAIMFORM Tofileyourclaimonline uploaddocumentationonanexistingclaim checkclaimstatusorgetpaidfastby signingupfordirectdeposit registeronAflac If uploading a picture from your phone please only submit the medical documentation for your proof of services When taking photo copies of the documents make sure the document is flat Flatten documents that have been folded or crumbled before uploading Check the lighting on the document s before submitting If the document is already dark
ACCIDENT WELLNESS BENEFIT CLAIM FORM 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 Pdicfiolder First Name Please use black or blue ink only and print legibly when completing this form in its entirety Keep a Please keep a copy of this completed form for your records Please print a separate form for each additional family member or call 1 800 99 AFLAC 1 800 992 3522 to request additional forms Claims for all other benefits covered under this policy must be filed separately using the claim forms available at aflac or by calling 1 800 99 AFLAC
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Aflac wants to put money into your pocket by encouraging you to file a wellness or health screening benefit claim Put simply many of our policies provide an annual benefit for proactively managing your health with a blood screening annual physical or eye exam mammogram pap smear prostate exam or another covered exam Cancer Screening Wellness Benefit Claim Form Some of the tests listed may not be covered under the Wellness Benefit of your policy Please check 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 sign the attached HIPAA Form and return it with the completed claim form Please check this box if you are filing for a wellness benefit under multiple coverages CAI001CIWB 12v4 CAI001CIWB 12v4 CAI001CIWB 12v4 Aflac is not licensed to solicit business in New York Guam Puerto Rico or the Virgin Islands The following tips will help you complete Aflac Wellness Claim Form easily and quickly Open the template in our feature rich online editor by clicking on Get form Fill in the required fields which are colored in yellow Press the green arrow with the inscription Next to move from one field to another Go to the e autograph solution to add an
Aflac Wellness Claim Form Fill And Sign Printable Template Online US Legal Forms
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https://www.aflacgroupinsurance.com/docs/customer-service/additional-forms/wellness_claim_form.pdf
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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Page 1 of 2 02 14 American Family Life Assurance Company of Columbus Aflac ATTN Claims Department 1932 Wynnton Road Columbus GA 31999 For information or to check claim status visit aflac or call 1 800 99 AFLAC 1 800 992 3522 Claims may be faxed to 1 877 44 AFLAC 1 877 442 3522 Accident Hospital Indemnity Wellness Benefit
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Aflac Printable Wellness Benefit Claim Forms - ACCIDENT WELLNESS BENEFIT CLAIM FORM 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 Pdicfiolder First Name Please use black or blue ink only and print legibly when completing this form in its entirety Keep a
