Aflac Wellness Benefit Claim Form Printable WELLNESS AND HEALTH SCREENING CLAIM FORM Failure to complete all sections may result in delayed processing of this claim Review your policy for specific benefits covered under your plan
Your Aflac policy provides a Wellness Benefit To receive your Wellness Benefit complete the form by following the instructions provided Please check your policy for specific details on this benefit Do not include receipts statements or other claim documentation with this form Do not write on form except as instructed Pleasekeepacopyofthiscompletedformforyourrecords Pleaseprintaseparateformforeachadditionalfamily memberorcall1 800 99 AFLAC 1 800 992 3522 torequestadditionalforms Claimsforallotherbenefitscovered underthispolicymustbefiledseparatelyusingtheclaimformsavailableataflacorbycalling1 800 99 AFLAC 1 800 992 3522 DUCK
Aflac Wellness Benefit Claim Form Printable
Aflac Wellness Benefit Claim Form Printable
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File a Wellness Benefit Claim Aflac is here to help If you are filing for a health screening on your Hospital Indemnity Accident or Critical Illness plan for Coronavirus COVID 19 testing select Biometric Screening as your exam Claims are subject to policy terms and conditions File a Wellness Benefit Claim Online Please be sure to include the following information along with this claim form positive Pathology Report and itemized bills from facility including diagnosis and or procedure codes and charge amounts Itemized bills may include but are not limited to the following UB04 from your provider HCFA1500 from your provider etc
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 Some of the tests listed may not be covered under the Wellness Benefit of your policy 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
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CW91264CAC PR 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 CANCER ANNUAL CARE BENEFIT CLAIM CANCER WELLNESS BENEFIT CLAIM FORM If you are interested in filing your claim online register using aflac smartclaim Benefits of filing your claim online include faster claim processing time and receiving claim communications by email Please read all instructions
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 Policyholder Information Policyholder s First Name
FREE 8 Sample Aflac Claim Forms In PDF ClaimForms
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https://www.aflacgroupinsurance.com/docs/customer-service/additional-forms/wellness_claim_form.pdf
WELLNESS AND HEALTH SCREENING CLAIM FORM Failure to complete all sections may result in delayed processing of this claim Review your policy for specific benefits covered under your plan
https://formspal.com/wp-content/uploads/2021/08/aflac-wellness-form.pdf
Your Aflac policy provides a Wellness Benefit To receive your Wellness Benefit complete the form by following the instructions provided Please check your policy for specific details on this benefit Do not include receipts statements or other claim documentation with this form Do not write on form except as instructed
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Aflac Wellness Benefit Claim Form Printable - 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
