Aflac Wellness Claim Form Printable Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac 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 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
Aflac Wellness Claim Form Printable
Aflac Wellness Claim Form Printable
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Claims Checklist Claims checklist Helpful Tips 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 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
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 AmericanFamilyLifeAssuranceCompanyofColumbus Aflac ATTN ClaimsDepartment 1932WynntonRoad Columbus GA31999 Forinformationortocheckclaimstatus visitaflacorcall1 800 99 AFLAC 1 800 992 3522 Claimsmaybefaxedto1 877 44 AFLAC 1 877 442 3522 CW06197CA Page2of2 06 17
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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 Aflac Attn Claims Department 1932 Wynnton Road Columbus Post Office Box 84075 Columbus GA 31993 Phone 800 433 3036 Fax 866 849 2970 groupclaimfiling aflac Aflac Group W ellness Claim Form
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 Aflac Wellness Claim Form Fill and Sign Printable Template Online US Legal Forms Aflac Wellness Claim Form Get Aflac Wellness Claim Form How It Works Open form follow the instructions Easily sign the form with your finger Send filled signed form or save aflac cancer wellness form rating 4 8 Satisfied 37 votes
Aflac Wellness Claim S Printable 2014 2024 Form Fill Out And Sign Printable PDF Template SignNow
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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 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
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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 Printable Claim Forms
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Hospital Indemnity Wellness Benefit Claim Form Aflac Group Insurance 2020 2021 Fill And Sign
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Aflac Wellness Claim Form Printable - 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 Email groupclaimfiling aflac I would like to Start Stop Change direct deposit of my claim payment s Account Type Checking Savings Other
