Printable Aflac Cancer Claim Form CANCER CLAIM FORM Please review your policy for specific benefits covered under your plan To prevent processing delays please have claim form completed in full and return the signed HIPAA Submit medical documentation from your healthcare provider to support your claim
Submit your claim online 24 7 Manage your account submit and track claims setup direct deposit and more Log in or Register Download MyAflac mobile app Understand what s needed Get filing requirements supporting documentation details and more Learn more File your claim via fax or mail Consider filing online for faster claims payment 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
Printable Aflac Cancer Claim Form
Printable Aflac Cancer Claim Form
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Fax this form to 1 877 442 3522 or return the form to Aflac Attn Claims Department Worldwide Headquarters 1932 Wynnton Road Columbus GA 31999 as soon as possible in order to expedite claim review All areas of this form should be completed This form must be signed and dated by the claimant patient below Cancer Claims Checklist Identify your policy Please include at least three pieces of identifying information Policy number Policyholder s name Policyholder s date of birth Policyholder s address Definitions acronyms HCFA 1500 non hospital bill Itemized hospital bill IHB UB04 itemized hospital bill
CANCER CLAIM FORM Failure to complete this form in its entirety may result in a delay in processing this claim FILING CLAIM FOR check all that apply Cancer Cancer With Disability Cancer With Hospitalization Deceased Date Deceased Cancer Policy Number Short Term Disability Sickness Disability Rider Policy Number Aflac cancer insurance 1 is here to help you and your family better cope financially and emotionally We believe your story requires real solutions to help support the financial and emotional challenges faced by patients and their families before during and after diagnosis How Does Aflac Cancer Insurance Work
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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 Forms Wellness Claim Form File an Accident Claim File a BenExtend Claim File a Cancer Claim File a Claim Checklist for our policyholders Learn which items are required to use Aflac s SmartClaim system to file a claim
Follow these five easy steps to file a claim and get paid fast Schedule and complete your checkup or screening with your doctor Visit aflac login to log in or register your account using your Social Security Number and Mobile Phone Number Once logged in select Submit a new claim PolicyholderInformation This denotesarequiredfield PolicyNumber PatientInformation LastName Suffix FirstName MI DateofBirth mm dd yy
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https://www.aflacgroupinsurance.com/docs/customer-service/claim-forms/CancerClaimform.pdf
CANCER CLAIM FORM Please review your policy for specific benefits covered under your plan To prevent processing delays please have claim form completed in full and return the signed HIPAA Submit medical documentation from your healthcare provider to support your claim
https://www.aflac.com/file-a-claim/default.aspx
Submit your claim online 24 7 Manage your account submit and track claims setup direct deposit and more Log in or Register Download MyAflac mobile app Understand what s needed Get filing requirements supporting documentation details and more Learn more File your claim via fax or mail Consider filing online for faster claims payment
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Printable Aflac Cancer Claim Form - DATE American Family Life Assurance Company of New York ATTN Claims Department 1932 Wynnton Road Columbus GA 31999 7255 For information or to check claim status visit aflac or call 1 800 366 3436 Claims may be faxed to 1 877 844 0201 NY S00220 NY Page 2 of 2
