Aflac Short Term Disability Claim Form. Web aflac group disability claim form_2020 post office box 84075 * columbus, ga. Web for assistance or information, call 1.800.99.aflac (1.800.992.3522).
Fill Free fillable Aflac Insurance PDF forms
Date of birth gender policy holder’s address: This * denotes a required field. If you are eligible for medicare, review the “guide to health insurance for people with medicare” available from aflac. My claims follow your claim from start to finish and receive alerts if we need additional information through our integrated claim status tracker. Policyholder’s statement (forms are to be completed on or after disability date to avoid processing delays) Nt (forms are to be completed on or after disability date to avoid processing delays) policy holder’s name: *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: To avoid delay, all questions must be answered.) please complete both pages of this form for pregnancy disability only: *last name *first name *date of birth (mm/dd/yy) / / physician information: *last name *first name *date of birth (mm/dd/yy) / / physician information:
Annual income must be $9,000 or greater for coverage to be issued. Policyholder’s statement (forms are to be completed on or after disability date to avoid processing delays) Web for assistance or information, call 1.800.99.aflac (1.800.992.3522). Web short term disability claim form *please attach paperwork for any additional income you are receiving during this period of disability.* **please sign and return the attached authorization. This * denotes a required field. Consider filing online for faster claims payment! Web short term disability claim form *please attach paperwork for any additional income you are receiving during this period of disability.* **please sign and return the attached authorization. You choose the plan that’s right for you based on your financial needs and income. Web for claim forms, visit our web site at aflac.com. Web claims checklist claims checklist helpful tips: If disability, is later, determined to be for a longer term, there will be follow up forms required at that time.
