Aflac Short Term Disability Claim Form. Web for claim forms, visit our web site at aflac.com. For claim forms, visit our web site at aflac.com.
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Consider filing online for faster claims payment! Web aflac group disability claim form_2020 post office box 84075 * columbus, ga. *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: 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. Web short term disability claim form. It is not a substitute for hospital or medical expense insurance, a health mainten ance organization (hmo) contract, or major medical expense insurance. This * denotes a required field. To be completed by aflac associate/agent.
This * denotes a required field. My coverage here you’ll find a copy of your policy and benefit details to see what’s covered and benefit amounts. *last name *first name *date of birth (mm/dd/yy) / / physician information: *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: Web form a57601coh 1 of 9 a576c01coh.2. Short term disability/long term disability claim form Attending physician’s statement to be completed byphysician certifying disabilityon or after disability dateto. Web file your claim via fax or mail. Web for claim forms, visit our web site at aflac.com. To be completed by aflac associate/agent. Web for assistance or information, call 1.800.99.aflac (1.800.992.3522).
