CRITICAL ILLNESS CLAIM FORM INSTRUCTIONS
CRITICAL ILLNESS CLAIM FORM . ... Please submit medical documentation from the health care provider indicating the diagnosis and severity. **Disclaimer: Some of the conditions and services listed may not be covered by your policy. Dates To and From Round Trip Mileage .
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CRITICAL ILLNESS CLAIM FORM (Page 1 of 2)
www.aflacgroupinsurance.comAflac Group Critica Illlness Claim Form _2020 . Post Office B ox 84075 * Columbus, GA. 31993 . Phone (800) 433 -3036 * Fax (866)849-2970 . groupclaimfiling@aflac.com . CRITICAL ILLNESS CLAIM FORM (Page 1 of 2) ATTENDING PHYSICIAN’S STATEMENT . PATIENT’S FIRST …
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Supplemental Hospital and Medical Indemnity Claim …
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Wellness Claim Form - Aflac: Supplemental Insurance for ...
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Insuring Over 40 Million People Worldwide
www.aflacgroupinsurance.comIf you have any questions, please contact our Customer Service Center at 1-800-433-3036, Monday through Friday from 8 a.m. to 8 p.m. Eastern time. For Home Office Use Only <Name> #<certificate number>
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www.aflacgroupinsurance.cominformation in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. California – For your protection California law requires the following to appear on this form: “Any person who knowingly presents …
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