Aflac Short Term Disability Claim Form. My claims follow your claim from start to finish and receive alerts if we need additional information through our integrated claim status tracker. Web file your claim via fax or mail.
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Web for claim forms, visit our web site at aflac.com. Flatten documents that have been folded or crumbled before uploading. *last name suffix *first name *date of birth (mm/dd/yy) / / patient information: This * denotes a required field. Please sign and return the attached hipaa. My coverage here you’ll find a copy of your policy and benefit details to see what’s covered and benefit amounts. You choose the plan that’s right for you based on your financial needs and income. Consider filing online for faster claims payment! It is not a substitute for hospital or medical expense insurance, a health mainten ance organization (hmo) contract, or major medical expense insurance. Annual income must be $9,000 or greater for coverage to be issued.
To be completed by aflac associate/agent. Flatten documents that have been folded or crumbled before uploading. If disability, is later, determined to be for a longer term, there will be follow up forms required at that time. That means no medical questionnaire is required. Web file your claim via fax or mail. Consider filing online for faster claims payment! This form is used to file a claim for short term disability. Short term disability/long term disability claim form My claims follow your claim from start to finish and receive alerts if we need additional information through our integrated claim status tracker. To be completed by aflac associate/agent. • it’s sold on an individual basis.
