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Get your Aflac Accident Wellness Benefit Claim Form in 3 easy steps
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01 Fill and edit template
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02 Sign it online
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03 Export or print immediately
What Is an Aflac Accident Wellness Benefit Claim Form?
An Aflac Accident Wellness Benefit Claim Form is a 2-page fillable blank an owner of the Aflac policy has to fill out to get reimbursement. On average, Aflac policy provides a client with one Wellness Benefit per policy year. However, these benefits are not payable for treatment within the first year of the policy’s effective date.
What do I need the Aflac accident wellness claim form for?
- If you want some wellness procedures or tests to be covered by your policy;
- To provide American Family Life Assurance Company with true, complete, and accurate information regarding the treatment that is to be compensated.
How to Fill Out Aflac Wellness Claim Form Accident?
- Check this page for a fillable template. Click the blue Fill this form button, and you will be guided to the page with a ready-made blank.
- Familiarize yourself with brief guidelines on Page 1.
- The second page requires detailed information about the policyholder, patient, wellness exam, and physician. There are red fillable boxes. You can use the Add Text tool to insert characters there.
- Provide the name and birthdate of the policyholder.
- Write the policy number, name, and birthdate of the patient.
- Don’t forget to put a treatment date and specify the type of wellness procedure (ultrasound, dental exam, PSA, eye exam, blood screening, immunization, etc.).
- Indicate the name, address, and phone number of the physician in charge of the procedure.
- Put the current date and sign the form by using the Add sign tool on the upper toolbar.
- Now you can save the changes and download the form on your PC or share it right away with another party.
Organizations that work with Aflac accident wellness benefit form
- Aflac (American Family Life Assurance Company of Columbus)
Fillable online Aflac Accident Wellness Benefit Claim Form