Aflac Accident Wellness Benefit Claim Form

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? 

1. 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.
2. Familiarize yourself with brief guidelines on Page 1.
3. 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.
4. Provide the name and birthdate of the policyholder.
5. Write the policy number, name, and birthdate of the patient.
6. 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.).
7. Indicate the name, address, and phone number of the physician in charge of the procedure.
8. Put the current date and sign the form by using the Add sign tool on the upper toolbar.
9. 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)