Aflac Hospital Indemnity Claim Form


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Get your Aflac Hospital Indemnity Claim Form in 3 easy steps

  • 01 Fill and edit template Fill Aflac Hospital Indemnity Claim Form
  • 02 Sign it online Sign Aflac Hospital Indemnity Claim Form
  • 03 Export or print immediately Export Aflac Hospital Indemnity Claim Form

What Is Aflac Hospital Indemnity Claim Form?

Aflac Hospital Indemnity Claim Form is a document that can help a policyholder get financial support to enhance their current coverage. The cases of its use are determined by The Aflac Group Hospital Indemnity plan benefits, which have limitations and exclusions that can affect payable benefits.

Aflac Hospital Indemnity Claim Form Screenshot

What do I need hospital indemnity claim form Aflac for?

  • To ask for reimbursement of the treatment due to illness, injury, or pregnancy;
  • To receive compensation for medical tests or exams you have come through during the treatment;
  • To provide additional bills or medical documentation that relates to this diagnosis for review of additional benefits.

How to Fill Out Aflac Hospital Indemnity Plan Claim Form

  1. To complete Aflac Hospital Indemnity Claim Form, you don’t need to leave this very page. Press the Fill this form button to get a fillable, ready-made template of the form.
  2. By choosing the Add text tool on the upper toolbar, fill out the red sections with the following information: policy number, name, birthdate, contact number, address, etc.
  3. Provide the patient’s data such as their name, birth date, sex, and relations with a policyholder. 
  4. Indicate whether the treatment happened as the result of injury, sickness, or pregnancy. Put the dates when the injury or disease that caused the disability took place as well as the date the first symptoms occurred.
  5. On the second page, write whether the patient was confined to the hospital, to the intensive care unit, to a rehabilitation center, etc. as the result of this treatment.
  6. Both the policyholder and the patient have to sign the form at the bottom of page 2. You can use the e-signature feature on PDFLiner for this. Put the current date, save the changes, and download the form on your PC.

Aflac Hospital Indemnity Claim Form Template Screenshot

Organizations that work with Aflac hospital indemnity plan wellness benefit claim form

  • American Family Life Assurance Company of Columbus (Aflac)
Fillable online Aflac Hospital Indemnity Claim Form
(4.9 / 5) 51 votes
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