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55184 We built our online claims process to save you time and to help give you peace of mind. /Encoding 4 0 R 0000001020 00000 n <>stream endstream 46a&g>*Zg/Di4fH;%L. Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). For step-by-step tutorials on filing an online claim, please see our claims checklists. 2"3sWA960?8;mmK#ZE2_=#C>QJ%q+@gg/`.\j'lY3GBQ_ecS2/`]F/b3$3maOCefRcJ`5!g@1,GaV\/9
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If this is a Disability Product with your policy number beginning with AFL, please use the form below. /Encoding 4 0 R Your employer is responsible for providing the information in Part B, and your attending physician is responsible for providing the information in Part C. In addition, please read and then sign the Authorization for Disclosure of Health Information (HIPAA form) included in Part A, as well as the separate Authorization for Disclosure of Health Information (HIPAA form). ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(;
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Aflac may include American Family Life Assurance Company of Columbus, American Family Life Assurance Company of New York, Continental American Insurance Company (marketed as Aflac Group), Tier One Insurance Company, and any other affiliated companies (collectively, Aflac), as applicable to the entity from whom you receive insurance services. )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> m^PaP#$T,QfVQ'7kTb=#ja*O^[oT:q1qW?WH%a_Lp. If your injury occurred on the job, a first report of injury filed with your employer must be attached to the completed claim form. nhH(@HB3(k..$A&2I&hNumCF[&]PjI*`R_D2M6]X>#-E#f;915&(PF6%>9Knd"E.:PO
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Take advantage of the quick search and innovative cloud editor to create an accurate AFLAC Short Term Disability. @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/%
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Offer your clients better benefit options with Aflac supplemental insurance policies. Z'qla+"Ni'F7cdihoHcj(u=..e%DbtGJWZF/nB*]I!`;q;hE9aN=iqM2-6r0A.0!kYlX,(D
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