Aflac Wellness Claim Forms Printable

Web Cancer Screening Wellness Benefit Claim Form.

You can file your wellness claim online at aflac.com/myaflac or through the myaflac® mobile app available for apple and android devices. Web file your claim via fax or mail. Web please be sure to include the following information along with this claim form: Visit aflac.com/login to log in or register your account using your social security number and mobile phone number.

Ub04 From Your Provider, Hcfa1500 From Your Provider, Etc.)

Positive pathology report and itemized bills from facility including diagnosis and/or procedure codes and charge amounts (itemized bills may include but are not limited to the following: Web follow these five easy steps to file a claim and get paid fast: Please review your policy for specific benefits covered under your plan. Web most accident, hospital indemnity and cancer insurance policies have wellness benefits.

Web Aflac Wants To Put Money Into Your Pocket By Encouraging You To File A Wellness Or Health Screening Benefit Claim.

Please keep a copy of this completed form for your records. Failure to complete all sections may result in a delay in processing this claim. Schedule and complete your checkup or screening with your doctor. Web mark only wellness exam boxes for test(s) and/or treatment(s) received.

Some Of The Tests Listed May Not Be Covered Under The Wellness Benefit Of Your Policy.

Once logged in, select submit a new claim. Put simply, many of our policies provide an annual benefit for proactively managing your health with a blood screening, annual physical or eye exam, mammogram, pap smear, prostate exam or another covered exam.*. Review your policy for specific benefits covered under your plan. Web accident wellness benefit claim form.