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  • Aflac Form Z06197c

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Do not write on the form except as instructed. Incomplete forms cannot be processed and will be returned. Please do not fax this completed form to Aflac. Mark only wellness exam box es for test s that you had performed. POLICYHOLDER NAME POLICYHOLDER STREET ADDRESS CITY STATE ZIP BIRTHDATE American Family Life Assurance Company of Columbus Aflac Attn Claims Department 1932 Wynnton Road Columbus GA 31999-7251 1-800-99-AFLAC 1-800-992-3522 aflac.

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You can mail your claim form to Post Office Box 84075, Columbus, Georgia 31993. You may also fax your claim form to our claims department at 866.849. 2970 or scan and email your claim form to groupclaimfiling@aflac.com.

Please print a separate form for each additional family member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms. Claims for all other benefits covered under this policy must be filed separately using the claim forms available at aflac.com or by calling 1-800-99-AFLAC (1-800-992-3522).

Simply log in to your account at aflac.com/myaflac. Or download the MyAflac® app to your mobile device. Step 3: Then go to “File a Claim” and follow the steps.

Fax this form to 1-877-442-3522 or return the form to Aflac, Attn: Claims Department, Worldwide Headquarters, 1932 Wynnton Road, Columbus, GA 31999, as soon as possible in order to expedite claim review.

1If all documentation is not available upon initial claim filing, you may upload the documents later by clicking “Upload Documents” on the mobile app or “MyClaims” on desktop. Register or Log in: Go to aflac.com/myaflac or download the Aflac SmartClaim Mobile app from the App Store or Google Play Store.

Itemized hospital bill (IHB). UB04 (itemized hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.)

Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

Claims approval process takes 5 days to process and pay out claims.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232