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Claim. FILING CLAIM FOR (check all that apply): Cancer Cancer With Disability Cancer Policy Number Cancer With Hospitalization Short-Term Disability/Sickness Disability Rider Policy Number Hospital Indemnity Policy Number Deceased - Date Deceased: / / Hospital Intensive Care Policy Number Life Policy Number INSTRUCTIONS: Complete and sign Section A: Policyholder/Patient Information. Your physician should complete and sign Section B: Physician's Statement (Pages 2 and 3). This Canc.

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UB04 (itemized hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.) (Please include at least three pieces of identifying information.)

Customer Service What are your hours of operation? The Aflac Customer Solutions Center is open 8 a.m. - 7 p.m. ET, Monday thru Friday. ... What is your phone number? Aflac Customer Solutions Center: 800.992.3522. ... What is your fax number? Claims: 877.442.3522 (fax)

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.

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.

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. One Day Pay*.

Keep a copy of the supporting documentation and this completed form for your records. Sign, date and mail the completed form to the address below or fax to 1-800-448-8922.

Unlike most insurance companies, Aflac doesn't put a time limit on filing for ANY claim, even your Wellness Benefits!

Cost Calculator Accidentup to $2,450Hospitalup to $2,450Short-Term Disabilityup to $2,720Critical Care & Recoveryup to $9,859Cancer/Specified-Diseaseup to $9,859

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).

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© Copyright 1997-2025
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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