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  • American Fidelity Medical Reimbursement Claim Form

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AFES SECTION 125 FLEXIBLE BENEFIT PLAN EXPENSE REIMBURSEMENT VOUCHER Name of Employee (Last, First, MI) Mailing Address Social Security # E-mail address Check here if this is a new address Name of.

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Physician Expense Pays a lump sum if you see a doctor. due to a covered injury or sickness.

What is a Pre-Existing Condition? A condition for which you have received treatment, incurred expense, taken medication, received services or a diagnosis or advice from a physician during the period described in the policy immediately before the effective date of coverage.

Claims are generally processed within 5-7 business days after all required documentation is submitted. Your cancer policy's annual diagnostic testing and screening benefit may qualify for quick processing.

The plan pays a benefit when an Accidental Death or Dismemberment occurs within 90 days of a covered accident. Policy is guaranteed renewable for as long as premiums are paid as required. You have a busy schedule, and your time is important.

DIAGNOSTIC TESTING BENEFIT No Lifetime Maximum Pays up to $60.00 per calender year for any Covered Person to have one or more of the following screening tests performed: mammogram; flexible sigmoidoscopy; colonoscopy; pap smear (test only); prostate specific antigen (PSA); chest X-ray; hemocult stool specimen or any ...

What is the processing time once a claim is submitted? Claims are generally processed within 5-7 business days after all required documentation is submitted. However, your accident policy's annual wellness benefit may qualify for quick processing.

Online Log in to your online account. Click on the File a Claim button. Click on the policy you want. Upload the requested documentation and click on the Upload File button. Click on the Next button and enter the remaining information on the following pages. Check the acknowledgment box and click on the Submit button.

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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
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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:
+1 833 426 79 33
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