Get New Claim Form Pdfs For Web - S00223 - Jeff Pols - Benefitinnovations

Completing the New Claim Form is a crucial step in submitting your claim to Aflac. This guide provides clear, step-by-step instructions to help you navigate and fill out the form accurately and efficiently.

Follow the steps to successfully complete your New Claim Form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Start by entering your policy number in the required field. Ensure that all information is accurate to avoid processing delays.
3. In the Policyholder Information section, fill out your last name, first name, middle initial, date of birth, and telephone number. Provide your home address, city, state, and zip code accurately.
4. Indicate if the address provided is a permanent address change by checking the corresponding box.
5. In the Patient Information section, complete the required fields including the patient's last name, first name, date of birth, and sex. Specify the relationship of the patient to the policyholder.
6. Refer to the Specified Event Checklist and select the condition the patient is filing for. Remember to gather and submit the necessary medical documentation to support your claim.
7. Provide dates for when symptoms first occurred and the first date of treatment for the condition. If applicable, answer questions regarding death resulting from the condition.
8. Complete additional questions regarding hospital confinement, physician details, ambulance transport, and any other relevant information for your claim.
9. Ensure all required fields are filled out completely to prevent delays. Review the information for accuracy.
10. Once you have completed the form, save changes. You can choose to download, print, or share the form as necessary.

Complete your documents online to ensure a smooth claim process.