HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS . To avoid delays in processing of your claim form, complete each section attaching documentation below when it applies. Supporting Documentation Needed Itemized bill if there was a hospital stay (UB04 from the hospital or medical facility)
Title: New Claim Form PDFs for WEB - S2029 Author: Registered to: AFLAC Created Date: 1/20/2023 06:50:44
File a Claim | Aflac
File your claim via fax or mail. Consider filing online for faster claims payment! Download form
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). All Fields are …
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The Aflac group Supplemental Hospital Indemnity Plan 1 pays $600 Amount payable was generated based on benefit amounts for: Hospital Emergency Room Visit ($50), Hospital Admission ($250), and Hospital Confinement ($150 per day).
Hospital Indemnity Claims Checklist Z2201221R1 This checklist is intended to assist policyholders when filing claims and does not constitute a guarantee of claims payments or act as an all-inclusive list.
HOSPITAL INDEMNITY CLAIM FORM Failure to complete all sections may result in a delay in processing this claim. To prevent delays, please provide documentation from your healthcare provider to support this claim. Please review your policy for …
Even a minor trip to the hospital can present you with unexpected expenses and medical bills. And even with major medical insurance, your plan may only pay a portion of your entire stay. That’s how the Aflac Group Hospital Indemnity plan can help. It provides financial assistance to enhance your current coverage. So you may be able to avoid ...
Submit only one treatment date per claim form. Do not attach receipts, statements or other claim documentation to this form. Please sign, date and mail/fax the completed form to the Aflac …
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