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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (165 Votes)
2011	4.2 Satisfied (37 Votes)
2009	4 Satisfied (44 Votes)
2008	4 Satisfied (59 Votes)

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What is a UB 04 form for Aflac?

Itemized hospital bill (IHB). UB04 (itemized hospital bill). ER visit.

What documents does Aflac need to submit a claim?

Date and description of injury. Location of the injury. Patients name and date of birth. Patients relationship to policyholder.

How much does Aflac pay for hospital indemnity?

Initial Hospitalization Benefit Aflac will pay $250 per period of hospital confinement** when a covered person is confined to a hospital for at least 24 hours for a covered sickness. This benefit is limited to one payment per calendar year, per covered person. No lifetime maximum.

What form does Aflac need to submit a claim?

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.)

How do I file a continuing disability with Aflac?

Send aflac continuing disability via email, link, or fax.You can also download it, export it or print it out. Edit your aflac printable claim forms online. Sign it in a few clicks. Share your form with others.

aflac initial disability claim form

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How do I get Aflac forms?

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).

How do I file a hospital indemnity claim with Aflac?

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

What is a UB04?

The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

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What is a UB 04 form for Aflac?

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How much does Aflac pay for hospital indemnity?

What form does Aflac need to submit a claim?

How do I file a continuing disability with Aflac?

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