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Click ‘Get Form’ to open the aflac specified event claim form in the editor.
Begin by filling out the Policyholder Information section. Ensure you complete all required fields marked with an asterisk, including your last name, first name, date of birth, and home address.
Next, provide Patient Information. Again, fill in all mandatory fields such as the patient's last name, first name, date of birth, and sex. Indicate the relationship to the primary policyholder.
In the Specified Event/Lump Sum Critical Illness Checklist section, select the condition for which you are filing a claim. Attach any necessary medical documentation that supports your claim.
Complete additional questions regarding treatment dates and hospital confinement. If applicable, submit supporting documents like hospital bills or police reports.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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What is a specified event for Aflac?

INITIAL ACCIDENT HOSPITALIZATION BENEFIT: Aflac will pay $1,000 when a Covered Person is admitted for a Hospital Confinement of at least 18 hours for treatment of Injuries sustained in a covered accident or Aflac will pay $2,000 if a Covered Person is admitted directly to an Intensive Care Unit of a Hospital for

What are the specified health events?

A qualifying life event for insurance is a major planned or unintentional change in your circumstances that can impact your insurance needs. A qualifying life event makes you eligible for a special enrollment period outside regular health insurance enrollment so you can shift to a new plan that fits your new needs.

What are the qualifying life events for Aflac?

SPECIFIED HEALTH EVENT RECOVERY BENEFIT: Aflac will pay $500 per month while a Covered Person remains in Specified Health Event Recovery upon receipt of written proof of Loss from that persons Physician. Lifetime maximum of six months per Covered Person.

What is an Aflac specified health event policy?

Primary Specified Health Event: Heart Attack, Stroke, Coronary Artery Bypass Surgery, End-Stage Renal Failure, Major Human Organ Transplant, Major Third-Degree Burns, Persistent Vegetative State, Coma, Paralysis, or Sudden Cardiac Arrest occurring after the Effective Date of coverage.