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Specified health event claim form

Aflac form s00223ca 2025

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The document is a Specified Health Event Claim Form from Aflac, detailing the process for filing claims related to accidents, hospital indemnity, and intensive care. It includes instructions for completing the form, necessary information from both the policyholder and treating physician, and requirements for submitting supporting documents such as hospital bills. The form emphasizes the importance of accuracy to avoid delays in processing claims and includes legal disclaimers regarding fraudulent claims.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much is the Aflac critical illness payout?

After the waiting period, a lump sum benefit is payable upon initial diagnosis of a covered critical illness. Employe benefit amounts are available from $15,000 to $30,000. Spouse coverage is also available in benefit amounts up to $15,000.

How much is the Aflac wellness payout?

Policy number. Policyholders name. Policyholders address. Date of injury or when symptoms first occurred. Definitions acronyms. ER visit. Surgery. Operative report - Must include the type of procedure or procedure code. My Claims.

How much does Aflac pay for a wellness check?

Each calendar year (Jan-Dec), you and your covered dependents have access to a $50 payout for having any of these testsyou just need to submit a claim.

How much does Aflac pay for cancer wellness benefit?

Cancer Insurance provides added financial protection to help cover cancer related expenses. This coverage also pays a wellness benefit of $75 onetime per year for each insured when they provide proof of a routine cancer screening test such as: mammography, pap smear, colonoscopy, or chest X-ray.