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Please check your policy for specific benefits covered under your policy. Sign date and mail the completed form to the Aflac address shown below. Policyholder Information Middle Initial Policyholder First Name M D Y Policyholder Last Name ZIP of mailing address Birth Date Policy Number Patient Information First Name Relationship Last Name Sex Primary Dependent Child Spouse Male Patient Female Wellness Exam Treatment Date Treatment date must be provided. Annual physical Blood screening Dental ex ...

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Got questions?

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 do you file a claim with Aflac?

To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. Download the form. Fill it out. Send it in to: PO Box 60676, Worcester, MA 01606.

Is there a time limit on filing Aflac claims?

How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate. Please review the provision and call us with any questions.

What forms are needed for Aflac claim?

Accident claims checklist. Z2100711. Identify your policy. Policyholders address. What you need to file a claim. HCFA 1500 (non-hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.) Proof of services. My Claims. MyAflac helpful tips: ▪

How much will Aflac pay me?

ACCIDENT SPECIFIC-SUM INJURIES BENEFITS: When a Covered Person receives treatment for Injuries sustained in a covered accident, Aflac will pay specified benefits ranging from $20$7,500 for dislocations, burns, skin grafts, eye injuries, lacerations, fractures, concussion, emergency dental work, coma, paralysis, and