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AFLAC Cancer Screening Benefit Claim Form 2025

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The document is a Cancer Screening Wellness Benefit Claim Form from Aflac, outlining the process for policyholders to claim their annual wellness benefit. It specifies that only one claim per covered person is allowed each calendar year and provides instructions on completing the form, including details required for various wellness tests. The document emphasizes the importance of following instructions to avoid delays and notes that claims for other benefits must be submitted separately. Additionally, it includes a section for claims authorization under HIPAA regulations.

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Click ‘Get Form’ to open the AFLAC Cancer Screening Benefit Claim Form in our platform.
Begin by filling out the Policyholder Information section. Enter your name, address, and birthdate clearly using black or blue ink.
Next, provide Patient Information. Indicate the relationship of the patient to the policyholder and fill in their birthdate and sex.
In the Wellness Exam section, mark only the boxes for tests you have completed. Ensure you include dates for any mammograms or Pap smears performed.
Complete the Physician Information section by providing your healthcare provider's details, including their name and contact information.
Finally, sign and date the form at the bottom to certify that all information is accurate before submitting it to Aflac.

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Versions	Form popularity	Fillable & printable
2014	4.1 Satisfied (29 Votes)
2009	4.5 Satisfied (60 Votes)

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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.

What is needed for an Aflac cancer claim?

Please submit the pathology report used in the diagnosis of a malignant cancer, the claimants birth certificate, and any itemized medical bills with the diagnosis and procedure codes, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form).

How long do I have to have Aflac before I can file a claim?

Aflac will not pay benefits for an illness, disease, infection, or disorder that is diagnosed or treated by a Physician within the first 30 days after the Effective Date of coverage, unless the resulting disability begins more than 12 months after the Effective Date of coverage.

How much will Aflac pay me for a colonoscopy?

Your wellness benefit is paid once per year when you file a claim (Accident/Hospital Indemnity is once per year per policy and Cancer is once per year per covered person).

Where do I get Aflac claim forms?

Take for example a colonoscopy. If you are signed up for both the Accident plan and the Critical Illness plan, you will receive a $100 payout for having the one colonoscopy. The same goes for a pap smear, COVID-19 testing, mammograms, and bloodwork. Its also important to know that it is never too late to file a claim.

How far back will Aflac pay?

We will pay the amount shown when, because of a covered accident, you are injured and those injuries cause confinement to a hospital for at least 24 hours within 90 days after the accident date. The maximum period for which you can collect the Hospital Confinement Benefit for the same injury is 365 days.

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Is there a deadline to file a claim with Aflac?

Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

Does Aflac pay for cancer screening?

If a Covered Person receives a Positive Medical Diagnosis for Internal Cancer or an Associated Cancerous Condition, this benefit will pay up to a total of three $75 payments per Calendar Year for screenings performed on such Covered Person. Screenings must be administered by licensed medical personnel.

AFLAC Cancer Screening Benefit Claim Form 2025

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How to use or fill out AFLAC Cancer Screening Benefit Claim Form with DocHub

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What is needed for an Aflac cancer claim?

How long do I have to have Aflac before I can file a claim?

How much will Aflac pay me for a colonoscopy?

Where do I get Aflac claim forms?

How far back will Aflac pay?

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