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Aflac beneficiary form

Aflac beneficiary statement form 2025

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The document is a Beneficiary's Statement that outlines the necessary steps and information required for beneficiaries to claim insurance benefits. It details the completion process, including requirements for multiple beneficiaries, executors, guardians of minors, and situations involving assigned policies. Additionally, it specifies documentation needed such as death certificates and medical records, along with instructions for direct deposit of claim payments.

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Click ‘Get Form’ to open the Aflac Beneficiary Statement in the editor.
Begin by entering the date of death, place of death, and cause of death in the designated fields. If applicable, provide details regarding any injury or sickness that led to the death.
Complete the section regarding physicians who attended to the deceased within three years prior to their passing. Include names, addresses, dates of treatment, and conditions treated.
If there are multiple beneficiaries, ensure all are included in one statement or request separate forms as needed. For minors or mentally incompetent persons, a guardian must complete this section.
Finally, review all sections for completeness and accuracy before submitting your form along with any required documents such as certified copies of birth certificates and death certificates.

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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.

What is the UB-04 form used for?

Your healthcare provider - You can request a sample UB-04 form from your healthcare provider. They may have a blank copy of the form that you can use as a reference. Commercial printing companies - Many companies specialize in printing medical forms, including the blank UB-04 form.

Who is the beneficiary of Aflac life insurance?

A UB04 document includes all information required to get your claim expedited the fastest. ACCIDENT/INJURY CLAIM instructions. Accident Claim Form Authorization to Obtain Information. SHORT-TERM DISABILITY CLAIM.

What is a beneficiary statement?

Life insurance beneficiaries are the individuals or organizations that you can designate to receive the death benefit payout when you pass away. You can name individuals, such as loved ones, or certain charities and trusts as beneficiaries. You can also name one or more beneficiaries.

What is a UB 04 form Aflac?

HCFA 1500 (non-hospital bill). Motor vehicle accident (MVA). Authorization to obtain information (AU). (This allows Aflac to request additional documentation on your behalf.)

What is an UB04 form for AFLAC?

The UB-04 uniform medical billing form is the standard claim form that institutional providers use, such as hospitals and community mental health care centers.