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Aflac wellness claim form

Aflac wellness claim form 2026

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4.9 out of 5

501 votes

The document is an Accident Wellness Benefit Claim Form that outlines the process for submitting a claim for wellness benefits. It emphasizes the importance of completing all sections to avoid processing delays, details the assignment of benefits to providers or Medicaid, and requires a signed HIPAA form to be submitted with the claim.

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Click ‘Get Form’ to open the aflac wellness claim form in the editor.
Begin by filling out your personal information, including your name, address, and policy number. Ensure all details are accurate to avoid processing delays.
Indicate if you are filing for a wellness benefit under multiple coverages by checking the appropriate box provided on the form.
Complete the section regarding benefits assignment. If you wish to assign benefits to a provider, include a signed written request as instructed.
If applicable, sign the attached HIPAA Form and ensure it is included with your completed claim form before submission.

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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.

Does Aflac pay you for wellness visits?

Some examples of wellness claims from non-traditional healthcare providers are: Receipt for a flu shot received at a drug store. Invoice for a smoking cessation program. Invoice from a weight-loss program.

How to file a wellness claim with Aflac?

AFLACs cancer policy and accident policy will pay you a cash benefit if you have a wellness exam each year. Hospital benefit option also provides benefits for doctor visits and diagnostic exams. AFLACs Accident plan provides a $60 wellness benefit each calendar year for wellness exam, dental exam, or eye exam.

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