How do I file a claim?
Our claim forms are available under the Filing a Claim tab. Please read and follow the detailed instructions for each applicable form, making sure to complete it in its entirety and signing where requested. If you have questions or need help completing a form, call our Customer Service Center at 800.433.3036.
What if all the provisions of the certificate are not met? How will it affect my claims processing time?
Claims submitted for benefits that may be subject to a pre-existing condition exclusion, a waiting period, or the certificate's contestability period may require additional medical information that can extend processing time.
Also, you will be notified within 7 to 10 business days if a claim form is not completed in its entirety or is not signed. Incomplete or unsigned forms will delay claim processing.
Will my claim be expedited if I send my claim form to you by express mail?
Sending your claim form by express mail will expedite the receipt of your claim form but will not expedite claim processing. Claims are processed in the order in which they are received; they are not prioritized by delivery method.
How long do I have to file a claim?
There is a one-year timely filing provision in your certificate. Please review the provision and call us with any questions.
How do I submit my claim form for processing?
What information do I need to file a claim?
It's important to follow the detailed instructions included on each claim form and to sign each form where indicated. Our claim forms are all available on the Claims tab, and instruct you to consider the following: Group Disability Insurance Claims - There are three areas on this form: one that requires specific information from you, one that requires specific information from your employer, and one that requires specific information from your attending physician. Be sure to sign and date the authorization portion of Part A, as well as all other applicable forms. Group Supplemental Hospital Indemnity Insurance Claims - We'll need an itemized bill showing admission and discharge dates, inpatient room charges for semiprivate or private rooms, a diagnosis, and any additional forms or bills related to your treatment. Group Accident Insurance Claims - Using the appropriate claims form, send us a complete description of your accident. If you were involved in a motor vehicle accident, we'll need a copy of the police or accident report. If your injury occurred on the job, please attach a copy of the first report of injury filed with your employer. If you were first treated in an emergency room, please attach a copy of the discharge papers from the hospital. All medical bills and supporting documents related to your injury should verify the diagnosis, the specific procedure or treatment and the supplies used. Group Critical Illness Insurance Claims - Notice that the claimant's birth certificate is required with the other critical illness insurance claim documentation. Please make sure your treating physician completes the second page (Attending Physician's Statement). Group Cancer Insurance Claims - When you send your cancer insurance claim documentation, include a pathology report used in the diagnosis of a malignant cancer, any itemized medical bills with the diagnosis and procedure codes, and the claimant's birth certificate. Beneficiary's Statement for Death Claim - Certified copies of the deceased person's birth certificate and death certificate are needed to process your claim. If the cause of death is an injury or accident, include a copy of any related police report and/or newspaper articles. The beneficiaries must sign and print their name at the bottom of the claim form.
I submitted a claim form. Did you receive it?
Once a claim form has been received, it normally takes two to three working days to pre-process the claim before it is sent to the claims examiner for processing. During this pre-processing stage, the claim form is not accessible for review. It will become accessible once pre-processing is complete and the claim is entered into the claim system.
Please closely follow the instructions on the claim form and sign in all places indicated before mailing it and all required documentation to us.
How is this coverage different from major medical insurance?
Major medical insurance pays for doctors and hospitals. Our coverage is designed to provide you with cash benefits, unless otherwise assigned, that you can use to help with daily expenses when you're sick or hurt—cash to be used as you wish to help you and your family with unexpected expenses.
Whom do I call with questions about my coverage?
Call our Customer Service Center at 800.433.3036 from 8 A.m. to 8 p.m. Eastern time. Each of our representatives is prepared to address questions about your insurance, and we're proud to offer interpretation services for over 50 languages.
Can I increase my coverage at any time if I continue my coverage on an individual basis?
No. The option to increase coverage is only available on a group basis.
What if I want to cancel my coverage?
Call our Customer Service Center at 800.433.3036 for cancellation procedures.
Will my benefit checks be payable to me?
Benefits will be paid directly to you, the insured, unless otherwise required by law or otherwise assigned.
You can also choose to direct a hospital, physician, or other health care provider to receive your benefits. This is called assigning benefits, and you can do so by signing the appropriate section on the claim form or by signing an assignment of benefits at the health care provider's office.
Are my benefits taxable?
If you pay premiums under a flexible benefits plan with pre-tax dollars, or if your employer pays part or all of your premiums, some of the benefits you receive may be taxable. Therefore you may receive a W2 form from your employer that will include the taxable benefit amounts you received. In addition, a 1099 form will be sent to the insured if a group Critical Illness benefit of more than $10,000 is provided. A 1099 form will also be sent for an disability benefits paid under a pre-tax plan. If you have questions about taxability of benefits, discuss them with your employer or tax advisor.
How do I make changes to my personal information, such as my name or address?
You can download a Service Request Form from our Web site (located under the Service Request tab) or call our Customer Service Center at 800.433.3036 to request the form by mail. Please closely follow the instructions on the form to receive the most efficient service.
Who completes the Beneficiary's Statement?
When a death occurs, the Beneficiary's Statement must be completed by the person or persons to whom the insurance may be payable. Please also note that if an assignment of benefits to a funeral home is made, this information will need to accompany the Beneficiary's statement/claim form.
If my disability claim is ongoing, will the initial claim form that I submit support my ongoing disability?
No. Please submit all supplemental claim forms, updated medical information, and employer's verification that your claim examiner requests. Since disability claims can be ongoing, we will request periodic updates from you on your condition and return-to-work status.
If I am eligible to keep my coverage on an individual basis, what payment options do I have?
If you terminate your employment with your employer, you may opt to continue your current Aflac Group plan on an individual pay basis. Please see your certificate for plan details.
You will have four payment options: monthly electronic draft from your banking account, quarterly, semiannual, or annual direct billing. Electronic draft is available for monthly payment only. Notices will be generated for premiums paid quarterly, semiannually, or annually when due.
Does my Whole Life and Universal Life insurance coverage accumulate cash value?
Yes. Whole Life and Universal Life plans accumulate cash value. However, it normally takes about three to six years for the value to build, depending on the plan.
If my certificate has built cash value, can I take a loan against that value? How long does the process take?
Please note that the only plans that build cash value are Universal and Whole Life plans.
You can take a loan against the accrued cash value. To do so, complete the applicable sections of the Service Request Form, sign the form where indicated, and mail or fax the form to us. An interest rate will be charged for loans as described on the certificate schedule page. Please allow a minimum of 45 days to a maximum of six months for processing.
How do I repay my loan?
The loan may be repaid partially at a minimum of at least $10 per payment or in its entirety (including accrued interest) while the certificate is in force and prior to the death of the insured.
What will happen to my life insurance certificate if the loan and accrued interest exceed the cash value?
The certificate will lapse (no longer be in force). You will be notified by mail at the owner's last known address at least 31 days before the plan lapses.
How is the cash value accumulated?
Cash values are accumulated by crediting premium payments and interest to a fund from which deductions are made for expenses and cost of insurance. The rates at which the interest is credited are declared by the company or may be specified in the certificate. The initial surrender charge is determined at the beginning of each certificate year. The fund value (not to be confused with the surrender value) is accrued based on the premium deposited. Once the fund value exceeds the surrender charge, the cash value begins to grow.
Can I continue my Universal Life or Whole Life insurance on an individual basis?
Yes. With the Universal Life and Whole Life plans, if the group master policy terminates, you will continue to have coverage as long as the premiums are paid.
What if I stop paying my premiums but do not surrender my Universal Life plan for its cash value?
If payment of premiums discontinues and the certificate is not surrendered, monthly deductions will continue as long as there is sufficient accumulated value. The certificate will remain in force until the earlier of the following dates:
1. The maturity date (if there is sufficient accumulated value to make monthly deductions to that date)
2. The end of the grace period
3. The date of the insured's death
How do I change the beneficiary on my life insurance plan?
Use the Service Request Form located under the Service Request tab or call our Customer Service Center at 800.433.3036 from 8 A.m. to 8 p.m. Eastern time. Please note that the designated witness to the transaction must be someone other than the beneficiary or the owner of the certificate.
Will I receive an annual life insurance statement?
You will receive an annual statement on the anniversary date of your Universal Life plan; however, annual statements are not generated on Whole Life plans.
What information will I find in the annual statement?
The annual statement shows the current certificate values, premiums paid, and deductions made since the last report, along with any outstanding certificate loans.
This is a brief overview only. The plans have limitations and exclusions that may affect benefits payable. Refer to the plans for complete details, limitations and exclusions. Coverage may not be available in all states.
Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. For groups sitused in California, group coverage is underwritten by Continental American Life Insurance Company. For groups sitused in New York, coverage is underwritten by American Family Life Assurance Company of New York.
“Aflac” pertains to American Family Life Assurance Company of Columbus, American Family Life Assurance Company of New York, Continental American Insurance Company and Continental American Life Insurance Company.
Columbia, South Carolina
©2018 Aflac Incorporated.