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Filing Claims
You can now make your claim online by accessing your online account.
You will be automatically redirected in 10 seconds or click the button below to be redirected immediately.
Managing your coverage has never been easier.
Download the GuideAflac is here to help. If you are filing for a health screening on your Hospital Indemnity, Accident, or Critical Illness plan for Coronavirus (COVID-19) testing, select Biometric Screening as your exam.
Claims are subject to policy terms and conditions.
File a Wellness Benefit Claim Online
Simply select "File Online" below and follow the instructions.
File a Wellness Benefit via Fax or Mail
Please fully complete the claim form for the Wellness Benefit.
Please date and sign all required forms where indicated.
Forms:
File an Accident Claim Online
Simply select "File Online" below and follow the instructions.
File an Accident Claim via Fax or Mail
Please provide a date and complete description of your accident. You can provide this information in the designated space on the claim form.
If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required. If your injury occurred on the job, a first report of injury filed with your employer must be attached to the completed claim form.
If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure.
Please include all dates of treatment and charges incurred due to the accident.
Please date and sign all required forms where indicated.
Forms:
Group BenExtend Claims
A BenExtend claim requires supporting documentation for review of benefits such as an itemized bill if there was a hospital stay, itemized bill from physician's office, surgical report if surgery took place, Xray/Diagnostic Test reports with dates and charges if applicable, accident report if applicable, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form).
Please date and sign all required forms where indicated.
Forms:
File a Cancer Claim via Fax or Mail
Please submit the pathology report used in the diagnosis of a malignant cancer, the claimant's 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). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.
Please date and sign all required forms where indicated.
Forms:
File a Critical Illness Claim Online
*Before filing a critical illness claim online, please ask your physician to complete and return the Physician's Statement Form*
If you have already had your physician complete and return this form, simply select "File Online" below and follow the instructions.
File a Critical Illness Claim via Fax or Mail
For critical illness claims, we need information from you and your attending physician. Please provide all information requested on the Insured's Statement portion of the claim form. The Attending Physician’s statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.
Please date and sign all required forms where indicated.
Forms:
File a Dental Claim via Fax or Mail
Please complete the Patient section, Boxes 8–18, as well as the Policyholder/Employee section (excluding Boxes 31–38 and 40.) Your dentist should complete the Billing Dentist section, Boxes 42–66 (excluding Box 53).
Please date and sign all required forms where indicated.
Forms:
File a disability via Fax or Mail
For disability claims, we will need information from you, from your employer, and from your attending physician. Please provide all the information requested in Part A of the initial claim form. Your employer is responsible for providing the information in Part B, and your attending physician is responsible for providing the information in Part C.
In addition, please read and then sign the Authorization for Disclosure of Health Information (HIPAA form) included in Part A, as well as the separate Authorization for Disclosure of Health Information (HIPAA form).
Please date and sign all required forms where indicated.
Forms:
Continuing Disability Claim Form
If this is a Disability Product with your policy number beginning with AFL, please use the form below.
File a Hospital Claim Online
Simply select "File Online" below and follow the instructions.
File a Hospital via Fax or Mail
A hospital indemnity claim requires supporting documentation for review of benefits, itemized bills showing medical treatment dates and diagnosed conditions, hospital admission and discharge papers for inpatient hospital admission and confinement benefits, pharmacy receipts for prescription drug reimbursement, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.
Please date and sign all required forms where indicated.
Forms:
Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claims
Please provide a certified copy of the deceased person's birth certificate and death certificate. If the cause of death is an injury or accident, include a copy of any related police report and/or newspaper articles.
Please date and sign all required forms where indicated.
Forms:
If your certificate number issued to you is in a numerical value, Example: 1234567891, please only use the two forms below.
Accelerated Death Benefit Claim Form
Beneficiary's Statement for Death Claim Form
If this is an Employer Sponsored Term Life Product with your policy number beginning with AFL, please use the forms below.
Universal Life Insurance underwritten by Trustmark Insurance Company
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.
1. Download the form.
2. Fill it out.
3. Send it in to: PO Box 60676, Worcester, MA 01606
Claim Forms
Accelerated Death Benefit Claim Form
Waiver of Premium Claim Form-Initial
Waiver of Premium Claim Form-Continuance
Waiver of Premium Claim Form-Permanent
Long Term Care/Home Health Care Benefit Claim Form
Service Forms
Automatic Bank Draft/Electronic Funds Transfer
Request Partial Life Surrender
New York Domestic Violence Notice (For Life Insurance Policyholders)
Authorization to Obtain Information Form
Please date and sign all required forms where indicated.
Forms:
Direct Deposit of Claims Payment Form
To have your claims payment direct deposited, please download and fill out this Electronic Funds Transaction Authorization form.
This form may be used on all product claims except Group Term Life, Group Whole Life and AD&D claims.
Once complete, please return it to:
Continental American Insurance Company
Mail: Post Office Box 84075, Columbus, GA 31993
Phone: 800.433.3036
Fax: 866.849.2970
Email: groupclaimfiling@aflac.com
Forms:
Waiver of Premium Form
Please date and sign all required forms where indicated.
Forms:
File a Wellness Benefit Via Fax or Mail
Please fully complete the claim form for the Wellness Benefit.
Please date and sign all required forms where indicated.
Forms:
File an Accident via Fax or Mail
Please provide a date and complete description of your accident. You can provide this information in the designated space on the claim form.
If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required. If your injury occurred on the job, a first report of injury filed with your employer must be attached to the completed claim form.
If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure.
Please include all dates of treatment and charges incurred due to the accident.
Please date and sign all required forms where indicated.
Forms:
File a Critical Illness via Fax or Mail
For critical illness claims, we need information from you and your attending physician. Please provide all information requested on the Insured's Statement portion of the claim form. The Attending Physician’s statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the
Forms:
File a Hospital Indemnity via Fax or Mail
A hospital indemnity claim requires supporting documentation for review of benefits, itemized bills showing medical treatment dates and diagnosed conditions, hospital admission and discharge papers for inpatient hospital admission and confinement benefits, pharmacy receipts for prescription drug reimbursement, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.
Forms:
Universal Life Insurance underwritten by Trustmark Insurance Company
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.
1. Download the form.
2. Fill it out.
3. Send it in to: PO Box 60676, Worcester, MA 01606
Claim Forms
NY - Accelerated Death Benefit Claim Form
NY - Waiver of Premium Claim Form-Initial
Waiver of Premium Claim Form-Continuance
NY - Waiver of Premium Claim Form-Permanent
NY - Convalescent Care Benefit Claim Form
Service Forms
Automatic Bank Draft/Electronic Funds Transfer
Request Partial Life Surrender
New York Domestic Violence Notice (For Life Insurance Policyholders)
Authorization to Obtain Information Form
Please date and sign all required forms where indicated.
Forms:
To file a life insurance, disability insurance, or absence claim, click the button below to access the member portal.
File a Claim© 2024 AFLAC INCORPORATED
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Individual Policies:
Coverage underwritten by American Family Life Assurance Company of Columbus. In New York, coverage underwritten by American Family Life Assurance Company of New York.
Direct to Consumer individual coverage underwritten by Tier One Insurance Company.
Aflac Worldwide Headquarters | Columbus, GA
Aflac Group Policies:
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 Group | Columbia, SC
“Aflac” may include American Family Life Assurance Company of Columbus, American Family Life Assurance Company of New York, Continental American Insurance Company (marketed as “Aflac Group”), Tier One Insurance Company, and any other affiliated companies (collectively, “Aflac”), as applicable to the entity from whom you receive insurance services.
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