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aflac continuing disability claim form Summary of Benefits for Benefits Eligible Employees Mar 31, 2022 Employees are covered by long-term disability insurance, beginning on the first day of employment. Mail: Post Office Box 84075, Columbus, GA 31993, For critical illness claims, we need information from you and your attending physician. endobj ;PmE,29/@]Q_gjie3>F*fbNG$7H6^5^trSgt@MX18^JE+B$K
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/I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R 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). 15 0 obj startxref oJ!qE004N-XBk;7k]qo&bs<9Pm9
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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. 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. xref Aflac is here to help. 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. 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0000000446 00000 n <> <> For Sale - 720 E 300 N, Provo, UT - $495,000. "tZ
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Explore the unlimited potential and flexibility that comes with the opportunity to become an Aflac insurance agent. Upload the PDF you need to design. 22 0 obj Please submit the pathology report used in the diagnosis of a malignant cancer, the claimant's birth certificate, and any itemized medical bills with the diagnosis and procedure codes, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). ^$F!_M^D.n0(qARn(aE/AgY,iIM9"8CcNDqjSN*8m)"
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Use Fill to complete blank online AFLAC INSURANCE pdf forms for free. Learn more claim-forms - Georgia Department of Administrative Services A(lCW]h%VdMt:8Y)JTJc(@p\,K2F73Vt)lr]_VGs^b4MoT7ZmT:ZlP&6C?-PWabHK;JrCnJnrcc
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<> <> 21 0 obj 17 0 obj endobj 0000000814 00000 n In NY both group and individual coverage is offered by American Family Life Assurance Company of New York. $d"'aL\l#A%IE5_YS4O4h)$pN261/3.91=eY! p!WHg/S/1>qh13::;;66rN. ?/8-TEfAU,j[:b-G[DjC57H"+$-Ag(@hZ
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[email protected]==Xc1]GcbA-_LZ\:A:pe2tj
Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement. :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=]
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stream trailer<> 19 0 obj Offer your clients better benefit options with Aflac supplemental insurance policies. (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> endobj 0000055102 00000 n IgeDH7TM\#pU10L#Ss`6=>>>RJf3(u"SS*/4)kIZjBeggFpXisbnT"]8aV=2.gG!O"):K$0*DuMhDAGnARk37
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[email protected]`gXCf+nfk(n(Oi3le.$J">(K1Vhh
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/Encoding 4 0 R We pay claims fast. 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. endobj To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. endobj )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> 44EBCGZWK1$09&Q#o?-4-.oof+30H,2'QUFu;$7Pkc
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0000030858 00000 n For groups sitused in New York, coverage is underwritten by American Family Life Assurance Company of New York. 0000000000 65535 f "Jk(XbKsV#$D'i]&;mcIV!r
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0000000446 00000 n 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. 19 0 obj ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj-
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0000054624 00000 n endobj Aflacs Premium Life, Absence and Disability Services are available in all states, except Puerto Rico, Guam or the Virgin Islands, and are offered by Continental American Insurance Company (CAIC). /BaseFont /Helvetica-Oblique 0000000814 00000 n 15 0 obj (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> . ,8A591pbF*6H'TJ)2Vei;P*o96rsB5bc053[IE).3_gms2M52R7$UKjL.Sh)0is*/8l=#[kk8`R
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Aflac Group | Columbia, SC 13 0 obj /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:>
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/Type /Font TLFC\4aS)n5C^j*@4%"P0VVa9rj(. 0000054519 00000 n Execute Aflac Initial Disability Claim Forms To Print within a few minutes following the guidelines below: Choose the template you need in the collection of legal forms. endobj C)U\u?j:;&T7I/iGm[n\T;_)`gEYqdm*YLN@N-_eg4^hU\]H7Co2_+ugag&:Fd?U>McjOT-(PdfS7Ma7
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