Aflac Claim Forms Hospital Sickness

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HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS

Details: Email form to [email protected]aflac.com or fax to 1.866.849.2970. Phone (800) 433-3036 * Fax (866) 849-2970 HOSPITAL INDEMNITY CLAIM FORM AUTHORIZATION Several states require that the following statement appear on claim forms: (Person who is sick or injured) Patient’s Date ofBirth Patient’s Gender physician's disability statement aflac form

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SICKNESS CLAIM FORM - Capital Insurance Agency, Inc.

Details: ˜ Complete Section A: Policyholder/Patient Information and sign your claim form. ˜ Have the treating physician complete Section B: Physician's Statement and sign the claim form. ˜ If you are filing for disability, please complete the Initial Disability Claim Form (S00224) as well. Forms are available on our web site at aflac.com. aflac claim forms to print

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› Url: https://www.capitalins.com/wp-content/uploads/2020/05/AFLAC_Sickness_HIC.pdf Go Now

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SICKNESS CLAIM FORM - GCCCD

Details: American Family Life Assurance Company of Columbus (Aflac) Attention: Claims Department • Worldwide Headquarters • 1932 Wynnton Road • Columbus, GA 31999 For information or help filing your claim, please call toll-free 1-800-99-AFLAC (1-800-992-3522) or visit our Web site at aflac.com Toll-free fax number 1-877-44-AFLAC (1-877-442-3522) 1. aflac disability claim forms printable

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› Url: https://www.gcccd.edu/formsdepot-hsb/documents/AFLACSicknessClaimForms-2029-ca.pdf Go Now

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HOSPITAL CONFINEMENT SICKNESS INDEMNITY …

Details: Form A-45075-SS RC(8/04) HOSPITAL CONFINEMENT SICKNESS INDEMNITY LIMITED BENEFIT POLICY SURGICAL BENEFIT AFLAC will pay benefits according to the Schedule of Operations when a covered person has a surgical operation performed for a covered sickness in a hospital or ambulatory surgical center. aflac short term disability claim form

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› Url: https://www.stfrancishouston.org/uploaded/Human_Resources/Open_Enrollment_2012/AFLAC/Hospital_Confinement_Sickness.pdf Go Now

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Personal Sickness Indemnity Plan - .web

Details: Aflac will pay $50 per day for each day a covered person is charged when confined in a hospital and transferred to a bed in a rehabilitation unit of a hospital for a covered sickness. This benefit is limited to 15 days for each covered person per period of hospital confinement** and is limited to a maximum of 30 days per calendar year. aflac attending physician statement form

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Online Claim Form - Aflac

Details: If you disagree with a claims decision, you may submit an appeal, citing supporting policy provisions: Mail: Aflac Claims Appeals, PO Box 84065, Columbus, GA 31908-9998 Please use the claim appeal form to organize your request. Please be sure to explain why you disagree with Aflac's decision, and include any additional supporting documentation. aflac cancer forms to print

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Supplemental Hospital and Medical Indemnity Claim …

Details: Supplemental Hospital and Medical Indemnity Claim Instructions 1. Please complete sections 1 through 6. 2. Read and sign the Authorization, section 8. The authorization will be used in obtaining information needed to process your claim. Failure to complete the Authorization will result in a delay in processing. 3. sickness disability statement aflac

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› Url: https://www.aflacgroupinsurance.com/docs/customer-service/new-york-claims/afny001hi_12v2.pdf Go Now

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Aflac sickness claim form - rw.seeleya.com

Details: Aflac sickness claim form SICKNESS CLAIM FORM – PHYSICIAN'S STATEMENT. Aflac Group Insurance Claim Forms. File a Wellness. Please fully complete the claim form for the Wellness Benefit. Please date. File a Critical Illness Claim. HOSPITAL INDEMNITY CLAIM FORM. Thank you for trusting Aflac with your Hospital Indemnity needs. If you are interested.

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› Url: http://rw.seeleya.com/aflac-sickness-claim-form.pdf Go Now

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Personal Sickness Indemnity Plan - .web

Details: Hospital Confinement Benefit, are the same for Levels 1, 2, and 3 (Policies NY-45100, NY-45200, and NY-45300). Hospital Confinement Benefit Aflac New York will pay the amount per dayfor the level chosen when a covered person requires hospital confinement as an inpatient for a covered sickness and incurs a charge. Benefits

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› Url: https://webordering.aflac.com/PDF/NY45075B1.PDF Go Now

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SICKNESS CLAIM FORM - cityofsitka

Details: ˜ Complete Section A: Policyholder/Patient Information and sign your claim form. ˜ Have the treating physician complete Section B: Physician's Statement and sign the claim form. ˜ If you are filing for disability, please complete the Initial Disability Claim Form (S00224) as well. Forms are available on our web site at aflac.com.

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› Url: http://www.cityofsitka.com/government/departments/hr/documents/sicknessclaim.pdf Go Now

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DUCK PHYSICIAN'S VISIT BENEFIT CLAIM FORM - SMCPS

Details: 1-800-99-AFLAC (1-800-992-3522) • aflac.com 1-800-SI-AFLAC (1-800-742-3522) en español Your Aflac Personal Sickness Indemnity policy pays a Physician's Visit Benefit for services rendered under the supervision of a physician, after the effective date of your policy (see policy schedule). PSI PSIWEB DUCK PHYSICIAN'S VISIT BENEFIT CLAIM FORM

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› Url: https://www.smcps.org/hr/forms/hr-insurance-benefits/aflac/179-aflac-physicians-visit-benefit-claim-form/file Go Now

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Aflac Wellness Claim Form - SignNow

Details: Aflac Accident Insurance Wellness Claim Form. Fill out, securely sign, print or email your hospital indemnity wellness benefit claim form - Aflac Group Insurance instantly with SignNow. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Available for PC, iOS and Android. Start a free trial now to save yourself time …

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HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS

Details: Alfac Group Hosptia Ildemntiy Claim Form_2020 . CONTINENTAL AMERICAN INSURANCE COMPANY . Post Office Box 84075 * Columbus, GA. 31993 Phone (800) 4333036 * Fax (866) 849- - 2970 . HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS . To avoid delays in processing of yoclaim formur , complete each section attaching documentation below …

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HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS - UC Plus

Details: [email protected]aflac.com . HOSPITAL INDEMNITY CLAIM FORM . Please review your policy for specific benefits covered under your plan. To prevent processing delays, please have claim form completed in full and return the signed HIPAA. Please submit medical documentation from your healthcare provider to support your claim.

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› Url: https://ucplus.com/wp-content/uploads/UC-Customized-Hospital-Indemnity-Claim-Form_FINAL.pdf Go Now

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New Claim Form PDFs for WEB - S00224 - Aflac

Details: PolicyholderInformation:This*denotesarequiredfield. *PolicyNumber: / / - --Anypersonwhoknowinglyandwithintenttodefraudanyinsurancecompanyorotherpersonfilesan

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› Url: https://api.aflac.com/docs/claimforms/S00224_CT.pdf Go Now

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Aflac Physician Treatment Summary Form - Fill Out and Sign …

Details: aflac hospital indemnity claim form. Create this form in 5 minutes! Aflac Incorporated 2007 Form 10-K - SEC.gov due to sickness and fixed amounts for physician services for accident or sickness. However, the accounting treatment for cross-currency swaps is different from The following table presents a summary of operating results

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› Url: https://www.signnow.com/fill-and-sign-pdf-form/80020-aflac-physician-treatment-summary-form Go Now

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New Claim Form PDFs for WEB - S2029 - Aflac

Details: Title: New Claim Form PDFs for WEB - S2029 Author: Registered to: AFLAC Created Date: 8/10/2021 01:21:38

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› Url: https://api.aflac.com/docs/claimforms/S2029.pdf Go Now

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You may want to read this: Aflac Claim Forms Hospital Indemnity - …

Details: Aflac Claim Forms Hospital Indemnity search trends: Gallery Nice image showing plan confinement group Quick read about confinement group confinement sickness Thanks for everyone contributing to group confinement sickness pay Cool picture of confinement sickness pay form Great new summary of pay form wellness

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CANCER WELLNESS BENEFIT CLAIM FORM - Revize

Details: member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms. Claims for all other benefits covered under this policy must be filed separately using the claim forms available at aflac.com or by calling 1-800-99-AFLAC (1-800-992-3522). DUCK American Family Life Assurance Company of Columbus (Aflac)

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How do I file an Aflac hospital indemnity claim? - AskingLot.com

Details: HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS If you choose to assign benefits, attach a signed and written request. Email form to [email protected]aflac.com or fax to …

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SPECIFIED-DISEASE CLAIM FORM

Details: American Family Life Assurance Company of New York (Aflac New York) ATTN: Claims Department 22 Corporate Woods Boulevard, Albany, NY 12211 For information or help filing your claim, please call toll-free 1-800-366-3436 or visit our Web site at www.aflacny.com. Toll-free fax number: 1-877-844-0201 SPECIFIED-DISEASE - PHYSICIAN'S STATEMENT

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› Url: https://ufadba.org/sites/default/files/CANCER%20Claim%20Form.pdf Go Now

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HOSPITAL INDEMNITY CLAIM FORM - Jefferson County, …

Details: HOSPITAL INDEMNITY CLAIM FORM . Failure to complete all sections may result in a delay in processing this claim. To prevent delays, please provide documentation from your healthcare. provider to support this claim. Please review your policy …

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› Url: https://www.jccal.org/Sites/Jefferson_County/Documents/Human%20Resources/5.%20Aflac%20Group%20Hospital-Indemnity-Claim-Form.pdf Go Now

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Hospital Intensive Care Protection - .NET Framework

Details: Hospital Intensive Care Unit Benefit Aflac will paythe following benefits when a covered person incurs a charge for confinement in a hospital intensive care unit or a step-down intensive care unit for a covered sickness or injury: Confinement in a Hospital Intensive Care Unit: Sickness Injury Days 1–7 $ 700 per day $ 800 per day

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Supplemental Hospital Insurance Plans for Individuals & Families - …

Details: 5 Assumes the average cost of a greeting card is $3.49 **, and the average cost of postage to mail is $0.55 ***. Comparison is based on the average weekly premium for Nebraska Payroll Premium rates for industry Class A; Aflac Hospital Choice Series B40100 - $500 Confinement Amount - Individual Age 18-49.

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AFLAC Claim Forms - Benefits Your Way

Details: AFLAC Claim Forms. Disability Claim.pdf. Adobe Acrobat document [82.2 KB] Acct Claim.pdf. Adobe Acrobat document [472.5 KB] Cancer Claim.pdf. Adobe Acrobat document [54.8 KB] Dental Claim.pdf. Adobe Acrobat document [76.9 KB]

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HOSPITAL INDEMNITY CLAIM FORM - Chevron Corporation

Details: Send to: Continental American Insurance Company . Post Office Box 84080 . Columbus, GA 31993-4080 . Phone: (800) 433-3036 Fax: (706) 243-7577 Email: [email protected]aflac.com. PLEASE SIGN AND RETURN ATTACHED HIPAA FORM WITH COMPLETED CLAIM FORM.

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› Url: https://hr2.chevron.com/Images/HI_ClaimForm_tcm36-7123.pdf Go Now

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Critical Illness Insurance Aflac - Benefit Solutions for the Public …

Details: For critical illness claims, we need information from you and your attending physician. Source: www.aflac.com. For critical illness claims, we need information from you and your attending physician. The attending physician's statement portion of the critical illness claim form is to be completed by the physician who.

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SHORT TERM DISABILITY CLAIM FORM INSTRUCTIONS

Details: Post Office Box 84075 * Columbus, GA. 31993 . Phone (800) 433-3036 * Fax (866) 849-2970 . [email protected]aflac.com . SHORT TERM DISABILITY CLAIM FORM

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HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS - …

Details: CONTINENTAL AMERICAN INSURANCE COMPANY Post Office Box 84075 * Columbus, GA. 31993 Phone (800) 433-3036 * Fax (866) 849-2970 . HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS

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› Url: https://www.gcsnc.com/cms/lib/NC01910393/Centricity/Domain/5025/Aflac%20Hospitalization_Claim_Form%202019.pdf Go Now

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CANCER CLAIM FORM - .NET Framework

Details: CANCER CLAIM FORM - PHYSICIAN'S STATEMENT American Family Life Assurance Company of Columbus (Aflac) Attention: Claims Department • Worldwide Headquarters • 1932 Wynnton Road • Columbus, GA 31999 For information or help filing your claim, please call toll-free 1-800-99-AFLAC (1-800-992-3522) or visit our Web site at aflac.com

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Aflac Hospital Indemnity Insurance

Details: Aflac Hospital Indemnity Insurance plan is selected. The insured has a high fever and goes to the emergency room. physician admits the insured into the hospital. The insured is released after two days. The Aflac Hospital Indemnity Insurance plan pays $1,400

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Afac Group Hospital Indemnity - cpschools.com

Details: AFLAC GROUP HOSPITAL INDEMNITY HI G Policy Form C80100VA The plan that can help with covered accidental injury and a covered sickness. HOSPITAL INTENSIVE CARE BENEFIT per day If your coverage terminates, we will provide benefts for valid claims that arose while your coverage was in force. See certifcate for details. NOTICES .

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› Url: https://cpschools.com/employee-benefits-risk-management/wp-content/uploads/sites/34/2019/09/AFLAC_Group_Hospital_Indemnity_Book_2020.pdf Go Now

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AFLAC ACCIDENT WELLNESS BENEFIT CLAIM FORM PDF - …

Details: ACCIDENT WELLNESS BENEFIT CLAIM FORM Some of the tests listed may not be covered under the Wellness Benefit of your policy. Please check TM your policy for a list of covered wellness procedures or call 1-800-99-AFLAC (1-800-992-3522) for a Wellness Form specifically tailored for your policy. Pdicfiolder First Name:

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› Url: https://www.durant.org/DocumentCenter/View/138/Aflac-Accident-Wellness-Benefit-Claim-Form-PDF Go Now

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Aflac Cancer Claim Forms Pdf - health-cancer.info

Details: CANCER WELLNESS BENEFIT CLAIM FORM. Health (Just Now) member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms. Claims for all other benefits covered under this policy must be filed separately using the claim forms available at aflac.com or by calling 1-800-99-AFLAC (1-800-992-3522). DUCK American Family Life Assurance Company of Columbus (Aflac)

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Aflac Short-Term Disability Income Insurance - TotalBen

Details: For claim forms, visit our Web site at aflac.com. SHORT-TERM DISABILITY INCOME COVERAGE Outline of Coverage for Policy Series A576 00 THIS IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the “ Guide to Health Insurance for People W ith Medicare” available from Aflac. 1. Disability Income Protection Coverage.

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Will Aflac pay for gallbladder surgery? - FindAnyAnswer.com

Details: No lifetime maximum. Surgical Benefit Aflac will pay $100–$2,000 when a covered person has surgery performed for a covered sickness in a hospital or ambulatory surgical center based upon the Schedule of Operations in the policy. Benefits are not payable for cosmetic or elective surgery that is not due to sickness.

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ACCIDENT CLAIM FORM - Lehigh University

Details: ACCIDENT CLAIM FORM • Was death a result of this injury? No Yes (If yes, please submit the certified death certificate and the Life- Beneficiary’s Statement.) • Was the patient confined to the hospital as a result of this injury? No Yes (If yes, please submit the itemized hospital bill, UB04, or HCFA 1500) Admission date: _ _Discharge Date: _

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› Url: https://hr.lehigh.edu/sites/hr.lehigh.edu/files/AFLAC%20AccidentClaimform.pdf Go Now

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Aflac Hospital Indemnity Form - best-doctor.net

Details: HOSPITAL INDEMNITY CLAIM FORM INSTRUCTIONS. Doctor Details: Email form to [email protected]aflac.com or fax to 1.866.849.2970.CONTINENTAL AMERICAN INSURANCE COMPANY Post Office Box 84075 * Columbus, GA. 31993 Phone (800) 433-3036 * Fax (866) 849-2970 HOSPITAL INDEMNITY CLAIM FORM AUTHORIZATION Several states require that the following statement appear on claim forms

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Aflac Claim Forms Cancer Policy - health-cancer.info

Details: Aflac Claim Forms Cancer Policy. Health (3 days ago) CANCER WELLNESS BENEFIT CLAIM FORM.Health (Just Now) under this policy must be filed separately using the claim forms available at aflac.com or by calling 1-800-99-AFLAC (1-800-992-3522). DUCK American Family Life Assurance Company of Columbus (Aflac) ATTN: Claims Department • 1932 Wynnton …

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AflAc HospitAl AdvAntAge - Children's Hospital of The King's …

Details: HOSPITAL SHORT-STAY $100 Aflac will pay $100 when a covered person receives treatment for a covered sickness or injury in a hospital, including an observation room or an ambulatory surgical center, for a period of less than 23 hours and a charge is incurred. This benefit is not payable for treatment received in a hospital emergency room.

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Printable Aflac Claim Forms Daily Catalog

Details: Online Claim Form Aflac. 7 hours ago Aflac.com Visit Site . If you disagree with a claims decision, you may submit an appeal, citing supporting policy provisions: Mail: Aflac Claims Appeals, PO Box 84065, Columbus, GA 31908-9998 Please use the claim appeal form to organize your request. Please be sure to explain why you disagree with Aflac's decision, and …

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Aflac S00224 2010-2021 - Fill and Sign Printable Template Online - …

Details: The tips below will allow you to fill out Aflac S00224 easily and quickly: Open the form in the full-fledged online editor by clicking on Get form. Complete the necessary fields that are colored in yellow. Hit the green arrow with the inscription Next to jump from field to field. Use the e-signature tool to put an electronic signature on the

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SHORT TERM DISABILITY CLAIM FORM - Westlake City School …

Details: short term disability claim form. please sign and return the attached hipaa. part a : policyholder’s stateme. nt (forms are to be completed on or after disability date to avoid processing delays) policy holder’s name: policy/certificate number: social security/ id: date of birth gender policy holder’s address:

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ACCIDENTAL INJURY CLAIM FORM - GCCCD

Details: American Family Life Assurance Company of Columbus (Aflac) ATTN: Claims Department Worldwide Headquarters: 1932 Wynnton Road, Columbus, GA 31999 For information or help filing your claim, please call toll-free 1-800-99-Aflac (1-800-992-3522) or visit our Web site at www.aflac.com. Toll-free fax number: 1-877-44-Aflac (1-877-442-3522)

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› Url: https://www.gcccd.edu/formsdepot-hsb/documents/AFLACAccident%20claim%20form.pdf Go Now

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Aflac Choice - University of North Alabama

Details: Hospital Confinement and is limited to a Calendar Year maximum of 30 days, per Covered Person. No lifetime maximum. C. HOSPITAL EMERGENCY ROOM BENEFIT: Aflac will pay $100 when a Covered Person receives treatment for a covered Sickness or Injury in a Hospital Emergency Room, including triage, and a charge is incurred for such treatment.

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› Url: https://www.una.edu/humanresources/benefits/docs/Supplemental%20Benefit%20Information%20and%20Scans%20052009/Hospital%20Choice%20Brochure.PDF Go Now

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Does Aflac cover colonoscopy? - FindAnyAnswer.com

Details: $1,000 Aflac will pay a Hospital Confinement Benefit of $1,000 when a covered person requires hospital confinement for 23 or more hours for a covered sickness or accidental injury and a charge is incurred. This benefit is payable once per period of hospital confinement, per covered person.

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