Get Aflac Initial Disability Claim Forms To Print

The UB-04 claim form is used to submit claims for outpatient services by institutional facilities (for example, outpatient departments, Rural Health Clinics and chronic dialysis centers).

Please print a separate form for each additional family 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).

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

To protect against fraud, Aflac uses technology and information gathered from consumer reporting databases. If you complete the online Authorization to Obtain Information form at the beginning of the claims process, Aflac can assist in gathering required documentation by contacting your health care providers directly.

UB04 (itemized hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.) (Please include at least three pieces of identifying information.)

Please print a separate form for each additional family 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).

Itemized hospital bill (IHB). UB04 (itemized hospital bill). ER report or operative report. (Please obtain the supporting documents for the corresponding benefit.)

Send to: Phone:(800) 433-3036. Fax:(866) 849-2970. Email: groupclaimfiling@aflac.com.

Proof of Loss: Written proof that is required to be furnished to the insurer about a loss to help determine the extent of insurer liability. Provider: A facility, licensed as such, that provides health services for an individual.

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. Download the form. Fill it out. Send it in to: PO Box 60676, Worcester, MA 01606.