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  • Critical Illness Wellness Claim Form - Aflac Group Insurance

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CRITICAL ILLNESS WELLNESS BENEFIT CLAIM FORM INSTRUCTIONSPlease use black or blue ink only and print legibly when completing this form in its entirety. Keep a copy of the supporting documentation.

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Wellness Benefit After the policy has been in force for 12 months, Aflac will pay $60 if you or any one family member undergoes routine examinations or other preventive testing during the following policy year.

Page 1. Your Aflac wellness claim pays you money for staying on top of your health by getting yearly checkups and medical screenings such as physicals, dental exams and eye tests. Most Aflac accident, hospital indemnity and cancer insurance policies have a wellness benefit to pay you for staying on top of your health.

Wellness Benefit After the policy has been in force for 12 months, Aflac will pay $60 if you or any one family member undergoes routine examinations or other preventive testing during the following policy year. Eligible family members are your spouse and the dependent children of you or your spouse.

Q. How long do I have to file a claim? A. There is a one-year timely filing provision in your certificate.

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

To receive your Wellness Benefit, complete the form by following the instructions provided. Please print a separate form for each additional covered family member or call 1-800-99-AFLAC (1-800-992-3522) to request additional forms.

Treatment must be received within 72 hours of the accident for benefits to be payable. This benefit is payable once per 24-hour period and only once per covered accident, per Covered Person.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232