<>stream 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 Worldwide Headquarters | Columbus, GA &>7[>d7(qqN/lSW8,9((\,+tAibO:g1>Tl'K;D\HUqeC^#X0pPUXu3oeqYppd\O0nI(-OoF3]X=)@;7_ <> /Encoding 4 0 R J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. endobj 0000000009 00000 n endobj trailer<> << /Creator (OpenText Exstream Version 16.6.20 32-bit) 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` 'L_g'N&-hd[;0t$*n/>649o==0mM=iT3\5)+p[n+X5`?CY@j.i4h`gXCf+nfk(n(Oi3le.$J">(K1Vhh <>stream N)G#g,5CuOCl3ttm>moVq5\t:irQ`YOX`hI[-7k@LAI*:FcS$CfJQIJO'l@aSJln)/KXYQh;4`]9N;Qj endobj Manage your account, submit and track claims, setup direct deposit and more. 2#Uk88j6F;!LPJCYg?_VnT>DO7>((M$tI28>B]"L9/3#3R1],d$6!$JJRKV2m(tG_Q]-T()Va>`2T]>l;eK>s(U,g-lu^? @oGDmsuR- endstream endobj TNMF9_Vr2,SFTeXfUSJa)jt-'"mb39a6fe"7:L*nQB6WHc=tGuKXhdlF@JojFLBR3CIdNL;Gs\omg&R3 << lPl9tY-IJ%_lFQbBP+,UB6!AO?&Q*kaBs. endobj Your employer is responsible for providing the information in Part B, and your attending physician is responsible for providing the information in Part C. 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Aflac Group | Columbia, SC (iYP)/&l>.oWNiPB[o&n&^M(Qi2$8 \&)R4M>ms@. Use the Cross or Check marks in the top toolbar to select your answers in the list boxes. 0000000326 00000 n 0000055102 00000 n . 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J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr The Attending Physicians statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. >> 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg% endobj e(d`r+1(IK_Z9J8FZEKhh]p"mOP2o\*_i:B,oR:q;pr&)1JfnGrF_2WN1&RdVP7b@X=`\9QI&,k/0N4e )qT)jZA=U\YiCp>=mtH$[\__]9X3fUD/SEtnbat` $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR endobj "k&*mXEOTDY; IulVik4tYO+5Y]5dC6+if#]pW>?S#%PB"2$kEPR@U_!W)J++r5@@21spCE@V_m\2SM=jcqaH.-P9&U%f /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> endstream ="8)^bHRPR0S#pBp\Hna_9-7K:diCtrB)_+K-\Z@W.j=Up^98J,Q-AtX6'$lc%D"gK+_Uc1u""HolR4)Hdg&NuR#8)Khmcol]#;]R+7)60eW.q/;.KZ6p49FV N8EYJ/rdd(..BX8/1[!lhITlJFmO/CsZ%j/>QaJ13;:-PF0g "Jk(XbKsV#$D'i]&;mcIV!r endstream FXd-mhfj\dS((^`0K6!.q%j)EYH;^Rd.Aa`hf%gahFK:H:&//7pMV3D2qV#r4Oea\q/upjBMGec[O,Y:5n_u^Q$*P(4j$+WU5q!\lQS0:!H;gK m^PaP#$T,QfVQ'7kTb=#ja*O^[oT:q1qW?WH%a_Lp. endobj EMnIpA`\`j9p%8Jb%g?3bB@@W^$A.t>R)@AV[$Gr+1aic5NY;`=A9#XB->:2MDO^@t[9!^9`hM)b9[&5Hfki>iJ2*idRMc*I1K7B)P.Ht.`'k-.R`,bZ1``cJ @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- . Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement. Yku1YRdk^9;TD\;*kl4jYjTa8Xl"SC:fUS)e;!AcrDK#l16`LFaGhEJ;`,G>'H*8^Jr\^>/E?FZ]1S?b ffBW;,%_AN*"_VFk^*[7l*M'q?n=q..L?F%d A&!R^maAJpBZW3)>! 15THsJWlVj?FW\)knqP*Lk! m-*&@,H9g(2[5#o!G;R4U9IEG=[4#Wq9g71 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY File a Disability Claim File a Hospital Claim File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim Aflac Group Insurance Additional Forms Authorization to Obtain Information Form Direct Deposit of Claims Payment Form fKM7f%?5*K:i'+aV_K!?49DLRD(oBT]NI)%kf!BU%-f'rI-kJBX(Gn\B]/9qU,\iQ;,gU.Z@%@^>"[]W:T%89f)q@tlS'SN77! . endstream "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs GtHt%Nh;7F1(!K[n[8/1g\PTUNaGT"=n\Bb:62T:Xt#[Q]!mJ,M&0#sD9($J$JR;eXA\0%6Xp-RXgTNJt5f^? /Encoding 4 0 R Online Claim Form Aflac https://www.aflac.com/file-a-claim/default.aspx When you use MyAflac filing your claim online is an easy way to get paid fast. Self-funded plans and absence services are administered by CAIC in all states but NY. endobj

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