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endobj endobj 0000054923 00000 n To have your claims payment direct deposited, please download and fill out this Electronic Funds Transaction Authorization form. << /Creator (OpenText Exstream Version 16.6.20 32-bit) 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY
Simply select "File Online" below and follow the instructions. 3. A0Y5rjtc-l=mpq_h=;$=@msV1)_!YAgb[=l4d[#_f!$4lHeElf,p`grp.1a3BKs:! 0000000326 00000 n "DFX!Fen1$B29'W4#sWKq
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If this is a Disability Product with your policy number beginning with AFL, please use the form below. E7qKa,AgM_>47ek>g$eb0N? m);lB2NZG/rMHahB@? 23 0 obj 'L_g'N&-hd[;0t$*n/>649o==0mM=iT3\5)+p[n+X5`?CY@j.i4h`gXCf+nfk(n(Oi3le.$J">(K1Vhh
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<> endstream #DL9JXFKGJ*Nm2)51;-%FmGTIk\].Cb:\N&Y1t`i2EL[>nuN_EC`3D;^lkjT%;rd! health plan (including CAIC or Aflac, with respect to other CAIC or Aflac coverages) or health care clearinghouse that has any records or knowledge about me. ]/:~>
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0000000814 00000 n 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). DCl*mJUg=pq^:YnVX2rH-?MoX;V+!pDt12?)+Ag/%cNZV^V$#m+E*A#TQr? 22 0 obj startxref 0000000932 00000 n m-*&@,H9g(2[5#o!G;R4U9IEG=[4#Wq9g71
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<> IsNhEk,PeVb^BZe[*I4rabcN&lDZ'ULHK+-T$;u]WD3GH('p*58J'[(3mgr(:*0TR2iG4M503dao>uU! 3. Choose My Signature. If this is an Employer Sponsored Term Life Product with your policy number beginning with AFL, please use the forms below. ffBW;,%_AN*"_VFk^*[7l*M'q?n=q..L?F%d
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CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. startxref There are three variants; a typed, drawn or uploaded signature. 0;p5g%:Gd\>Io0dB\q^f8G>h/i$&$eAg8lGgN!bHFN/%]=BXD&^?mb,/u7t)rbDTL)pZ8Q"RdB*(8=i? mhQCujn[DM`k5Vu9TL8/lY,n@)69`YnLctGSmP1C9g-Y\7nk0=`m#b/(aquK(k!OU2OhA)L%au^_^KfM
/Encoding 4 0 R Consider filing online for faster claims payment! Get more info about Aflac for business owners.. Aflac promised to be here when you need us most and a big part of that promise is making the claims process easy. )F9)MP$gjIIV>!H
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View Site Continuing Disability Claim Form Aflac https://api.aflac.com/docs/claimforms/S13270.pdf Claims are subject to underwriting . 0000035380 00000 n EMnIpA`\`j9p%8Jb%g?3bB@@W^$A.t>R)@AV[$Gr+1aic5NY;`=A9#XB->:2MDO^@t[9!^9`hM)b9[&5Hfki>iJ2*idRMc*I1K7B)P.Ht.`'k-.R`,bZ1``cJ
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Request a quote dialog. To file a life insurance, disability insurance, or absence claim, click the button below to access the member portal. .8k,%=2e-? In CA, CAIC does business as Continental American Life Insurance Company (CAIC NAIC 71730) "iE5=j8``/gXCMXF
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Aflac Continuing Short Term Disability Claim Form Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf Please note: The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. 0000000932 00000 n 0000054519 00000 n 21 0 obj File a Critical Illness Claim via Fax or Mail. $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR
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0000000686 00000 n Administrative services are not insurance and are not considered legal advice. :b_AV)1V(ZcOZDX/m5A*jYG7Ls#=[g?T6ig2h"/>:-ToJWI)s^O
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