This manual is a reference guide for associates to use with aflacs a8 series dental plan. Aflac dental doesnt have precertification requirements. If you choose to assign benefits, attach a signed and written request. Aflac expands product offerings with new dental and vision. Refer to the policy for complete details, limitations, and exclusions. Because aflac doesnt use a network of dentists, you can go to any dentist you choose. Aflac critical illness, accident, and hospital indemnity plans. Most aflac accident, hospital indemnity and cancer insurance policies have a wellness benefit to. We care about aflac s policyholders affected by recent severe weather. Schedule of dental procedures this schedule accompanies plan. Aflac dental form fill and sign printable template online. Aflac specified event form fill out and sign printable pdf. 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. Aflac dental form fill and sign printable template.
Aflac has come to be known as a high quality insurance company, so an aflac dental insurance coverage is one that can be trusted and relied on. Aflac is currently operating in the united states and in japan, where it currently holds a dominant position in the insurance market. Jan 12, 2021 insurers growth plan comprises continual evolution of product offerings to help meet u. If a covered ada code is revised or replaced by the american dental association, aflac will pay the amount shown in the schedule of dental procedures for the code most comparable to the revised or replaced code. I chose my dental policy after completing the process online via the california affordable care. How to generate an electronic signature for the aflac dental claim form yumpu on ios devices. This benefit is payable twice per policy year, per covered person. American family life assurance company of columbus aflac attn. Policy series c80000 how it works the plan has limitations and exclusions that may affect benefits payable. Aflac helps you cover expenses that health insurance doesnt, so you can focus on recovery. Aflac will pay the following benefits when a charge is incurred for covered dental treatment that is received while coverage is in force. American family life assurance company of columbus aflac worldwide headquarters columbus, georgia 31999 form a46075ss ic 907 hospital confinement indemnity insurance this insert page is to be used with policy series a46000, plans 2 and 3 only.
Dental insurance planhighlights freedomofchoice chooseanydentist. If the treatment is covered by your policy, you dont need aflac s permission to receive it. This plan is limited benefit supplemental insurance coverage and is not. Fill out, securely sign, print or email your aflac claim form instantly with signnow. Mar 31, 2020 the accident policy of aflac covers the broken tooth treatment in its policy.
For benefits to be payable, dental wellness visits must be separated by 150 days or more. Aflac hospital advantage hospital confinement indemnity insurance policy series a49000 p r eferr ed this brochure is for a hospital confinement indemnity policy providing limited benefits. This benefit is payable once per visit, regardless of the number of treatments received. The policyholders dental policy number available on their id card and enclosed in their policy the policyholders complete name as it is printed on their aflac dental id card. Claimsmaybefaxedto187744 aflac 18774423522 cwhciweb page1of1 0214. This website is an online resource for many of the insurance and benefit documents that you may need. Agc00558arup 812 aflac critical illness, accident, and hospital indemnity plans insurance coverage.
Please keep a copy of this completed form for your records. Many of the forms, benefits, policy provisions, etc. If you need to file a claim under another aflac policy. Fill out, securely sign, print or email your aflac specified health event claim form 20172020 instantly with signnow. Get and sign aflac dental claim form yumpu 20192021. Dentists pretreatment estimate dentists statement of actual services specialty see backside 3. Benefit assignmentbenefits are payable to the policy holder unless written authorizationis received from you or your healthcare provider to assign benefits to the provider. Aflac worldwide headquarters columbus, ga aflac group policies.
Aflac aflac new york wwhq 1932 wynnton road columbus, ga 31999. Aflac dental provides benefits for periodic checkups and cleanings, xrays, fillings, crowns, and much more. Aflac dental insurance standard coverage messer financial. If you own an ios device like an iphone or ipad, easily create electronic signatures for signing a aflac dental claim form yumpu in pdf format. Its no secret that routine dental care leads to good health, which reduces the risk of medical conditions that are complicated by poor oral health. By logging into, i acknowledge and agree that these terms, in addition to any other terms of confidentiality agreements and other agreements the agreements that i may have previously entered into with aflac will govern my use of. American family life assurance company of new york aflac new york attention. Claims for all other services covered by your policy must be submitted separately with the corresponding application form. Aflac specified event form fill out and sign printable. American family life assurance company of columbus worldwide headquarters 1932 wynnton road columbus, georgia 31999 aflac. Claims for all other benefits covered under your policy must be filed separately using the appropriate claim form. Benefits provided are supplemental and are not intended to cover all medical expenses. Aflac has been in the business for 50 years, and have been committed to ensuring the quality of your insurance coverage.
Refer to your certificate for complete details, definitions, limitations, and exclusions. This page must accompany the hospital confinement indemnity brochures, plans 2 and 3 only. This checklist is intended to assist policyholders when filing claims and does not constitute a guarantee of claims payments or act as an allinclusive list. Contact steven markham at 8552820008 tollfree or email. Only dental claims may be filed with this claim form.
Aflac will increase each covered persons policy year maximum by. For costs and complete details of the coverage, contact your aflac insurance agentproducer. This benefit is payable twice per policy year, per. Please call our tollfree number 180099 aflac 18009923522. Benefit assignmentbenefits are payable to the policy holder unless written authorization is received from you or your healthcare provider to assign benefits to the provider.
Claims department 1932 wynnton road columbus, ga 319997255 for information or help filing your claim, please call tollfree 18003663436 or visit our web site at tollfree fax number 18778440201 relationship. Dental claim form american dental association, 1999 version 2000 american dental association, 1999 1. Continental american insurance company caic, a proud member of the aflac family of insurers, is a whollyowned subsidiary of aflac incorporated and underwrites group coverage. Employees may enroll in aflac within 30 days from date of hire or during open enrollment. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Feb 17, 2020 aflac is one of the largest insurance providers in the united states and offers multiple policies such as accident, vision, dental, and life insurance. This benefit is not payable for hearing aids, wigs, or dental aids.
Start a free trial now to save yourself time and money. Please see your agent for the plan details specific to your employer. Any person insured under the coverage type you applied for. The treatment must be performed by a dentist or dental hygienist. Thats the benefit of the aflac accident insurance plan.
Mar 27, 2021 aflac dental insurance is a good option that is not too pricey and is good for basic dental care. Supplemental insurance by aflac alpine homecare, llc. If your aflac policy also provides a mammogram benefit, please mark the appropriate box and indicate the date the mammogram was performed. In new york, coverage will be underwritten by aflac new york. In 2021, for all states that have approved the aflac dental and vision insurance products, coverage will be underwritten by aflac. Alpine is offering supplemental insurance by aflac at discounted group rates to our employees up to 60% cheaper than. One of our agents will contact you shortly at the number you provided. Additionally, i agree to use the information and data contained within in accordance with all applicable federal and state.
Your dentist may prefer to file your claims electronically. American family life assurance company of columbus aflac. In new york, coverage is underwritten by american family life assurance company of new york. Complete aflac dental form online with us legal forms. Aflac individual dental insurance supplemental plan youtube. Aflac individual dental insurance supplemental plan. Refer to the policy, riders, and outline of coverage for complete details, limitations, and exclusions. This brochure accompanies schedule of dental procedures a82es75sch. Individual coverage is underwritten by american family life assurance company of columbus. Aflac dental insurance basic coverage messer financial. Cosmetic benefit rider a82051 after rider in force 24 months, aflac will pay benefits when charge incurred by covered person for eligible dental treatment that occurs while coverage in force. This benefit is payable once per covered accident, per covered person and is not payable for hearing aids, wigs, or dental aids, to include false teeth.
Aflac dental claim forms establishing a secure connection. Aflac dental insurance good dental care the unique and. American family life assurance company of columbus aflac worldwide headquarters 1932 wynnton road columbus, georgia 31999 aflac. Aflac critical illness, accident, and hospital indemnity plans arup. If you want to cancel an aflac policy or change providers, you can easily end individual or employerprovided coverage. Caic is not licensed to solicit business in new york, guam, puerto rico, or the virgin islands. American family life assurance company of columbus aflac brushuponallthedetails. Because aflac doesnt use a network of dentists, you can go to. Continental american insurance company dental claim. Aflac claim forms fill out and sign printable pdf template. The policy has limitations and exclusions that may affect benefits payable. To help provide relief for california policyholders residing in monterey or san luis obispo counties and are affected by recent winter storms, aflac will provide a premium grace period starting jan.
1045 850 152 390 205 740 1006 25 1644 1702 417 936 1590 1254 1426 1014 211 1522 537 256 761 248 173 1462 650 251 883 69