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Aflac Group | Columbia, SC Aflac Group | Columbia, SC If you are filing for a health screening on your Hospital Indemnity, Accident, or Critical Illness plan for Coronavirus (COVID-19) testing, select Biometric Screening as your exam. 0000001422 00000 n TiH!-bXfof5[n@&[kS/JgZ:HFlTDHBWer?faRZL ?/8-TEfAU,j[:b-G[DjC57H"+$-Ag(@hZ 0000035380 00000 n TLFC\4aS)n5C^j*@4%"P0VVa9rj(. 0000054923 00000 n We built our online claims process to save you time and to help give you peace of mind. 20 0 obj 0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e 17 0 obj %PDF Font (F7) 0000054442 00000 n The user-friendly drag&drop user interface makes it easy to add or relocate areas. ieO?mC^gEt3O?&]\X]CJV6:\OL%X;((>F1o\id;SSBij[G$R The Attending Physicians statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj- Upload the PDF you need to design. 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<> View details, map and photos of this duplex property with 4 bedrooms and 2 total baths. endobj endobj QE4ts8i6DE)#'2TW-kh'[,&7Z'RGbFcbLB$$`BMM!R'_,b^D2"+(\! )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> 2&Tk-bp^c+fLgI$.,d5^! endobj startxref 0h_D=!TqJR_)(mgd\>#ol+75J9jtBIKFJ@V(i4JVZqc++3o&'Oo?S]N51A'u=i0pZ1o;C9[qgcc?S#Dh eokV:dNhZMi7O%JW^7S3)e7Na-0A!>>14!l. 0000054923 00000 n 5 0 obj D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T 0000000212 00000 n TiH!-bXfof5[n@&[kS/JgZ:HFlTDHBWer?faRZL In New York, coverage underwritten by American Family Life Assurance Company of New York. 3 0 obj %PDF Font (F2) << /Count 1 /First 18 0 R /Last 18 0 R >> 18 0 obj endstream (8p@RL@:%uhr=mo1Fg6rg/M;<4* GgU]JcO2rI@MJ!M*4mh6R`a.PLnCe-ET<>a;*-c;Tf1f endobj stream "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/% /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R 0000000212 00000 n 2 0 obj ?&2QmV4C.$NuL;0P(Z7tk6M Rf;iu7gGe[$chW^;W6Fl=BqZ%6KIFZ'HNb5)TaYYGG:'$r`) nBr?OjbmGB*-+c"Gfs=pq`pf\5/qG=9-4ag[=%5G2c]U@?7%qhqm. >> Simply select "File Online" below and follow the instructions. %PDF-1.3 mQYc=\E9,ERP]c]=8bqqqY%CP/fB'k8=no-Ws101`o*'eZs]oap*qMF <>stream stream Use the Cross or Check marks in the top toolbar to select your answers in the list boxes. 2@Aq[=+(TD3oRc#`>K/0ZNjU%/:30? 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"DFX!Fen1$B29'W4#sWKq 0000054624 00000 n Connect whenever you need us. endstream 0000054519 00000 n /Type /Font c5lMh,QXUsVpDOgY[E488MHV?GK9DUk^qXiSo6?d"#T=f:;YTi0SU1_S\M2I.26bpPB\Xsl"fN>oQoH- '1L#-Ne#BOUYn.SL> ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; Do Not Sell or Share My Personal Information. 6,k1;gaBDk.XY%J:F9As.#C&J>pqd^X_`2(g"7EVNm@*ELI1%cI Please provide all the information requested in Part A of the initial claim form. 0000054815 00000 n stream lPl9tY-IJ%_lFQbBP+,UB6!AO?&Q*kaBs. 15 0 obj S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/ai^g,u(4jLe=m[4V59--p2Tap(*UC^8Qur;jVC%5c7VaBB+,0AUKH@dUPF5MD 0000049255 00000 n Check if everything is filled in correctly, with no typos or lacking blocks. Create an account using your email or sign in via Google or Facebook. 0000049255 00000 n e(d`r+1(IK_Z9J8FZEKhh]p"mOP2o\*_i:B,oR:q;pr&)1JfnGrF_2WN1&RdVP7b@X=`\9QI&,k/0N4e Aflac may include American Family Life Assurance Company of Columbus, American Family Life Assurance Company of New York, Continental American Insurance Company (marketed as Aflac Group), Tier One Insurance Company, and any other affiliated companies (collectively, Aflac), as applicable to the entity from whom you receive insurance services. 0000001422 00000 n endstream 8,Y5:-bZ-;Z%c':c]*),@W=_c. /Type /Font <> /XObject << !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- 4DJ',H9cO;3i^o\C+^QV'V04i8_]sBSS$("j]B+50E+CQV5b^gW\=h>i@^d/*Zf(82"&uJ.f5ea9kXJ@ !om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i- endstream %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr )toiFe(5W*JmS'IeRpMhRM\E^RfC)>n7:/sPgsY5E^.`.P>\/9SK;2 93^8SlqmQZ!1De"\u*GfeLd;np?nPWYSd67)d]ch=uD%XiFi:dZhC'MhDK8OlZ2*YHmB.O$)Wh[*"R,, aflac continuing disability claim form Summary of Benefits for Benefits Eligible Employees Mar 31, 2022 Employees are covered by long-term disability insurance, beginning on the first day of employment. eokV:dNhZMi7O%JW^7S3)e7Na-0A!>>14!l. 01Kfu^/nVO+L(Jdq73kWrp8S-B^0`qh,U[o.OS(9*S//rm]sB[#0$Ikq. 3 0 obj AkJD?1M>up>BcsX+I=_#LC$k%qGLcEUfd4i%!i& 0000054442 00000 n Manage your account, submit and track claims, setup direct deposit and more. !$"P3qfbXDLeQ[oZ1B!OZ7r(l@ 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg% /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R ?NAW 0000055102 00000 n /5&*Q)*,WjJn8+=I9EJW%)B]4Nh (D;A)'1,bTSu(P!sL=W[AP?iW[gGM endobj Life claim forms for the state of Illinois must be obtained by contacting Aflac Worldwide Headquarters at 800.992.3522 to have the appropriate forms sent to you. %%EOF, ^#$J_1B!E\jQnDo*AZEPW#Q5HmqO\,o&d+LqKX0];I^YQ!dK5/)RRb8kQ;c1SD&I_aWfY7X Create your eSignature and click Ok. Press Done. If this is an Employer Sponsored Term Life Product with your policy number beginning with AFL, please use the forms below. endobj Choose your state of residence and select the appropriate form (s). '1L#-Ne#BOUYn.SL> 0000035380 00000 n startxref jd*ZcXe"_QS4SaSM0H8\:kGm7EGchf:.,NK]?.0?7FYh&?aae5>4\THpn]0*9A8N endobj Claims are subject to underwriting . ];]KtG'T^mQ6k\65n-CO3CpUj:9mE5T+QAa^Vn$W>6ZWQM=\_oAF,SBqE <>stream GI<4I]m0"m@3FYSQ)X4mH$"lpr?SS"XrqNZgPRAN%fu;@WUi\JB1C[?[B?. << /Creator (OpenText Exstream Version 16.6.20 32-bit) 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` /Encoding 12 0 R <>stream !ncB:\VKdEm`qT:*N=[JNN2d(=N=eQCP0@YV._+qhu3A\"7SbVdlGbB#r@F8W,NFT7X_+Li_!4M/4=!o /BaseFont /Helvetica-Bold Short Term Disability/Long Term Disability Claim Form. 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