Aflac Vision Claim Form
Please do not fax this completed form to aflac.
Aflac vision claim form. If you are filing for the eye exam benefit or the vision correction benefit please use form s 00222 vision nowsm eye exam vision correction materials claim form. Post office box 84075 columbus ga. Please use the claim appeal form to organize your request.
New claim form pdfs for web cw06198vs author. New claim form pdfs for web s00221 author. Aflac vision qnv1000 series.
Incomplete forms cannot be processed and will be returned. Save or instantly send your ready documents. To sign a aflac claim form right from your iphone or ipad just follow these brief guidelines.
In 2021 for all states that have approved the aflac dental and vision insurance products coverage will be underwritten by aflac. Aflac claims appeals po box 84065 columbus ga 31908 9998. Mark only wellness exam box es for test s that you had performed.
Please be sure to explain why you disagree with aflac s decision and include any additional supporting documentation. In arkansas policy form qnv1100mar. Vision nowsm eye exam vision correction duck.
Easily fill out pdf blank edit and sign them. Applies to policy series qnv1000. In new york coverage will be underwritten by aflac new york.
You have the right to appeal a decision up to a maximum of three times per claim. Aflac wwhq 1932 wynnton road columbus ga 31999. Obtain a form by calling 1 800 99 aflac 1 800 992 3522.
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