The Aflac hospital indemnity claim form is what turns a covered hospital stay into a cash benefit, and you can submit it three ways: online through your MyAflac account, by fax to 877-442-3522, or by mail to Aflac, 1932 Wynnton Road, Columbus, GA 31999. Filing online through SmartClaim is the fastest route and is the only path that qualifies for Aflac’s One Day Pay program.1Aflac. File via Fax or Mail – MyAflac Resources The form asks for your policy details, information about the hospital visit, and your authorization for Aflac to review the related medical records.
Pick the Form That Matches Your Policy
Aflac uses different forms for individual and group policies. Individual plans are underwritten by American Family Life Assurance Company of Columbus (or its New York affiliate for New York residents); group plans sold through an employer are underwritten by Continental American Insurance Company.2Aflac. Filing Claims The group hospital indemnity claim form is downloadable from Aflac’s group insurance site.3Aflac Group Insurance. Aflac Hospital Indemnity Claim Form For an individual policy, log into MyAflac to pull the right form or file directly online. Using the wrong form will stall processing, so check your policy documents or certificate if you’re unsure which coverage you have.
Gather These Documents Before You Start
Missing paperwork is the most common reason claims get held up. Have the following ready before you open the form:
- The UB-04 from the hospital — the standardized itemized facility bill showing admission date, discharge date, and charges during confinement. Request it from the hospital’s billing department. A health insurer’s explanation of benefits or a summary statement will not substitute.3Aflac Group Insurance. Aflac Hospital Indemnity Claim Form
- The HCFA-1500 from your treating physician — the standard professional services bill, separate from the hospital’s facility charges.4Aflac. Aflac Hospital Indemnity Claims Checklist
- Your policy or certificate number, found on your policy documents, your MyAflac dashboard, or your employer’s benefits portal.
- Your primary (major medical) health insurance provider name and ID number.
Hospitals can take a week or more to generate an itemized UB-04 after a long stay. Call the billing department shortly after discharge so the document is ready when you are.
Filling Out the Form, Section by Section
The group hospital indemnity claim form runs several pages, but each section is self-contained.3Aflac Group Insurance. Aflac Hospital Indemnity Claim Form
Policyholder and Patient Information
The opening section collects your full name, Social Security number, date of birth, gender, address, phone, email, employer name, policy number, and major medical insurance information. If the patient is a covered spouse or dependent rather than you, add that person’s name, date of birth, gender, and relationship to you. Double-check the policy number. A single transposed digit can bounce the claim back before anyone reviews the medical records.
Claim Details
This section asks whether treatment was for an injury or an illness, and the fields branch from there. For an injury, you’ll enter the date it happened, how it occurred, whether it was on or off the job, and whether a motor vehicle accident was involved. For an illness, you’ll enter the diagnosis, the date symptoms first appeared, the date of first treatment, and whether other physicians have treated the same condition. Pregnancy claims have a dedicated subsection for delivery date, type of delivery, and any complications.
Hospital Confinement Details
Enter the facility name and phone number, admission date, and discharge date. Separate yes/no questions cover intensive care, emergency room treatment, and surgery. An employer facility benefit provision subsection asks whether the hospital is your workplace or partners with your employer’s healthcare system, which can affect benefit calculations under certain group plans. You’ll also list your primary treating physician’s name, address, and phone number here.
HIPAA Authorization
A dedicated authorization page lets Aflac communicate with your medical providers to verify the stay. Print your name, certificate number, and address, then sign and date. If the patient is a minor or someone you legally represent, a separate line captures the legal representative’s signature and relationship. Aflac cannot process the claim without this authorization.
Electronic Funds Transfer
An optional section at the end sets up direct deposit for the benefit payment. Select checking or savings, enter the nine-digit routing number and account number, and provide the financial institution’s name and address. Setting this up on the form itself is faster than waiting for a paper check.
Submitting the Form
You have three ways to get the completed form and supporting documents to Aflac.
Online Through MyAflac
Log into MyAflac, select New Claim, answer the prompts, upload your documentation, sign electronically, and submit.5Aflac. Getting Started Guide Online filing through SmartClaim is the only route that qualifies for One Day Pay, which processes and disburses eligible claims within one business day when submitted by 3 p.m. ET Monday through Friday.6Aflac. Aflac Raises the Bar for Insurance Industry by Introducing One Day Pay
Fax
Fax the completed form and all supporting documents to 877-442-3522.1Aflac. File via Fax or Mail – MyAflac Resources Keep the transmission report. Missing pages are a common faxing problem.
Send everything to Aflac, 1932 Wynnton Road, Columbus, GA 31999.1Aflac. File via Fax or Mail – MyAflac Resources Use a tracked shipping method; the package contains your Social Security number and medical history. Confirm every page of the UB-04 and HCFA-1500 is in the envelope, because a partial itemized bill will trigger a request for the missing pages and reset your wait.
When to Expect Payment
Aflac processes most group hospital indemnity claims in about four days.7Aflac. Aflac Group Hospital Indemnity A claim filed online through SmartClaim with complete documentation attached can qualify for One Day Pay, provided it reaches Aflac by 3 p.m. ET on a weekday.6Aflac. Aflac Raises the Bar for Insurance Industry by Introducing One Day Pay Claims missing documents or needing extra verification from the hospital take longer. Payments arrive as a paper check unless you set up Electronic Funds Transfer on the form or in MyAflac.
Hospital indemnity benefits are fixed-dollar amounts written into your policy schedule, not a percentage of what the hospital billed. Check the schedule before filing so you know roughly what the claim should pay.7Aflac. Aflac Group Hospital Indemnity
Reasons a Claim Can Be Denied
A complete form with every document attached still won’t produce a payment if the stay falls under a policy exclusion. The common ones:8Aflac. Supplemental Group Hospital Indemnity Insurance
- Treatment for a pre-existing condition, unless more than 12 months have passed since your effective date of coverage.
- Childbirth within the first ten months of coverage, or a pregnancy that existed before coverage began.
- Elective surgery that isn’t medically necessary, within the first 12 months of coverage. Cosmetic surgery that isn’t medically necessary is excluded entirely.
- Hospital stays resulting from voluntary drug or alcohol use, unless the substance was prescribed and taken as directed.
- Intentional self-inflicted injury.
- Hospitalization for organ donation within the first 12 months of coverage.
Aflac also reserves the right to offset future benefits if it determines prior payments covered claims that weren’t actually eligible. Fraud in any part of a claim voids coverage for that claim entirely.8Aflac. Supplemental Group Hospital Indemnity Insurance
Tracking the Claim After You File
Log into MyAflac to see whether the claim is in review, whether Aflac needs additional documentation, and when payment has been issued. Without online access, call Aflac customer service; the number is on the back of your policy documents and on Aflac’s contact page.9Aflac. Contact Aflac Claims or Customer Service If the status flags a documentation request, respond fast. The processing clock effectively restarts once the missing item reaches Aflac.