File a Claim
Aflac New York Group makes it easy to file a claim

What type of coverage are you filing a claim?

We're here to help you. Each of our representatives is prepared to answer your questions about your plans, and we're proud to offer interpretation services for more than 50 languages.

If the information you need isn't addressed below, give us a call. We look forward to helping you.

Claims

For the most efficient service, please follow these instructions and provide as much information as possible. All claims require a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Claims can be mailed to:

Continental American Insurance Company
Post Office Box 84075
Columbus, GA 31993

groupclaimfiling@aflac.com

or faxed toll-free to: 1.866.849.2974

Aflac NY Group HIPAA

Aflac New York Group Hospital Indemnity Plan

A hospital indemnity claim requires supporting documentation for review of benefits, itemized bills showing medical treatment dates and diagnosed conditions, hospital admission and discharge papers for inpatient hospital admission and confinement benefits, pharmacy receipts for prescription drug reimbursement, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement.

Hospitalization Claim Form

Aflac New York Group Accident

Please provide a date and complete description of your accident. You can provide this information in the designated space on the claim form.

If the accident resulted from the use of a motor vehicle(s), a copy of the police or accident report is required. If your injury occurred on the job, a first report of injury filed with your employer must be attached to the completed claim form.

If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure.

Please include all dates of treatment and charges incurred due to the accident.

Please date and sign all required forms where indicated.

Accident Claim Form

Aflac New York Group Critical Illness Plan

For critical illness claims, we need information from you and your attending physician. Please provide all information requested on the Insured's Statement portion of the claim form. The Attending Physician’s statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the

 Critical Illness Claim Form

Health Screening Benefit or Wellness Benefit Claims

Please fully complete the claim form for the Accident Wellness Benefit or the Critical Illness Health Screening Benefit.

Please date and sign all required forms where indicated.

Accident Wellness Claim Form

Critical Illness Wellness Claim Form

Universal Life Insurance underwritten by Trustmark Insurance Company

To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form.

  • Download the form.
  • Fill it out.
  • Send it in to: PO Box 60676, Worcester, MA 01606

Claim Forms

NY - Death Benefit Claim Form

NY - Accelerated Death Benefit Claim Form

NY - Waiver of Premium Claim Form-Initial

NY - Waiver of Premium Claim Form-Continuance

NY - Waiver of Premium Claim Form-Permanent

NY - Convalescent Care Benefit Claim Form

Service Forms

Change Your Name

Change Your Beneficiary

Secondary Addressee

Automatic Bank Draft/Electronic Funds Transfer

Request Loan

Request Life Surrender

Request Partial Life Surrender

Change of Ownership

Change of Age (Birthdate)

Removal of Riders

New York Domestic Violence Notice (For Life Insurance Policyholders)

Lost Check Agreement