Aflac Group cancer insurance claims, underwritten by Continental American Insurance Company, use this seven-page form. The attending physician's statement on page 3 records the type of cancer, initial diagnosis date, treating physicians, hospitalization, surgery, and chemotherapy or radiation. For a first claim, the pathology report or exam with diagnosis is required.
The policyholder completes the policyholder and patient information and any transportation or lodging log, and signs with the patient. The attending physician completes the statement on page 3 and signs with degree and medical ID number.
Download the current version from the source each time; forms change without notice.
Aflac Group Cancer Claim Form
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Yes, for the first claim. The physician's statement asks whether the patient has been diagnosed with cancer and, if so, to submit the initial pathology report or exam with diagnosis. The policyholder section also asks for the date a pathologist first diagnosed the cancer.
Only with an assignment. Benefits are payable to the policyholder unless Aflac receives written authorization from the policyholder or the healthcare provider to assign benefits to the provider. To assign, a signed written request goes in with the claim.