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Web or • mailcompleted claim form to: Press done after you fill out the form. To qualify for reimbursement from flexible spending accounts, expenses must be incurred during the plan year for which you are requesting reimbursement. Any person who knowingly and with intent to defraud any insurance company, files a statement of claim
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Web 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. Apply a check mark to indicate the answer wherever necessary. Failure to completeall sections may result in delayed processing of this claim. Web 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.
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