Claim Requirements 

Critical Illness Claims

  • Completed Critical Illness claim form
  • Medical records including discharge summary from hospital
  • Positive pathology report (when filing claim for cancer) from doctor for initial claim
  • Itemized hospital billing statements showing medical CPT codes of procedures, descriptions, treatment, and charges

Cancer Claims

  • Completed Cancer claim form
  • Positive pathology report from doctor for initial claim
  • Itemized hospital billing statements showing medical CPT codes of procedures, descriptions, treatment and charges
    • UB04 form specific to surgery or ICU stays – if applicable
  • Blood, chemotherapy, and radiation treatment statements for continued care

Accident Claims

  • Completed Accident claim form
  • Medical Records providing proof of accident treatment and diagnosis (within 72 hours of the occurrence)
    • Doctor’s notes, hospital discharge summary, statement
  • Itemized hospital billing statements showing medical CPT codes of procedures, descriptions, treatment, and charges
    • UB04 form specific to surgery or ICU stays – if applicable
  • Police report if applicable for vehicular accidents
  • Proof of follow-up treatment with diagnosis

Wellness Claims

  • Insured’s name and SSN
  • Claimant’s name
  • Procedure that was performed
  • Date the wellness procedure was provided
  • Care provider’s contact information

Hospital Indemnity Claims

  • Completed Hospitalization claim form
  • Itemized hospital billing statements showing medical CPT codes of procedures, descriptions, treatment and charges
  • Police report if applicable

Disability Claims

  • Completed Disability claim form (all sections including Claimant Statement, Employer Statement, and Physician’s statement)
    • Employer’s Statement should include first report of injury report if an on-the-job accident
    • Physician’s Statement should include discharge summary from hospital if ER involved
  • Medical records
  • Itemized hospital billing statements showing medical CPT codes of procedures, descriptions, treatment, and charges

Carrier Online Login Info 

Transamerica. Colonial Life. Aflac. Guardian Life.

Transamerica

https://customers.transamericaemployeebenefits.com/Portal/Home/Default 

  • Initial Setup requires SSN and a policy number to verify status as policyholder – only required the first time. You are then free to set up a username and password to log in to your online account.

Transamerica Wellness Claim Instructions

Click here to download this form.

Transamerica Accident Claim Form Instructions

Click here to download this form.

Transamerica Accident Claim Form

Click here to download this form.

Transamerica Cancer Claim Form Instructions

Click here to download this form.

Transamerica Cancer Claim Form

Click here to download this form.

Transamerica Hospital Indemnity Claim Form

Click here to download this form.

Transamerica Short Term Disability Claim Form

Click here to download this form.

Transamerica Short Term Disability Instructions

Click here to download this form.

Colonial Life

https://www.coloniallife.com/individuals/claims

  • Will require a username and password to log in.

Colonial Life Wellness Claim Form

Click here to download this form.

Colonial Life Accident Claim Form

Click here to download this form.

Colonial Life Cancer Claim Form

Click here to download this form.

Colonial Life Critical Illness Claim Form

Click here to download this form.

Colonial Life Hospital Confinement Or Surgery Form

Click here to download this form.

Colonial Life Initial Disability Claim Form

Click here to download this form.

Colonial Life Medbridge (Hospital) Claim Form

Click here to download this form.

Aflac

https://phs.aflac.com/aflac.phs.app/account/login 

  • Create a username and password to log in.

Aflac Accident Wellness Claim Form

Click here to download this form.

Aflac Traditional Cancer Wellness Claim Form

Click here to download this form.

Aflac Traditional Accident Claim Form

Click here to download this form.

Aflac Traditional Cancer Claim Form

Click here to download this form.

Aflac Traditional Critical Illness-specified Event Claim Form

Click here to download this form.

Aflac Traditional Hospital Indemnity Claim Form

Click here to download this form.

Aflac Traditional Initial Disability Claim Form

Click here to download this form.

Guardian Life

https://www.guardianlife.com/forms

  • Will require a username and password to log in.

Guardian Life Wellness Claim Form

Click here to download this form.

Guide to Submitting a Cancer Claim

Click here to view the guide.

Guide to Submitting a Critical Illness Claim

Click here to view the guide.

Guide to Submitting an Accident Claim

Click here to view the guide.

Guide to Submitting a Hospital Indemnity Claim

Click here to view the guide.