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Aflac Administration and Service GuideWe appreciate your business
Z150676 7/15
Date:
Dear
We’re glad to have you, and your employees, as part of the Aflac family.
As a pioneer of supplemental insurance, Aflac began with a simple promise: to be there for policyholders in their time of need. Our company still operates this way today and is committed to paying claims fairly and promptly. In fact, when it comes to paying claims, no one flies faster.
At Aflac, we make it a priority to pay claims as fast as possible because expenses won’t wait, and neither should those who rely on us. One Day PaySM* is designed to process and pay, not deny and delay.
I am pleased to be your local Aflac agent and look forward to serving you. I believe in the value of conducting business face-to-face, so please expect me to contact you throughout the year to ensure your needs are being met. However, of course, never hesitate to contact me if a need or question arises.
Enclosed are results from open enrollment as well as resources that will be valuable to keep on hand.
I’d like to personally thank you for choosing Aflac, and I look forward to working together on your company’s benefits program.
At your service,
*One Day PaySM available for most properly-documented, individual claims submitted online through Aflac SmartClaim® by 3 p.m. ET. Aflac SmartClaim® not available on the following: Short-Term Disability (excluding Accident and Sickness Riders), Life, Vision, Dental, Medicare Supplement, Long-Term Care/Home Health Care, Aflac Plus Rider and Group policies. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2015.
Individual coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, individual coverage is underwritten by American Family Life Assurance of New York.
7/15 Z150676
Table of Contents
Aflac Contacts
About Aflac
3
1
What To Do When7
Frequently Used Forms
New Hire Letter/Flyer New Hire Notification FaxEmployee Separation Fax
8
Product Offering2
Service Schedule4
Employee Deductions, Online Billing, and Invoicing5
6 Open Enrollment Annual Enrollment Agreement Enrollment Results
For Your RecordsSalary Redirection Agreements,Participation Waivers
Cafeteria Plan Documents (Section125 Tax Information) Deduction Summary
9
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance
Company of New York.
*One Day PaySM available for most properly-documented, individual claims submitted online through Aflac SmartClaim® by 3 p.m. ET. Aflac SmartClaim® not available on the following: Short-Term Disability (excluding Accident and Sickness Riders), Life, Vision, Dental, Medicare Supplement, Long-Term Care/Home Health Care, Aflac Plus Rider and Group policies. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2015.
7/15
About Aflac
Aflac was founded in 1955 by three brothers who knew Americans needed financial support when an
unexpected accident or illness strikes.
As a pioneer of supplemental insurance, Aflac began with a simple promise: to be there for policyholders in
their time of need. The company still operates this way today and is committed to paying claims fairly and
promptly, most within an average of 4 days. And with One Day PaySM, you can get paid in just one day when
you submit claims online by 3 p.m. ET.* Aflac is a Fortune 500 company and a leader in voluntary insurance
policies that pay cash benefits directly to policyholders so they can focus on getting better instead of
worrying about how they’ll pay the bills. Insuring more than 50 million people worldwide, Aflac is the
principal subsidiary of Aflac Incorporated, an international holding company based in Columbus, Georgia.
In 1958, Aflac developed a ground-breaking cancer expense policy. In its initial year 5,810 plans were sold, and
by the end of the decade 376 agents were selling insurance in Georgia, Alabama, and Florida. Additional
policies were added and are continually enhanced to ensure Aflac offers a robust, innovative portfolio of
products to help your employees be better prepared for whatever life may throw their way.
Today, more than 400,000 businesses offer their employees Aflac via the convenience of payroll deduction -
making worksite the largest distribution channel for Aflac.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Z150676
1“World’s Most Ethical Companies,” Ethisphere magazine, Q1 2015. [quarterly] 2“100 Best Companies to Work For,” Fortune magazine, February 20153“Masters of Technology,” InformationWeek magazine, September 11, 20124“50 Best Companies for Latinas to Work for in the U.S.” Latina Style magazine, August 2014. [monthly/bimonthly]5“40 Best Companies for Diversity,” Black Enterprise magazine, January 15, 2015. [monthly] 6“The Global 2000,” Forbes magazine, May 7, 20127“Training Top 125,” Training magazine, February 2010. [monthly]
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Reputation matters when it comes to selecting a provider you can trust.As an nine-time recipient of Ethisphere’s World’s Most Ethical Companies designation1 and a 16 time
recipient of FORTUNE Magazine’s 100 Best Companies to Work For award,2 Aflac believes that a key to
our success is the spirit of trust that has been built over time.
Aflac Incorporated, listed on the New York Stock Exchange since 1974 under the ticker symbol AFL, has
total assets of more than $119.7 billion, with annual revenues surpassing $22.7 billion (Aflac 2014 Year in
Review). In 2014, Aflac U.S. and Aflac Japan paid or provided for $12.9 billion in benefits for insureds.
GLOBAL 2000EVERY YEAR SINCE THE
RECOGNITION BEGAN IN 20046
WORLD’S MOST ETHICAL COMPANIES
EACH YEAR SINCE THE AWARD’S INCEPTION IN 2007 –
THE ONLY INSURANCE COMPANY IN THE WORLD
THAT CAN MAKE THAT CLAIM.1
BLUE-RIBBON COMPANY
6 YEARS
WORLD’S MOST ADMIRED COMPANIES
14 YEARS
“LIFE AND HEALTH” WORLD’S MOST ADMIRED
COMPANIES
FORTUNE 500
GLOBAL 500
100 BEST COMPANIES TO WORK FOR
17 CONSECUTIVE YEARS2
40 BEST COMPANIES FOR DIVERSITY
9 YEARS5
TOP 125 EMPLOYER-SPONSORED WORKFORCE
TRAINING AND DEVELOPMENT PROGRAMS,
10 YEARS7
50 BEST COMPANIES FOR LATINAS TO WORK FOR
IN THE UNITED STATES 15 YEARS4
500 MOST INNOVATIVE USERS OF CORPORATE
TECHNOLOGY 10 YEARS3
DOW JONES SUSTAINABILITY
INDEX, NORTH AMERICA LIST
4 CONSECUTIVE YEARS
For more information about Aflac, visit aflac.com/aboutaflac
Z150676
FORTUNE
7/15
Citizenship at AflacAflac, our employees, and the independent sales agents across the country are involved in many
philanthropic organizations throughout our communities. Since 1995, Aflac has raised and donated more
than $98 million to the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, a
national leader in the research and treatment of childhood cancer and blood disorders. In 2013, the Aflac
team in the U.S. contributed more than $8 million for the treatment and research of childhood cancer.
Aflac Smart Green
At Aflac, we choose, use, and dispose of materials wisely. From the materials
we use in our daily operations to helping our employees be good stewards,
we are working hard to implement responsible practices across our company
to be good stewards of our natural surroundings. We are also providing tools that enable our policyholders
to reduce their impact on the environment. In recognition of our efforts, we have been included on the Dow
Jones Sustainability Index for four consecutive years.
Aflac is involved in the following environmentally-friendly initiatives that we refer to as
our SmartGreen philosophy:
67% Employees are
women
28%Officers are women
22 %
Officers areminority
49 %
Management(supervisor level and above) are women
23 %
Management(supervisor level and above) are minority
43% Employees are
minority
33% Employees are
minority women
Diversity at Aflac
Business Operations
Facilities Management
Waste Management
Employee Engagement
Strategic Sourcing and Procurement
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676
Product Overview
1Injury Facts, 2014 Edition, National Safety Council.2"Costs for Hospital Stays in the U.S.," Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, October 2014, P. 4. 3Cancer Facts & Figures 2013, American Cancer Society.
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Short-Term DisabilityProvides you with a source of income if you’re disabled due to an accident or illness.LifeHelps your family through the tough times with funds to help pay the bills if something happens to you.
Availability varies by state. Short-Term Disability policies: in Idaho A57600IDR; in Oklahoma A57600OK and A57600LBOK; in Virginia A57600VA and A57600LBVA. Life policies: in Idaho and Oklahoma ICC64100, ICC64200, ICC64300, and ICC64500; ICC1368100, ICC1368200, ICC1368300, ICC1368400.
Hospital ConfinementEases the financial burden of hospital stays due to an accident or illness by providing cash benefit. DentalProvides benefits for periodic checkups and cleanings, X-rays, fillings, crowns and much more. VisionHelps with the costs of eye exams, treatments, and vision correction materials.
Availability varies by state. Hospital Confinement Indemnity policies: in Idaho A49100ID–A49400ID and A4910HID; in Oklahoma A49100OK–A49400OK and A4910HOK; and in Virginia A49100VAR–A49400VAR and A4910HVAR. Dental policies: in Arkansas A82100RAR through A82400RAR; in Idaho A82100RID through A82400RID; in New York NY82100 through NY82400; in Oklahoma A82100ROK through A82400ROK; in Oregon A82100ROR through A82400ROR; in Pennsylvania A82100RPA through A82400RPAR; in Texas A82100RTX through A82400RTX; and in Virginia A82100RVA through A82400RVA. Vision policies: in Arkansas VSN100AR; in Idaho VSN100ID; in New York NYVSN100; in Oklahoma VSN100OKR; in Oregon VSN100OR; in Pennsylvania VSN100PA; in Texas VSN100TX; and in Virginia VSN100VA.
AccidentReduces the financial impact of an accident by providing cash benefits.Cancer/Specified-DiseaseHelps with the costs of cancer treatment.Critical Illness (Specified Health Event) Helps with the costs of treatment if you experience a covered health event, such as a heart attack, stroke, or paralysis.Lump Sum Critical Illness Provides a lump sum cash benefit if you’re diagnosed or treated for a covered critical illness event, such as a heart attack, stroke, or paralysis.Lump Sum CancerProvides a lump sum cash benefit if you’re diagnosed with cancer.
Availability varies by state. Accident policies: in Idaho A35100ID through A35400ID, A35B24ID & A35BOFID; in Oklahoma A35100OK through A35400OK, A35B24OK & A35BOFOK; and in Virginia A35100VA–A35400VA, A35B24VA & A35BOFVA. Cancer/Specified-Disease policies: in Idaho A78100ID through A78400ID; and in Oklahoma A78100OK through A78400OK. Critical Illness (Specified Health Event) policies: in Idaho Policies A71100ID and A71200ID; in Oklahoma A71100OK and A71200OK; and in Virginia A71100VA and A71200VA. Lump Sum Critical Illness policies: in Idaho A73100ID and A7310HID; in Oklahoma A73100OK and A7310HOK; and in Virginia A72100VA. Lump Sum Cancer policies: in Idaho A72200ID; in Oklahoma A7200OK; and in Virginia A72200VA.
$10,400is the average cost of a hospital stay in the U.S.2
1-in-2The lifetime risk of U.S. men for developing cancer. For
women the risk is a little more than one-in-three.3
1-in-8people seek medical attention
for an injury each year.1
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676
Your Aflac associate(s):
Name
Address
City, State, Zip
Phone
Broker:
Name
Address
City, State, Zip
Phone
Regional Sales Coordinator:
Name
Address
City, State, Zip
Phone
Your Aflac associate(s):
Name
Address
City, State, Zip
Phone
District Sales Coordinator:
Name
Address
City, State, Zip
Phone
Market Office:
Name
Title
Address
City, State, Zip
Phone
Aflac Contacts
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676 7/15
HQ Customer Service
Aflac’s Customer Service Center — staffed by more than 500 professional representatives in Columbus,
Georgia and Nebraska — is the communication line to our clients and policyholders. While most of our
competitors have automated their telephone systems with elaborate menus, our clients and policyholders
continue to speak to a friendly, knowledgeable customer service representative each time they call.
ONLINE
ONLINE
ONLINE
PHONE
PHONE
aflac.com/BusinessServices Register for online billing to make it easy.
aflac.com/mypolicy
1.800.99.Aflac (800.992.3522) 8 am to 8 pm ET, Monday through Friday
800.99.Aflac (800.992.3522) 8 am to 8 pm ET, Monday through Friday
FAX
1.800.448.8922
FAX
877.442.3522 Fax completed claim forms
aflac.com/mypolicy
Aflac Worldwide Headquarters ATTN: Claims Dept. 1932 Wynnton Road Columbus, Georgia 31999MAIL
For Employers
For Policyholders
To Submit a Claim
Go to aflac.com/claims to download or submit claim forms. For telephone claim form requests,
please call 800.99.Aflac (800.992.3522) between 8 am to 8 pm ET, Monday through Friday.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676 7/15
M2216 5/15
*One Day PaySM available for most properly documented, individual claims submitted online through Aflac SmartClaim® by 3 PM ET. Aflac SmartClaim® not available on the following: Short-Term Disability(excluding Accident and Sickness Riders), Life, Vision, Dental, Medicare Supplement, Long Term Care/Home Health Care, Aflac Plus Rider and Group policies. Aflac processes most other claims in about four days. Processing time is based on business days after all required documentation needed to render a decision is received & no further validation and/or research is required. Individual Company Statistic, 2015. For an optimal online experience, we recommend using one of these popular browsers: Internet Explorer, Safari, Chrome or Firefox. Some functionality may not be available in other browsers. Also, depending on your settings, your pop-up blocker may need to be disabled. Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Worldwide Headquarters | 1932 Wynnton Road | Columbus, GA 31999.
Enjoy the convenience and ease of managing your policy online Because life happens outside of business hours
Aflac Policyholder Services, our online policyholder service center, gives you 24/7 access to your
account and the tools to manage your policy whenever you need to. Register today to see how easy it is to
have Aflac. Go to aflac.com/mypolicy and click Register Now.
And, when it comes to paying claims, no one flies faster. We process, approve and pay in just a day.* You only have to:
My Policies Aflac Always® My Claims Personal InfoView your policies, coverage details, make a payment, or submit changes.
Sign up to ensure you keep your policies and never experience a lapse in coverage, no matter if your employment or other benefits change.
Initiate claims online with Aflac SmartClaim®, upload supporting documents, review details, status, and download forms.
Update your contact information, change password, and view your Message Center.
USE SMARTCLAIM UPLOAD SUPPORTING DOCUMENTS
SUBMIT BY 3 PM ET
To learn more or apply for coverage, contact your Aflac agent at
or call
Aflac account number
Initial plan year start and end Effective date
Date of first deduction
Payroll cycle Audit first invoice and payment
Annual Benefits Review
Enrollment strategy and planning begins:
Quarterly Service Visits
Service Visit #1 Service Visit #3
Service Visit #2 Service Visit #4 & Enrollment Planning
Account Schedule Account Information
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Z150676 7/15
Employee Deductions, Online Billing, and Invoicing
Aflac bills in arrears, meaning your payroll deductions should occur before your first invoice date.
Or, stated another way, Aflac invoices reflect deductions that you have already withheld from each
employee’s paycheck. This helps ensure that you have the funds needed at the time of invoice.
Take some of the hassle out of benefits administration with Aflac Business Services,
a Web service that makes managing your account easy.
Register and login to Aflac’s secure, easy-to-use site to manage your account at your
convenience. Go to Aflac Business Services at aflac.com/BusinessServices
Sign up for online billing to receive push email notifications when your invoice is ready, make
payments electronically, and enjoy faster processing and more accuracy of your Aflac account.
Fast, easy access to your account information
View and update account and/or employee information
View invoice and payment options
Print commonly used forms
Username Password
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Z150676 7/15
Aflac Business Services
View Employee Information The Invoice screen provides detail on each policy, including premiums and payment. You can review each employee’s deduction for any discrepancies as well as change the amount sent for payment. Be sure to choose the type of change from the drop-down menu on the appropriate line.
Payment Options An electronic payment ensures timely processing of changes and more accurate invoices. Changes to the invoice cannot be fully processed until payment is received. Business Services allows you to:
• Enter bank draft information and submit a one-time electronic payment.• Schedule a payment up to five days past the invoice due date with the Payment Scheduler
feature.• Print a payment stub and pay with a paper check.
The Aflac Advantage Annual Enrollment Agreement
Aflac offers enrollment services and solutions to fit any need. From selecting the right product offering
to benefits education and enrolling, we’ll work with you to design an open enrollment experience that
meets the needs of you, your business and your employees.
This plan is our commitment to: Account Name Account Number
Open Enrollment takes place:
Dates
Aflac Enrollment (check all that apply):
Term Life
Critical Illness
Accident
Hospital Confinement
Lump Sum Critical IllnessVision
Whole Life Juvenile Life
Dental
Short-Term Disability
Cancer
Lump Sum Cancer
No. of eligible employees:
We will communicate to your benefit-eligible employees the value of the following benefits that you currently offer (check all that apply):
Major Medical Dental Group STD Group LTD
Group Term Life Health Care FSA 401K Long Term Care
Legal Plans Tool Expense
Please note: Selecting this option requires that we are given necessary information regarding the total benefits offerings in
a timely manner. We will provide a basic overview of your current benefit plan to your employees, describing coverage,
and answering any questions. This does not include Aflac Group products.
New Hires: We will be available to meet with your new hires to ensure that they understand what’s
available and have the opportunity to enroll off-cycle. (i.e. – monthly, quarterly, biannually, etc.)
Employees who elect not to participate in any benefit options must sign a waiver which confirms the offer was made
and their desire to waive coverage.
Enrollment Conditions
or
I ndividual Meetings: Aflac Benefit Specialists will meet with each benefit-eligible employee during (check one)
meetings at a date and time which we agree on. If necessary, we can meet during all 3 shifts.
Group Benefit Briefings: We will introduce the program to employees during (check one) or group meeting(s).
group meeting(s). We will then follow-up with each benefit-eligible employee that expresses interest individually to discuss
their personal benefit needs.
voluntaryrequired
Vision
Dependent Care
FSA Other
voluntaryrequired
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Meeting Needs
The company will have a representative assist, and if necessary, attend all enrollment meetings.
For required meetings, a roster of employees will be verified and provided by a company representative.
minutes per employee during normal business hours (excluding lunch The company agrees to allow up to or breaks) for presentations of the program.
Benefits Communication & Marketing
The company agrees to use the following marketing and communication channels to create awareness
and educate employees before, during- and post-enrollment.
Data Needs
The company will provide a complete list of all employment locations including the address, number of employees at each location, and point of contact to schedule and coordinate enrollment.
Other
Our signatures below demonstrate acknowledgment of the Enrollment Agreement and commitment to this year’s enrollment.
Company Representative Signature/ Date Aflac Representative Signature/ Date
Title Title
Please Type or Print Name Please Type or Print Name
Payroll Stuffers
Posters/Flyers
Product Videos
Tent Cards
Personalized letter to current policyholders (Aflac Benefit Letter)
Website Banners
Other
This is not a legal-binding contract; only used for planning purposes.Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676
What to do when you are Plan Administrator/Employer and
You have a new hireContact your local Aflac agent so your new employee can receive a welcome letter.
Notify your employee of the next scheduled enrollment date based on the
scheduled visits for new hire enrollments.
An employee separates from the company
Provide them with a copy of the Policy Services flyer (page 10) notifying them about the portability of Aflac products.
Contact your local Aflac agent or inform via fax so that we can initiate their option to continue their coverage.
Should you require additional assistance to ensure that the invoice is reconciled to reflect any changes, do not hesitate to contact your local Aflac agent or any other contacts provided. We will be happy to assist.
You have questions about your invoice or deductions Contact your local Aflac agent via phone or email, or any other contacts provided.
Contact Aflac HQ Customer Service Center.
Log in to your account via aflac.com/BusinessServices
What to do when Your Employee
Has a question about Aflac coverage or needs to make a change to their policy
Contact your local Aflac agent via phone or email.
Contact Aflac HQ Customer Service Center.
Log in to account via aflac.com/mypolicy
Needs to file a claim
Contact your local Aflac agent via phone or email.
Download a claim form at aflac.com/claims or initiate a claim online at aflac.com/mypolicy Contact Aflac HQ Customer Service Center.Fax completed claim form to Aflac HQ Claims (see page 10).
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. Z150676 7/15
New hire letter/flyer
New hire notification fax
Employee separation fax
Frequently Used Forms
John Example
1932 Wynnton Road
Dear <Employee Name>,
You work hard for your paycheck, and we’d like to help you protect it.
We know that life is a balancing act. It’s about standing up to the expected and unexpected every day. For 60 years, we’ve been dedicated to helping people protect their financial security and peace of mind when they’ve needed it most.
While you can’t possibly foresee everything that can come your way, you can make smart choices so you are better prepared for the things life can throw at you. That’s why I’d like to talk to you about Aflac insurance.
Aflac is different from health insurance; it’s insurance for daily living. While major medical insurance pays doctors and hospitals, Aflac pays cash benefits directly to you.1 Benefits are paid regardless of any other coverage you may have—even workers’ compensation. And because we want you to be able to focus on getting better and not worry about how you will pay the unexpected medical bills or other everyday living expenses such as rent/mortgage payments, we focus on getting you cash as quickly as possible. Most claims are paid within four days and with One Day PaySM, eligible claims can be paid in just a day when you submit online.2 And you use the money however you see fit.
When you have an Aflac policy, it belongs to you, not your company. You own it. So if you change jobs, don’t worry.
For more information about Aflac policies and to apply for coverage, call us at <XXX.XXX.XXXX>.
You’ll always have our promise that we’ll help protect you and your family. I look forward to assisting you.
<Agent Name>, <CA License No.>
<Agent Phone>
<Agent Email>
You can’t predict it. But you can help protect it.
<Name> <Address 1> <Address 2> <City, State, Zip>
1Benefits are paid directly to you, unless otherwise assigned. 2One Day PaySM available for most properly-documented, individual claims submitted online through Aflac SmartClaim® by 3 p.m. ET. Aflac SmartClaim® not available on the following: Short-Term Disability (excluding Accident and Sickness Riders), Life, Vision, Dental, Medicare Supplement, Long-Term Care/Home Health Care, Aflac Plus Rider and Group policies. Most other claims are processed within four days. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2015. Aflac processes most claims in about four days. Processing time is based on business days, after all required documentation needed to render a decision is received and no further validation or research is required. Aflac Individual Company Statistic, October 2015. Individual coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Assurance Company of New York. Worldwide Headquarters | 1932 Wynnton Road | Columbus, Georgia 31999
Z150263R 7/15
SAMPLE
Company Name:
Employee Name:
Phone Number:
Hire Date:
Attention:
Phone:
Fax:
Please be advised that we have a new employee!
Thanks,
New Hire Fax
Disclaimer: Sending this fax doesn’t remove said employee from the monthly invoice and those changes should be submitted online via Aflac Business Services.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Z150676 7/15
Company Name:
Employee Name:
Separation Date:
Address:
Home Phone Number:
Attention:
Phone:
Fax:
The above named employee is no longer employed by
Please notify them of their options to continue coverage on a direct basis.
Thanks,
Employee Separation Fax
[Enter Account Name].
Insert
Wellness Claim Form
<Insert deduction summary>
<Insert copies of Salary Redirection Agreements/Waivers>
<Insert copies of Section 125 plan documents>
For Your Records
Insert
deduction summary
Insert
copies of Salary Redirection Agreements/Waivers
Insert
Insert copies of Section 125 plan documents
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Customer Satisfaction SurveyMark Appropriate Answer
How would you rate your experience with Aflac?
Excellent Good Fair
How would you rate the ease of doing business with Aflac?
Excellent Good Fair
How would you rate the benefits communication and enrollment experience with Aflac?
Excellent Good Fair
Would you recommend Aflac to other businesses?
Yes No
If so, please take a moment to write down the contact information of three people you know or do business with that would benefit from having Aflac.
Company Name
Contact Person
Phone #
Company Name
Contact Person
Phone #
Company Name
Contact Person
Phone #
1
1
2
2
3
3
4
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
Z150676
One Day PaySM available for most properly-documented, individual claims submitted online through Aflac SmartClaim® by 3 p.m. ET. Aflac SmartClaim® not available on the following: Short-Term Disability (excluding Accident and Sickness Riders), Life, Vision, Dental, Medicare Supplement, Long-Term Care/Home Health Care, Aflac Plus Rider and Group policies. Processing time is based on business days after all required documentation needed to render a decision is received and no further validation and/or research is required. Individual Company Statistic, 2015. Individual coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, individual coverage is underwritten by American Family Life Assurance Company of New York. Worldwide Headquarters | 1932 Wynnton Road | Columbus, GA 31999Z150676 7/15
Accident Cancer HospitalLump Sum Cancer
Lump Sum Critical IllnessCritical Illness
