Claims Forms

For Aflac

Accidental Death Claim Form

Accidental Injury Claim Form

Dental Claim Form

Authorization Form

Cancer Annual Care Benefit Form

Cancer Claim Form

Direct Deposit for Claim Payments

Disability Claim Form - Initial

Disability Claim Form - Continuing

Hospital Indemnity Claim Form

Hospital Sickness Claim Form

Physicians Visit Benefit Claim Form

Specified Event Claim Form

Vision Claim Form (Eye Accident)

Vision Claim Form (Eye Exam)

Wellness Claim Form (Accidental Hospital)

Wellness Claim Form (Cancer)

Wellness Claim Form (Vision)

Our Office

1640 S 70th St #200,

Lincoln, NE 68506

Contact Us

(402) 904-3026
sallberry@goueb.com

Office Hours

Mon-Fri: 8:30am – 5:00pm
Sat-Sun: By Appointment

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