Aflac is a company that provides supplemental insurance plans for individuals and groups. If you are interested in obtaining a policy through Aflac, or if you would like to learn more about the company, you can fill out an interest form on their website. The form allows you to provide information about yourself and your needs, and it will help Aflac determine what policies might be right for you. Filling out the form is easy and takes only a few minutes, so it's a great way to get started on finding the right coverage.
Question | Answer |
---|---|
Form Name | Aflac Interest Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | aflac interest printable, aflac application forms, aflac interest sheet, aflac blank form |
Aflac Interest Sheet
1 Personal Info **Please complete all fields**
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Job Title:______________________________________ |
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(Includes all children up to age 26) |
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Address: _____________ |
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2 Available Plans **Want more information? Just check the plan you would like to hear more about**
Individual |
Employee & Spouse |
1 Parent Family |
Family Plan____ |
Accident
Cancer
Hospital
Specified Health Event (HEART/STOKE)
Life
Dental
Vision
Short Term Disability
Disability quoted individually based on salary and other criteria.
3 How Aflac Works
AFLAC pays CASH benefits directly to you, not the doctor or hospital.
AFLAC benefits can be used to pay
AFLAC benefits are designed to pay every day living expenses like Rent or mortgage, groceries, utilities, car payments and more.
AFLAC plans are GUARANTEED renewable, meaning we will never cancel on you. AFLAC policies are PORTABLE. Even if you change jobs, you can take it with you. AFLAC has NEVER had a rate increase, so you know the cost in the future.
AFLAC pays 92% of our claims in 4 days, so you get the money when you need it most. AFLAC has been named Ethisphere’s ost ETHICAL I sura ce Co pa y 5 years i a row! AFLAC plans provide a safety net of cash for about an hour’s wage per week
AFLAC policies can be extended to cover the whole FAMILY
Your Agent: Juanita Burks, CA License # O640977
Phone:
email: Juanita_burks@us.aflac.com
4 Policy Infromation
Accident Indemnity Advantage
Covers you & your family 24/7
At work, Sports, School, Home and Commuting
Pays $1,000 initial Hospitalization benefit/$2000 Intensive Care
Hospital Confinement benefit of $250 per day
Wellness payout of $60 every 12 months for routine check ups
Dental Insurance
No
Annual benefits amounts range from $1,200 to $1,800 per person depending on plan
Benefits for Orthodontics and Cosmetic dentistry can be added.
Short Term Disability
***Guaranteed Issued ***for new policies
Benefits from $500 to $5,000 per month
Pays in 4 days compared to 30 days the state requires to process.
Benefits are own occupational payouts
Life Insurance
Plans include 10, 20, 30 year term & Whole life
Benefit amounts as high as $200,000
**If you have Major Medical you can also access these programs**
Personal Cancer Care
$6,000 initial diagnosis benefit, builds by $500 per year
$300 per day for hospitalization
$500 per week for experimental treatment, No Major Medical plan covers this
Pays you $100 per covered person in wellness every year
Hospital Advantage
***Guaranteed Issued ***for new policies
Covers hospitalizations for Accidents, Sickness and pregnancies
Pays $1000 first day of hospital confinement
Pays daily hospitalization benefit
Pays wellness benefit of $150 every year, per person covered for Medical Diagnostic & Imaging
Specified Health Event
Covers heart attack, stroke,
$5,000 initial diagnosis benefit, builds by $500 per year
$300 per day for hospitalization
$ Pays wellness benefit of $150 every year for Mammograms