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Claim Forms

2023 The Standard Disability Claim Form *NEW

2023 The STANDARD Disability Claim Packet.pdf 378.18 KB (Last Modified on December 30, 2022)

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Aetna Claim Form

AETNA - medical-claim-form.pdf 884.58 KB (Last Modified on February 23, 2022)

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PCA-Rx Precertification Request Form

PCARx_Prior-Authorization-Request-Form-for-Contact-Center_09-14-2022.pdf 247.08 KB (Last Modified on February 10, 2023)

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MetLife Dental - Claim Form

MetLife Dental Claim Form.pdf 672.56 KB (Last Modified on August 3, 2019)

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Superior Vision - Claim Form

Superior Vision Claim Form.pdf 57.33 KB (Last Modified on August 3, 2019)

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Medical Reimbursement Claim Form

2021 MFSA_ClaimForm - FLEX.pdf 1.01 MB (Last Modified on December 11, 2020)

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American Fidelity Physician Expense Disability Claim Form (1 Day)

2019 - American Fidelity - Physician Expense Benefit Statement Disability Claim Form.pdf 175.7 KB (Last Modified on December 11, 2020)

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Allstate Wellness Claim Form

Allstate Wellness Claim Form.pdf 28.55 KB (Last Modified on August 9, 2019)

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Allstate Cancer-heart-Stroke Claim Form - Individaul Plans

Allstate Cancer-Heart-Stroke Claim Form - Individaul Plans.pdf 190.38 KB (Last Modified on August 9, 2019)

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Disability Forms - Instructions for Disability Claims

If you have any questions regarding your disability benefits through American Fidelity Assurance Company, please call our First Financial Agent, Morgan Harris, at (432) 456-9783 or (432) 556-4172.

2019 - American Fidelity - Regular Disability Claim Form.pdf 1.65 MB (Last Modified on August 3, 2019)

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