Good Forms 101: The Critical Illness Form

Filing insurance claims may feel like a confusing or stressful (or both) process for you and your employees, but it doesn’t have to be.

As part of an ongoing series to address common questions about claim forms, here are some tips and solutions for frequently asked questions we hear from employers and employees regarding the critical illness claim form.

Question #1: What’s the quickest way to file?

Online! You can file your claim online or through AFmobile^®, removing the need for you to complete and submit a paper form. Once the Attending Physician Statement is complete, you can upload them to your claim through your online account.

Question #2: What is a critical illness?

The definition may vary between individual and group policies, but covered critical illnesses typically include heart attack, permanent damage due to a stroke, permanent paralysis resulting from a covered accident, major organ failure, and end stage renal failure. Listed illnesses may differ, so check your policy for further clarification.

To download your policy:

Log in to your account or AFmobile
Under My Benefits, select the policy name you wish to view
Select View Policy Document

Question #3: Does my claim qualify for benefits?

Benefits are only eligible to customers suffering from a listed critical illness. While there are many critical illnesses, only ones listed under the policy are eligible for benefits.

American Fidelity’s AF™ Limited Benefit Critical Illness Insurance policy also includes a benefit for annual health screenings, which qualifies for AFQuickClaims^® processing. This means policyholders could receive their benefit payment in as little as one day when enrolled in direct deposit. Please check your policy documents for details or reach out to your account manager if you have questions.

Question #4: Does the policy pay my entire medical bill?

Critical illness benefits are a lump sum of money paid to the policyholder, based upon the benefit amount selected when purchased. American Fidelity’s AF™ Limited Benefit Critical Illness Insurance policy offers benefit amounts ranging from $10,000 to $30,000, in $10,000 increments. That money can be used to pay all or a portion of your medical bill (depending on your selected benefit amount), but it can also be used for other expenses, such as household needs, medication, or other out-of-pocket costs.

Question #5: Do I really need to fill out the entire claim form?

For the claim to be processed efficiently, yes, the whole form must be completed. Fortunately, most of the critical illness form is completed by your doctor. Complete the Statement of Insured and the Authorization to Disclose Information Including PHI sections yourself, then have the physician in charge of your care complete the remaining pages.

Question #6: What documentation do I send with the completed claim form?

Required documentation differs depending on the critical illness you’re filing a claim for, though supporting medical records are always required. Below are some examples of extra documentation that may be required, but always check your policy for more details:

End Stage Renal Failure: Must send supporting medical records, date put on transplant list, and date put on dialysis (if applicable) along with the completed claim form.

Major Organ Failure: Must send supporting medical records and date placed on United Network for Organ Sharing (UNOS) list along with the completed claim form.

Occupational HIV or Occupational Hepatitis B, C, or D: Must send supporting medical records and an incident report or notice of exposure along with the completed claim form.

Question #7: Why can’t I use my medical bills or the explanation of benefits from my primary insurance carrier for the required documentation?

Detailed information is required to properly review claims for applicable benefits. Typically, medical bills or EOBs don’t have the comprehensive details that are crucial to process your claim correctly and efficiently.

Question #8: How long does a claim take to process?

Claims are generally processed within 5-7 business days, and the fastest way to check the status of a claim is through your online account, or on our mobile app, AFmobile.

These were only some of the common questions we hear. You can find more answers and helpful resources on the critical illness insurance support page.

Your dedicated account manager can always help with questions, too!

This blog is up to date as of November 2019 and has not been updated for changes in the law, administration or current events.