Critical Illness Insurance Support
Frequently Asked Questions
AF™ Limited Benefit Critical Illness Insurance is designed to pay a benefit directly to you if you’re diagnosed with a covered life-altering illness. You may use this benefit to help pay for deductibles, copayments, everyday living expenses, or even lost income while you’re recovering.
Covered illnesses/conditions may include:
- Heart attack
- Coronary artery bypass surgery
- Permanent damage due to a stroke
- Permanent paralysis resulting from a covered accident
- Major organ failure
- End stage renal failure
Benefits are paid directly to you, so you may use the money toward medical costs or daily living expenses as needed.
A condition for which medical advice, consultation or treatment, including prescription medications, was recommended by or received from a member of the medical profession, prior to the Covered Person’s Effective Date of coverage, within the timeframe listed in the Schedule of Benefits.
For American Fidelity to release information to anyone other than the policyholder, the insured will need to complete the Friends/Family Authorization to Disclose Information Including PHI form.
Or, the insured may create and submit a signed and dated statement indicating who they are giving authorization to speak on their behalf. If the insured is unable to sign their own authorization, we would need a Power of Attorney on file to release any information.
The fastest way to file a critical illness insurance claim is through your online account or our mobile app, AFmobile®.
- Online
- Log in to your online account
- Click on the File a Claim button
- Select Insurance Claim
- Upload the requested documentation and click on the Upload File button
- Click on the Next button and enter the remaining information on the following pages
- Check the acknowledgment box and click on the Submit button
- AFmobile
- Touch the File a Claim button on the AFmobile dashboard
- Select the policy you are filing a claim and touch the Choose Files button
- Either snap a photo of your documentation and touch the Attach Documents button or upload it from your mobile device and hit Next
- Follow the prompts and fill out the required information
- Check the acknowledgment box and click on the Submit button
- Fax or Mail
- Download and complete a critical illness claim form here. Please note, paper claim filing is not the fastest option.
When filing a critical illness insurance claim you will need to provide the following documentation:
- Statement of Insured, completed via online claim filing or paper claim form.
- Attending Physician Statement: Complete the Statement of Insured on the first page, then have the physician in charge of your care complete the remaining pages. Upload the form via your online account, or mail or fax it.
- Medical records or office notes from the date you were first treated for symptoms associated with the condition until the present date.
We may also need:
- Authorization to Disclose Information Including PHI: This form gives us authorization to get records from your medical provider(s) and others who may hold information necessary for us to review your claim. Upload the form via your online account, or mail or fax it.
The fastest way to file an infectious disease claim is through your online account or our mobile app, AFmobile®.
When filing an infectious disease claim you will need to provide the following documentation:
- Statement of Insured, completed via online claim filing or paper claim form.
- Attending Physician Statement: Complete the Statement of Insured on the first page, then have the physician in charge of your care complete the remaining pages. Upload the form via your online account, or mail or fax it.
- Medical records or office notes from the date you were first treated for symptoms associated with the condition until the present date.
- If filing for occupational HIV/Hepatitis B, C, or D, you will also need to provide an incident report or notice of exposure.
We may also need:
- Authorization to Disclose Information Including PHI: This form gives us authorization to get records from your medical provider(s) and others who may hold information necessary for us to review your claim. Upload the form via your online account, or mail or fax it.
You can download and print a paper claim form here. Please note, paper claim filing is not the fastest option. File a claim online or through AFmobile to get your money faster.
Claims are generally processed within 5-7 business days after all required documentation is submitted..
However, your critical illness policy’s annual screening benefit may qualify for quick processing. When you submit your screening benefit claim online or through AFmobile, you can receive payment in as little as one day when enrolled in direct deposit, no extra documentation required.
Yes. Benefits will not be paid for critical illnesses resulting from or caused by:
- Self-inflicted injury or sickness
- Suicide or attempted suicide
- Under influence of narcotics outside of physician care
- Committing a felony
- Being incarcerated in any type of penal institution
- Alcoholism or drug addiction
- Diagnosis outside the United States
These exclusions may vary.
The fastest way to check the status of a claim is through your online account or our mobile app, AFmobile®.
- Online
- Log in to your online account
- Click on the Claims tab
- AFmobile
- From the AFmobile dashboard, scroll down to Insurance Claims
- Once a claim has been processed, find the status of the claim under the insurance policy name
Benefit amounts range from $10,000 to $30,000 and are payable in $10,000 increments. Children are covered at 25% of the employee benefit amount at no additional cost. Spousal coverage is available at 50% of the employee benefit amount at an additional cost.
A document that details information about specific plan benefits. You can view your Schedule of Benefits in your policy document through your online account.
This benefit is payable for the Insured and spouse, if applicable, once per calendar year for annual health screening tests. Maximum of one covered test per calendar year. Qualified tests include:
- Blood test for triglycerides
- Doppler ultrasound
- Echocardiogram
- Electrocardiogram (EKG)
- Fasting blood glucose test
- Serum cholesterol test to determine HDL and LDL levels
- Exercise or Pharmacologic stress test
- Neuroimaging studies
If a covered person receives a recurrent diagnosis or second occurrence date for a covered critical illness, for which the Critical Illness Benefit has been paid, we will pay an additional benefit equal to 50% of the benefit amount purchased.
The first occurrence date and the recurrent diagnosis must:
- Occur while the policy is in force and
- Be separated by at least 180 days
Recurrent Diagnosis Benefit will be payable only for the following:
- Heart attack
- Permanent damage due to a stroke
- Major organ failure
A benefit will be paid following a Heart Attack (Acute Myocardial Infarction) due to Coronary Artery disease resulting in death of a portion of the heart muscle.
A heart attack is not congestive heart failure, atherosclerotic heart disease, angina, cardiac arrest, or any other dysfunction of the cardiovascular system.
A benefit will be paid for permanent damage due to a stroke. A stroke is defined as permanent neurological damage to the brain which results from an acute or sub-acute interruption of blood flow to brain tissue, including infarction of brain tissue due to blood flow to the brain tissue, including infarction of brain tissue due to embolism, thrombus, or bleeding. Permanent damage due to a stroke does not include Transient Ischemic Attacks (TIA).
A benefit will be paid for failure of major organ function diagnosed by a physician that results in placement on the United Network for Organ Sharing (UNOS) list for transplant of the heart, liver, lungs or entire pancreas. Kidney failure is included under the End Stage Renal Failure Benefit.
A benefit will be paid for irreversible failure of both kidneys to function and requires regular dialysis or renal transplantation. Failure of one kidney is not included unless the covered person only has one kidney.
A benefit will be paid for a spinal cord injury due to a covered accident resulting in the loss of use of two or more limbs. Paralysis must be diagnosed by a physician as permanent, total and irreversible.
As long as you were continuously covered for 12 consecutive months prior to the date your coverage under the policy ends, you can submit a request to American Fidelity within 30 days of losing eligibility, for continuation of coverage.
Learn more about keeping your coverage, or if you have any questions, please contact the Policy Continuation team online or call 800-943-2231.
File a Critical Illness Insurance Claim
The fastest way to file a critical illness insurance claim is through your online account or our mobile app, AFmobile®. Download AFmobile from the App Store® or Google Play™.
Examples of Critical Illness Insurance Benefits
For a covered illness, you may receive a lump sum benefit for the following:
- Heart attack
- Coronary artery bypass surgery
- Permanent damage due to a stroke
- Permanent paralysis resulting from a covered accident
- Major organ failure
- End stage renal failure
Log in to your online account to view your policy details.
Health Screening Benefit
This benefit pays a lump sum when a covered person receives a health screening test. Tests include but are not limited to:
- Blood test for triglycerides
- Doppler ultrasound
- Echocardiogram
- Electrocardiogram
- Fasting blood glucose
- Serum cholesterol
- Exercise or pharmacologic stress test
- Neuroimaging studies
Get Your Money Faster
Your critical illness policy’s annual health testing benefit may qualify for quick processing! When you submit your wellness benefit claim online or through AFmobile, you can receive payment in as little as one day when enrolled in direct deposit, no extra documentation required.
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