Aflac Hospital/Surgical Claim Instructions

Here is the claim form that you need to fill out for your Surgery or Hospital stay of 24 hours or longer:  Hospital Claim


You will need your Policy # ___________________________


Please follow these steps:

  1. Fill out Page 1 and 2 with information about yourself, the patient, and the injury or illness
  2. Attach any applicable documents from the lists below
  3. Fill out this form to authorize Aflac to have access to your medical records:
  4. Send the above documents completed to Omnia Benefits if you would like our assistance -or- you may upload the documents yourself online via your SmartClaim account

Fax:                 443-740-9214




If you were admitted to the Hospital for longer than 24 hours:

  • Itemized Bill from the Hospital
  • Discharge Summary (not discharge instructions)


If you underwent surgery please obtain the following from your medical record:

  • Anesthesia Report
  • Operative Report/Surgical Report
  • Itemized Bill from the Hospital
  • Discharge Summary