Claim Forms

Below, please find various flexible benefit claim forms to aid in the process of processing a claimed benefit. 

 

 

CONTACT

Claim Forms
Patricia Applewhite

Flexible Benefits Lead

Phone

 404-463-3589

Email

 Patricia.Applewhite@doas.ga.gov

View All Division Contacts

Claim Forms And Documents

01/13/15

Specified Illness Claim Form

01/13/15

Delta Dental Claim Form

01/13/15

How to File a Disability Claim

01/13/15

Long Term Care Coverage Form

01/13/15

Blue View Walmart Claim Form

01/13/15

Accelerated Benefit Option Claim Form

01/13/15

Accidental Death & Dismemberment Claim Form

01/13/15

Life Waiver of Premium Claim Form

01/13/15

Disability Claim Form

01/13/15

Vision ID Card Printing Instructions

01/13/15

Dependent Care Spending Account Claim Form

01/13/15

Health Care Spending Account Claim Form

01/13/15

Aflac CAIC Specified Illness Health Screening Form

 
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