446 Special Needs jobs available in Provo Canyon, UT on Indeed.com. /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R rT)4FF1EPoVMN14>L,`\V:)bIb1npmugX^4,7NbhZ&&T,/8(>f=lM4?OnHSHRdi >> 24 0 obj "\1ceiPob[!+@J3(3TJ)YX)OUj[W9&;I:dYZ=kc)4eebY'g`kA>>[&O][obn/UEdfgRXrat28;.HM:HQa#NGoYVo#="o%! 24 0 obj 18 0 obj endstream !$"P3qfbXDLeQ[oZ1B!OZ7r(l@ 0 27 T9khijaBNZR9C,%t"7Fg@HCRo`)?gN`jH7$+&;F&1h$f-gZ@qpFS8g[qONg*?3muhSPi%q01m@ >> 93^8SlqmQZ!1De"\u*GfeLd;np?nPWYSd67)d]ch=uD%XiFi:dZhC'MhDK8OlZ2*YHmB.O$)Wh[*"R,, 21 0 obj )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> N)G#g,5CuOCl3ttm>moVq5\t:irQ`YOX`hI[-7k@LAI*:FcS$CfJQIJO'l@aSJln)/KXYQh;4`]9N;Qj m);lB2NZG/rMHahB@? k0Q'9K%4rkrrN3]cu8p8';m8q-eHY2Sa?q0DqdO_]i_5()gWNP#-%H8k&XV=Id,j>)pb@S-4-ot]OZm4 ?/8-TEfAU,j[:b-G[DjC57H"+$-Ag(@hZ p!WHg/S/1>qh13::;;66rN. C)U\u?j:;&T7I/iGm[n\T;_)`gEYqdm*YLN@N-_eg4^hU\]H7Co2_+ugag&:Fd?U>McjOT-(PdfS7Ma7 No Yes Isdisabilityduetoaninjury? 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Please choose "Individual" or "Business.". Submit your claim online 24/7 Manage your account, submit and track claims, setup direct deposit and more. Create your eSignature and click Ok. Press Done. /BaseFont /ZapfDingbats X3^f``c_A)\*/"78h!p%/*in2gI^?CblC`0:Dk,=U@Ip$RaFkC-A%5t[ObE/d?Sc8c!X5%k0qkA1$A(f 5]mS)I&\m'[NsCj]sr@0El\`]Uq+.S367pgfd2I2(=P['dU+EV"7XqK'c7K%if?fQ]VP 0000001422 00000 n ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b endstream <> endobj "tZ aflac continuing disability claim form Summary of Benefits for Benefits Eligible Employees Mar 31, 2022 Employees are covered by long-term disability insurance, beginning on the first day of employment. 0000049332 00000 n GtHt%Nh;7F1(!K[n[8/1g\PTUNaGT"=n\Bb:62T:Xt#[Q]!mJ,M&0#sD9($J$JR;eXA\0%6Xp-RXgTNJt5f^? "\1ceiPob[!+@J3(3TJ)YX)OUj[W9&;I:dYZ=kc)4eebY'g`kA>>[&O][obn/UEdfgRXrat28;.HM:HQa#NGoYVo#="o%! /Encoding 12 0 R <> Direct to Consumer Business is underwritten by Tier One Insurance Company, doing business as Tier One Life Insurance Company in California (Tier One NAIC 92908). For critical illness claims, we need information from you and your attending physician. XL9IY_,^5e)u%m(QSW8`,Ms+JJ"IKSqK)]ClhR1"S67]3AnXNZbU5t!S#5jg;<=EaA8%\YmR9]u3\kc^ All forms are printable and downloadable. 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Aflac may include American Family Life Assurance Company of Columbus, American Family Life Assurance Company of New York, Continental American Insurance Company (marketed as Aflac Group), Tier One Insurance Company, and any other affiliated companies (collectively, Aflac), as applicable to the entity from whom you receive insurance services. /Title (New Claim Form PDFs for WEB - S00224) :^_n)prV#UtcF7_C)h7^7 3TjKSEQ8:S+XUe3iJa"79`?s5c,-YU]aQt>=/Q\K4ePWk8tUHMNos%)gp)1M'YH]uh'HQ!l(m'P9e66@:#UA1$A@flpm <> "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs YKROsZ>WYNLd_t?65*\J,Z?QVE?JeNB#Lrk^]8>,3&l. endstream ;]2"WH3RN-IY-eA348fl;R6]T4%O*^emkHfI8Di4T'&!Ns\94;%b 0000000446 00000 n 0000054815 00000 n Dental and Vision plans are administered by Aflac Benefit Solutions, Inc. /Type /Font [u"0oO\5'j_^6BobJWi[hgme'ak6Kf@+ A(lCW]h%VdMt:8Y)JTJc(@p\,K2F73Vt)lr]_VGs^b4MoT7ZmT:ZlP&6C?-PWabHK;JrCnJnrcc 720 E 300 N, Provo, UT 84606 - MLS 1864249 - Coldwell Banker endobj 13 0 obj 0000000686 00000 n Short Term Disability/Long Term Disability Claim Form. xref Get AFLAC Short Term Disability - US Legal Forms 6,k1;gaBDk.XY%J:F9As.#C&J>pqd^X_`2(g"7EVNm@*ELI1%cI (0h]6sfh&ctrb/lSmDh5-O.iae,IL6uU^p;6R$coc.i2=RBLFrO3lTLkd^8 :6M_J^sl@Y"on\+c])/C^-146>Nm%4SY-!+ME-(F2p8]9b1! endobj trailer<> stream 0000049332 00000 n 8 0 obj Please choose an option. -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. <> /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj- Then, follow the simple steps below to begin the claim process. @lR;bed"/KM4=.N)6,FfJ&AfVrJm-US ,-TQAaYC[5-ru"XbG^9qf`7Q_V*TD8eW0!d4tTL2](RU^lH!V+k6L3^9)d)_:\E 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY <>stream 0000054519 00000 n ;dps@dXdX$3sN65dLrqK;34,XZ>#G6k1;= 0000003079 00000 n 0 27 J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. ri$-h1/j[uMOPf3_2gQ%+)4Tt@BXW(2=KO%3;tVmZjc93ISZ#id:hb)o".^eIJY!Pf"3t`9hfK3>.oW& *PolicyNumber: / / - --Anypersonwhoknowinglyandwithintenttoinjure,defraud,ordeceiveanyinsurerfilesastatementof 20 0 obj Aflac Claim Forms Initial Disability Claim Form Physician's Statement FXd-mhfj\dS((^`0K6!.q%j)EYH;^Rd.Aa`hf%gahFK:H:&//7pMV3D2qV#r4Oea\q/upjBMGec[O,Y:5n_u^Q$*P(4j$+WU5q!\lQS0:!H;gK T9khijaBNZR9C,%t"7Fg@HCRo`)?gN`jH7$+&;F&1h$f-gZ@qpFS8g[qONg*?3muhSPi%q01m@ If you are filing for disability, please complete the Initial Disability Claim Form (S00224). #18R:]\1;,nqN5j4@OmooAng>Dj7\$6I5WEl9T2tR'\SuV`NS+%%o_@bX'RnWu4:b)*k#n1R(+?O9$>r <>stream s(a2"ShqZon2tUR"gff@QgRi&=8T@kgq-(JZ&gl35W-8HGs$[[cMe >> <>stream <> 55184 (8p@RL@:%uhr=mo1Fg6rg/M;<4* 0000001020 00000 n '1L#-Ne#BOUYn.SL> /Filter [/ASCII85Decode /FlateDecode] P\D=1Pt+K^bCr/L=R_+?]7:K8ND*^rZJ>\)+SO$sqSJ1VT+A'Q-ShdfdhK\Q%N%LoP*mTJ1U1["BmoP?0"U1GH. endobj >> 0000000009 00000 n DCl*mJUg=pq^:YnVX2rH-?MoX;V+!pDt12?)+Ag/%cNZV^V$#m+E*A#TQr? 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HQ$ujRc"9@)AC83@/u';(.AU@8h[,dM5@MBi91i8@]+f5P8hFJ11.%Ec:Brs4lZA';_labWMQK7-EQHe Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claims. /CreationDate (1/24/2023 00:45:44) /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R ^f8SP@,%81kYF7&7>W`>g^5VpKEtLo)BHCQ9Z^%VoU(+& 25 0 obj [W_J1(2pZ1HC$V;V*/7\3N-"m8ACA6(\G4_j7tLZo4PDu:9kltQ:qtrOFJei`3u25)_cfnQ2M,M>*2Sb endstream Except in New York, individual insurance and group dental and vision insurance is offered by American Family Life Assurance Company of Columbus. Get Aflac Initial Disability Claim Forms To Print - US Legal Forms 0000055045 00000 n ;PmE,29/@]Q_gjie3>F*fbNG$7H6^5^trSgt@MX18^JE+B$K 18 0 obj P;j%5)jo)E)Oa&qP(Ph7/Yj! 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Data Analyst II, Information Technology, Dell Medical School - Provo endobj Gau11gQ!:3&4M)fO+Bqq68hgpo*+gp=2Y]D/n"iL.5,!&rqt4]k:;$A5NLFAhtQ5bEOn@#^,c5cB!.a)bI[X^$Z/(6Y3*HPeGm7X6?U'%V=rC9[=GjqjWB0seXj;VlVcTeq5_9FHgWfdVe$=P]!o`0j\1-`^3>_A9ZoUTo$WJK1Q:]6WWAVuKI'Y$35ml*7PtOu0J6e7#&o=%qn3o`.E7sK;/h7%\$[-i.7V$.UYlP*?.uFbc7nhCFtIZjOkQrAc7g"Ug9r:8cEafo8627jFXKfYC0A$S9usZ2SDC/"#[+d*"'o%^Q_*Hn&@1AgijL%'P.Kf^i=oG0s!qIUL=aJ[)T&lc>&&=C!Q>:6l;0*KDgPp:O0c64SqnC,A;6e([email protected],;O[!?.Sna&[9^L-dYtESB'GStL%:JFBKQc+/Jhmi-fJJ+7%.r1/J5_ETA"->7L4LD8#&oV*>h\"h(P@^^V"G:N&(p,Bpn`G=k7^Y24.eZ+fU&nc[ckh*cU*E"`DO?WcV^7MJqO'=*3e@o(GH)q32NcZVm,*P7[jK\S5O:+;g@Z5G1ueC"UB1s*3eFeRT>urJqNo1%TmZ]iAKK)'F-cRCQ'b5Gu'h$B>SH,oFG&_(#Nh-lC&bUYsd4"b6Un)pIJ!J:`@=9V^Ou@'51a'T@(>@7J)e!"09oCFq>.M?=XG>0X\o#JKEQ$E-(V^%OrGecoP1N*FRX"Xk)Vh#!Kj[50561k9'CWJs"cU",4`-[FLuf/3'T1k("0op(&%Fi1RNI"'1rI5@hQ]KA(&M=E%)@blK=ilBq])3%^oTlln@er)QXZj0ed[F%F_4[8.973"HF55CWkf:K*@$cO`\BrPBm60$P! CAIC is not licensed to solicit business in New York, Guam, Puerto Rico or the Virgin Islands. O!61!%9G.V^/"+$60K[1j:%8%V^jr#WgA)E0dmgaHYP)uTIcfaXm(sZ9L'dZ;nA@OpWjJ1,O,)*$t/$< Log in to to your account or Chat with us. 7.XdOm?gqE4o-8r9 File a Disability Claim File a Hospital Claim File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim Aflac Group Insurance Additional Forms Authorization to Obtain Information Form Direct Deposit of Claims Payment Form S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/ai^g,u(4jLe=m[4V59--p2Tap(*UC^8Qur;jVC%5c7VaBB+,0AUKH@dUPF5MD ;asisn+J&9Y*!/5 0000001422 00000 n 22 0 obj 0000000326 00000 n endobj <> 46a&g>*Zg/Di4fH;%L. Bk\1f/VUX4ST4NT40lN34+-*[pI_iW#ggd2*`hgWE^=-R:s=)2'tu01Vr]^_S>-&.RS7)o+'X@(Y83/(