Forms
This page contains important insurance forms. You can download them and print them off using the links below:
Aflac
- Cancer Claim Form
- Cancer Wellness Form
- Accident Claim Form
- Initial Disability Claim
- Bank Draft Authorization Form
- Cancellation Form Fax this form back to my office at 717-721-3198
- Aflac online access This is the best way to file Aflac Claims now. Click on to get the instructions on how to do it. Then click onWingspan Instructions Page to see what the web page will look like for you online. Be sure to click on “Aflac Always” so your Aflac policy never lapeses.
- SRA/FSA Form Use this form for making your Annual Flexible Spending Account deductions. If you are waiving just fill out your name and sign at the bottom and initial at the waiver box (last box).
- Flex Claim Form Use this form for filing your FSA claims
- FSA Direct Deposit Form Use this form for having your claim check directly deposited to your checking or savings account.
Lancaster Regional & Heart of Lancaster
- New Illinois Mutual Disability Application and Bank Draft form
- Lancaster Regional Disability Rates 0-7 6 Mo
FTJOL, LLC
The Jay Group
