American Fidelity Assurance Company

Toll Free:  1-800-662-1113

Fax:  1-800-818-3453

www.americanfidelity.com

Click on the links below to access the appropriate disability form.

Expense Reimbursement Voucher for Health Flexible Spending Account (Health FSA) or Health Reimbursement Arrangement (HRA)

Routine Pregnancy Claim

Group Disability Claim

Request for Continuing Disability Benefits

Physician Expense Claim

Request for reimbursement of Hospital and Office Visits under Medical GAP Policy

Dependent Day Care Reimbursement/Provider Acknowledgement Form