Contact Form: Customer Services

Personal Information

First Name: *

Last Name: *

State of Residence: *

E-mail Address: *

Phone Number: *

Are you a current American Fidelity customer?

Yes
No

Preferred contact method

E-mail
Phone

Your Workplace Information

In what type of industry do you work? *

Employer's Name: *

Customer Number:

If applicable. Please provide your customer number or the last four digits of your social security.

Comments/Concerns/Requests

Comments

If you can provide additional information, especially a policy and/or claim number. It helps us address your concern.

Quick Access

Your Account
View your policies, download forms and check the status of your claims - all in one spot!
Claim & Flex Forms
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Flex Benefits
Accident Benefits
Cancer Benefits
Critical Illness
Disability Benefits
Hospital Indemnity
Life Benefits
Medical (GAP)
HRA Benefits
2Select your state & industry:
Check Claim Status
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