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Claim forms are available in PDF format to be downloaded, printed and mailed accordingly. If you don’t already have Acrobat Reader, it is a free application that can be downloaded at adobe.com/reader/

Mail any Cancer Wellness Claims to the following address:
AGIA Affinity Services
Wellness Claims
P.O. Box 9006
Phoenix, AZ 85068-9756

 

Mail any Claim Forms to the following address:
AGIA Affinity Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068

  1. Download and print the claim form (only required if NOT a Cancer Wellness Claim)
  2. Review the claim FAQs
  3. Follow the check list
  4. Mail your completed claim form

Submitting a claim is as easy as following these simple steps

  1. I have completed the claim form in full.
    • You can avoid delays in claim processing by completing the required fields of the claim form.
  2. I have completed the signature field on the first page of the claim form.
    • Please sign and date in the space provided near the bottom of the claim form to verify all statements on the form are complete and true.
  3. I have provided the name and address of any physician who treated me in the year prior to my policy effective date.
    • This is ONLY required if you've had your coverage for less than ONE year.
  4. I have signed and dated the “Authorization for the Use and Disclosure of Protected Health Information” document.
  5. I have verified my itemized bills include the dates of service, description of services provided, the charged amount, the diagnosis for the treatment provided and the medical coding associated with my treatment.
  6. (If applicable) I have included a copy of the pathology report that diagnosed my cancer.
  7. (If applicable) If I received treatment at a Veterans Administration Hospital, I have provided the admission/discharge paperwork and/or daily progress notes in place of an itemized bill.

Please note: If required information is omitted, this may result in a delay in the processing of your claim. Please allow 30 days for your claim to be processed. Should you have questions, please feel free to call a claims representative at 1-877-883-8800.

Download Claim Forms Below

Form Product Form Type Download
Claim Form Cancer Care TransAmerica Cancer Care Insurance Plan Claim Form Download
Claim Form Hospital Indemnity Plan TransAmerica Hospital Indemnity Plan Claim Form Download

Download Fast Track Claim Instructions Forms Below

Form Product Form Type Download
Fast Track Claim Instructions FAQ HIP Hospital Indemnity Plan Claim Instructions Download
Fast Track Claim Instructions Checklist HIP Hospital Indemnity Plan Claim Instructions Download
Fast Track Claim Instructions FAQ Cancer Cancer Care Plan Claim Instructions Download
Fast Track Claim Instructions Checklist Cancer Cancer Care Plan Claim Instructions Download
 

Contact Us

We're committed to serving you!

Contact ust by pone or mail. Be sure to describe your issue
as clearly as possible.

For immediate service call us at: 1-877-883-8800.
Monday - Friday: 8am - 7pm (EST).

How to Contact Us

Call 1-877-883-8800
Monday - Friday 8am - 7pm (EST)

For information about a particular product or a question about your plan’s coverage, a change of address, or to submit a claim, call us Monday through Friday between the hours 8am and 7pm, Eastern Time at 1-877-883-8800.

Claims Mailing Address

Mail any Cancer Wellness Claims to the following address:
AGIA Affinity Services Wellness Claims
P.O. Box 9006
Phoenix, AZ 85068-9006

Mail any Claim Forms to the following address:
AGIA Affinity Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068