Request For Testing Benefits Form
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Filing Instructions
Save Time and Paper - File Your Claim Online!
We offer two ways to file your testing expense claim: online or by mail/fax.
How to File Online:
1.
Login to your secured Online Service Center (OSC) account at
2.
From the “My Claims” tab, click “File a Claim” to get started.
3.
Conveniently upload the bill, receipt, or evidence which includes the name of the test and the date of service.
4.
Follow step-by-step instructions to complete your online claim filing process.
5.
Check the status of your claim by selecting the “My Claims” tab at the top of the screen!
How to File by Mail or Fax:
1.
Complete the Statement of Insured.
2.
Attach copies of the bill, receipt, or evidence which includes the name of the test and the date of service.
3.
Mail the completed forms to American Fidelity at the address listed above.
4.
If you wish to fax your completed forms, please fax to 800-818-3453.
Whether completing this claim online or with the below packet, all portions must be completed to avoid undue delay in process-
ing claimant’s request for benefits. If you have any questions regarding completion of this form please call:
Toll Free: 800-662-1113
Local: 405-523-5025
Educational Services Division
Benefits Department
P.O. Box 25160
Oklahoma City, Oklahoma 73125-0160
BN-708-0315(AFES)
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Parent category: Business