Question about Aflac’s calendar year:
I submitted a claim for a Wellness Benefit with a service date in February 2025, but Aflac denied it, stating that I had already received a Wellness Benefit payout for this calendar year. However, my last Wellness Benefit was for a service in November 2024, which was part of last year.
Could it be that Aflac interprets the “calendar year” as running from May to April, since my policy started in May 2015? Or did they make a mistake in denying my claim?
It sounds like there might be some confusion regarding what Aflac means by “calendar year” for your Wellness Benefit claims. Typically, insurance providers operate on either a calendar year (January to December) or a policy year (the 12 months following the start date of your policy).
Since your policy began in May 2015, it’s possible that Aflac uses a policy year format for your benefits, meaning that the relevant time frame for your Wellness Benefits would be from May to April. If that’s the case, and you received a Wellness Benefit in November 2024, it wouldn’t count against your benefits for the calendar year of 2025.
To clarify this situation, I suggest the following steps:
Review Your Policy: Look for any sections that specifically mention how the Wellness Benefits are defined in terms of time period—be it calendar year or policy year.
Contact Aflac: Reach out to customer service and ask them to clarify their definition of “calendar year” for your policy. Make sure to mention your policy start date and the specific dates of service for your claims.
Document Everything: Keep a record of all correspondence, including claim submission dates, claim denial details, and any notes from phone calls with Aflac representatives.
If you confirm that your understanding is correct and that your claim should indeed be valid, you can consider appealing their decision. They may need to reevaluate the claim based on the correct interpretation of the policy year.