Forms with this icon are in PDF format. You will need Adobe Reader to view and print the documents. These documents will need to be faxed to us at 515-247-2435. BillingPreauthorized Check Use this form to change your bank or method of premium payment for automatic monthly withdrawals. PolicyAffidavit to Authorize American Family Mutual Insurance Company to Pay Policy Benefits Use this form to have a check reissued that was previously issued to the estate. Privacy Authorization Form - American Family Insurance Group Use this document to grant covered entity permission to release information to designated individuals. PharmacyPrescription Drug Claim Form Need to make a claim for a prescription drug? This is the form you need to submit to Express Scripts, Inc. 030811
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