Forms

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.

Billing

Preauthorized Check
Use this form to change your bank or method of premium payment for automatic monthly withdrawals.

Policy

Affidavit 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.

Pharmacy

Prescription 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