Fully Insured Group Health Plan Documents

Summary of Benefits and Coverage (SBC) and Certificate documents

If you are already a member, you can log into the member portal at https://www.alliedbenefit.com//access/allstatebenefitslogin to access additional documentation specific to your plan.

To locate participating providers and pharmacies, the provider directory can be located at, https://allstatevoluntary.com/fullyinsured/providerdirectory/

Plan Documents

1. Sample Certificates
2. Texas Standard Prior Authorization Forms
3. Florida Gold SBCs - 2023
4. Florida Silver SBCs - 2023
5. Florida Bronze SBCs - 2023
6. Indiana Gold SBCs - 2023
7. Indiana Silver SBCs - 2023
8. Indiana Bronze SBCs - 2023
9. Texas Gold SBCs - 2023
10. Texas Silver SBCs - 2023
11. Texas Bronze SBCs - 2023
12. Florida Gold SBCs - 2024
13. Florida Silver SBCs - 2024
14. Florida Bronze SBCs - 2024
15. Indiana Gold SBCs - 2024
16. Indiana Silver SBCs - 2024
17. Indiana Bronze SBCs - 2024
18. Texas Gold SBCs - 2024
19. Texas Silver SBCs - 2024
20. Texas Bronze SBCs - 2024

Sample Certificates (top)

Texas Standard Prior Authorization Forms (top)

2023

Florida - Gold (top)

Florida - Silver (top)

Florida - Bronze (top)

Indiana - Gold (top)

Indiana - Silver (top)

Indiana - Bronze (top)

Texas - Gold (top)

Texas - Silver (top)

Texas - Bronze (top)

2024

Florida - Gold (top)

Florida - Silver (top)

Florida - Bronze (top)

Indiana - Gold (top)

Indiana - Silver (top)

Indiana - Bronze (top)

Texas - Gold (top)

Texas - Silver (top)

Texas - Bronze (top)