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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 - 2024
  4. Florida Silver SBCs - 2024
  5. Florida Bronze SBCs - 2024
  6. Indiana Gold SBCs - 2024
  7. Indiana Silver SBCs - 2024
  8. Indiana Bronze SBCs - 2024
  9. Texas Gold SBCs - 2024
  10. Texas Silver SBCs - 2024
  11. Texas Bronze SBCs - 2024
  12. Florida Gold SBCs - 2025
  13. Florida Silver SBCs - 2025
  14. Florida Bronze SBCs - 2025
  15. Indiana Gold SBCs - 2025
  16. Indiana Silver SBCs - 2025
  17. Indiana Bronze SBCs - 2025
  18. Texas Gold SBCs - 2025
  19. Texas Silver SBCs - 2025
  20. Texas Bronze SBCs - 2025
  21. Missouri Gold SBCs - 2025
  22. Missouri Silver SBCs - 2025
  23. Missouri Bronze SBCs - 2025
  24. Wisconsin Gold SBCs - 2025
  25. Wisconsin Silver SBCs - 2025
  26. Wisconsin Bronze SBCs - 2025

Sample Certificates (top)


Texas Standard Prior Authorization Forms (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)



2025

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)



Missouri - Gold (top)



Missouri - Silver (top)



Missouri - Bronze (top)




Wisconsin - Gold (top)



Wisconsin - Silver (top)



Wisconsin - Bronze (top)