Member Downloadable Forms

Appeals

Dental Claim Form

Forms and information members ​need to appeal a claims decision

​Employees fill out this form for a dental claim

Employee
Change Request Form

Allows an employee to change their name, take dependents off coverage, change beneficiaries or change class of insurance

All States - COBRA
(including California with 20
or more employees)

COBRA guide and various forms

Standard Life and Accident
Insurance Company

Limited benefit claim form

Prescription Drug Plan Forms

Mail order forms, claims forms and more

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If you are unable to find what you're looking for, please contact Allied Client Services.