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Member Downloadable Forms

Compliance Notices

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


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

Allied National
4551 W. 107th St. #100, Overland Park, KS 66207-4037


Sales Support  888-767-7133 sales@alliednational.com 
Client Services  800-825-7531 clientservices@alliednational.com   

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© 2021 Allied National, LLC. All Rights Reserved.
  • Home
  • Employers
    • Self-Service Login
    • Prescription Benefits
    • LabCard
    • Abenity
    • Employer Resources
    • EBA Newsletter
  • Members
    • Member Connection
    • Member Resources
    • HealthCare Assistant
    • HealthChoices
    • Self-Service Login
    • Find A Provider
    • Prescription Benefits
    • Telehealth
    • Abenity
    • Member Download Forms >
      • Compliance
    • Member FAQs
  • Agents
    • Agent Edge
    • Plans >
      • Level Funding >
        • Freedom Plan >
          • Traditional
          • Essentials
        • PPO
        • Cost Saver Plan
        • Preventive Minimum Essential Coverage
        • Direct Primary Care >
          • DPC Directory
      • Dental Design
      • Pivot Health Individual Plans >
        • Short Term Medical
        • The Bridge to Medicare
        • Fixed Indemnity
        • Brilliant Dental
      • Premium Only Plan
    • Self-Service Login
    • Download Forms - Agents
    • Product Availability
    • Training Webinars
    • Agent FAQs
  • About Us
    • History
    • Testimonials
    • Blog
    • Newsroom >
      • Allied Logos
  • Contact Us