In order for us to present relevant phone numbers and forms, please make the following selection.

I am

For enrollment, premium, billing, reporting and general administrative-type questions.

Determine the region in which your company is located:

Region Toll-Free Number
West Region (800) 655-5142
Central Region (800) 369-3809
East Region (800) 769-7159

*Please do not put sensitive information in the subject line of your e-mail.

To find the forms that best suit your needs, please select your company's situs state:

Dental

Group Toll-Free Number
Dental
(Mutual of Omaha) - Visit Web Site
(877) 999-2330

Short-Term Disability

The following is the process to file a short-term disability claim:

  1. Contact the local benefits administrator
  2. Choose how to report the claim to Mutual of Omaha:
    1. Phone: (800) 877-5176
    2. Web-based claim form
    3. Paper form
  3. Employees will need to provide the following information:
    1. Employer's address and telephone number
    2. Name and telephone number of attending physician
    3. Policy number
  4. Provide the attending physician a copy of the signed authorization to disclose information.
  5. If claims are administered by FMLASource, employees will call (877) 365-2666.

After the initial notification, the employee may receive a call from a claims analyst. If the analyst is unable to obtain the medical information needed to process the claim, the employee may need to contact the physician.

Long-Term Disability

Print a long-term disability claim form and submit it via fax or mail as shown on the form.

Accidental Death & Dismemberment

Print and complete an AD&D claim form and submit it as shown on the form. Attach a copy of the policy and toxicology reports.

Term Life

  1. Beneficiary or claimant prints and completes the term life claim form
  2. Attach the following documents as applicable:
    1. Original certified Death Certificate (required for all claims)
    2. Certified copy of the Letters of Administration
    3. Original enrollment form/records plus any beneficiary changes
    4. Certified copy of Appointment of a Guardian (if minor or legally incompetent)
  3. Submit form as indicated

Life Premium Waiver

Print and complete a life waiver of premium form and submit it as shown on the form. Attach the original enrollment form. Attending physician should complete the Attending Physician's Statement.

The following information is provided to assist with your administration of your company's plan. Some of the sections listed below may not apply to your specific coverages. Individual sections of information will be updated periodically, so please bookmark this page for future use.

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Billing

You will be provided a link to your initial billing statement. Subsequent billing statements will be sent to you via mail. Billing statements are available online. Payments may be remitted online or via mail. When submitting via mail, simply detach the remittance slip and include it with your payment to ensure accurate processing. Please be sure that the correct amount and your group number are clearly visible on the payment.

Plan-Specific Documents

  • Certificate of Insurance Booklets
    • Summary of Coverage
    • Schedule of Benefits
    • Description of Employee Eligibility
    • Provisions for Payment of Claim
  • Master Policy Booklets
  • Insurance Riders

Web functionality

Our secure plan management Web site allows you to:

  • Add or terminate employee coverage
  • View reports from the comfort of your office
  • Pay bill online
  • Submit billing numbers
  • View plan-specific documents

If you haven't registered to use the plan management system, contact your service team for a registration key and demonstration.

Enrollment

New Business Implementation Process

Step 1 - Group identification number

Step 2 - Link to your initial billing statement, plan-specific documents and registration key for online access.

Cafeteria Plans

Conversions

Portability

General Information

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