Privacy Notices and Forms

GLBA Privacy Notices

The following are notices of privacy and safeguarding practices with respect to our customer’s nonpublic personal, financial and health information in compliance with the Gramm Leach Bliley Act (GLBA) and state privacy laws.

GLBA Privacy Notice - National (PDF)

State special GLBA Privacy Notices are available for residents of California (PDF), Minnesota (PDF), Montana (PDF), Nevada (PDF), New Mexico (PDF), North Dakota (PDF) and Vermont (PDF). If you are a resident of one of these states, click on your state for a PDF copy of the GLBA Privacy Notices applicable to your state.

HIPAA Privacy Notices and Forms

HIPAA Privacy Notice

The following is notice of privacy practices and legal duties applicable to our customer’s Protected Health Information in compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). This notice describes how Mutual of Omaha Insurance Company and its affiliated companies may use and disclose Protected Health Information about you, and important information about your privacy rights. HIPAA Privacy Notice (PDF)

HIPAA Privacy Rights Forms

• Access Request Form (PDF)
• Accounting Request Form (PDF)
• Amendment Request Form (PDF)
• Complaint Form (PDF)
• Confidential Communications Request Form (PDF)
• Restrictions Request Form (PDF)

Privacy Office Contact Information

If you have questions or need further assistance regarding these notices, you may contact:

Mutual of Omaha Insurance Company
Attn: Privacy Office
3300 Mutual of Omaha Plaza
Omaha, NE 68175

Or, you may email us at: Privacy.office@mutualofomaha.com.