Privacy

Request for Records

Use this form to request copies of beneficiary records maintained by Health Net Federal Services, LLC or its subcontractors.

• Created: May 14, 2013
• Modified: Sep 15, 2023
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Request to Amend Protected Health Information (PHI) Records

Use this form to request amendments or corrections to the PHI maintained by Health Net Federal Services, LLC (HNFS) or its subcontractors, if you feel the information inaccurate, incomplete or incorrect.

• Created: Sep 15, 2023
• Modified: Sep 15, 2023
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California Consumer Privacy Rights Request Form

Per the California Consumers Privacy Act (CCPA), this form may be used by California residents to request the following:

• accounting (report) of personal information collected, used or shared, 
• deletion of personal information or
• opt-out of the sale of personal information. 

We do not sell personal information for money; however, we may disclose personal information for business purposes to certain third parties. Subject to exceptions, we may be able to honor certain opt-out requests.

Return this form via fax or mail.

• Created: Aug 1, 2022
• Modified: May 31, 2022
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