Welcome Logout

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-opt 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.

Fax: 1-844-813-7788


Health Net Federal Services, LLC
Privacy Compliance Office
10730 International Drive
Rancho Cordova, CA 95670

  • Created: Dec 31, 2019
  • Modified: Dec 31, 2019
  • View »