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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.

Fax: 1-844-813-7788


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

  • Created: Feb 4, 2020
  • Modified: Feb 4, 2020
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