English Gramm-Leach-Bliley Privacy Notice
Spanish Gramm-Leach-Bliley Privacy Notice
English HIPAA Privacy Notice
Spanish HIPAA Privacy Notice

Binding Legal Agreement for Online Users
By accessing or downloading online forms, the User automatically agrees to release, indemnify and hold harmless Ameritas Life Insurance Corp. and/or its subsidiaries for any damage or liability incurred by use of these forms. It is solely the User's responsibility to keep only the most current Ameritas forms on file. Access to these online forms is solely for the purpose of permitting the User to print and submit the form(s) to Ameritas Life Insurance Corp.

Authorization for Release of Protected Health Information
To be in compliance with the HIPAA Privacy Rule, a patient/guardian/personal representative must complete this form to authorize disclosure of confidential health information about any member/insured. Print and complete the form and return it to us at:

Privacy Office
P.O. Box 81889
Lincoln, NE 68510-1889

Or fax it to the Privacy Office at 402-309-2580.

English Authorization for Release of Protected Health Information
Spanish Authorization for Release of Protected Health Information

HIPAA Individual Rights Forms

Our HIPAA Privacy Notice describes member/insured’s rights with respect to the protected health information (PHI) we maintain. All requests in connection with these rights must be made in writing.

Request for Alternate Means of Communication
Request for Amendment of Protected Health Information
Request for Accounting of Disclosures of Protected Health Information
Request to Inspect or Copy Protected Health Information
Request to Restrict/Terminate Restrictions on Disclosures

Legal Information and Terms of Use

Product Issuers and Distributors
Ameritas Group, a division of Ameritas Life Insurance Corp. (Ameritas Life), an Ameritas Acacia Company, offers group dental and eye care products nationwide. In New York, products are offered through First Ameritas Life Insurance Corp. of New York (First Ameritas). Certain plan designs may not be available in all areas.

Legal Information and Terms of Use
This Legal Information and Terms of Use governs your access and use of the web sites of The Ameritas Acacia Companies, their affiliates and subsidiaries. As used here "The Ameritas Acacia Companies" refers to Ameritas Acacia Mutual Holding Company, Ameritas Life Insurance Corp. and Ameritas Variable Life Insurance Company (in New York, First Ameritas Life Insurance Company of New York), and Acacia Life Insurance Company, Acacia National Life Insurance Company, Ameritas Investment Corp., Ameritas Investment Advisors, Inc., The Advisor’s Group, Calvert, Ltd., Acacia Federal Savings Bank, their affiliates and subsidiaries.

Your Acceptance of Terms
By linking, referencing, using or accessing web sites of The Ameritas Acacia Companies, you agree to these Terms of Use, including agreeing to indemnify and hold harmless The Ameritas Acacia Companies from all claims of any nature. These Terms of Use may be changed at any time at the sole discretion of The Ameritas Acacia Companies.

Privacy
All personal information is subject to the Privacy Policy of The Ameritas Acacia Companies.

Products and Services
Products and services are offered through The Ameritas Acacia Companies. Not all products and services described are available in all states of the USA, or elsewhere in the world.

The product information contained on this Web site has been prepared for informational purposes only and is not intended to constitute a solicitation or offer for sale. For further information, please contact The Ameritas Acacia Companies affiliate offering the product, or your agent or representative through whom the product may be purchased, for detailed information about the product’s benefits, costs, risks and suitability for your specific needs.

Links to Other Web Sites - Limitation of Liability
The Ameritas Acacia Companies may provide, for your convenience and information only, links to other Internet Web sites. Because The Ameritas Acacia Companies do not have control over these sites, you agree that The Ameritas Acacia Companies are not responsible for any liability resulting from the access or use of sites not owned by The Ameritas Acacia Companies and that The Ameritas Acacia Companies are not responsible for any content, advertising, product, or any other matter or issue, available through other Internet Web sites, whether linked to, or from, web sites of The Ameritas Acacia Companies. Further, you agree that The Ameritas Acacia Companies shall not be responsible or liable, directly or indirectly, for any damage or loss caused, or alleged to be caused by or in connection with the use of web sites The Ameritas Acacia Companies own.

Indemnification
By linking, referencing, using or accessing web sites of The Ameritas Acacia Companies, you agree to these Terms of Use, including agreeing to defend, indemnify and hold harmless The Ameritas Acacia Companies, their officers, directors, employees, agents, licensors, suppliers and any other third party, without limitation, against all losses, expenses, damages and costs, including reasonable attorneys' fees, resulting from any violation of these "Terms of Use."

This Web Site - Disclaimer of Warranty and Limitation of Liability
USE OF THIS SITE IS ENTIRELY AT YOUR OWN RISK. THE SITE AND MATERIALS ARE PROVIDED "AS IS." TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE AMERITAS ACACIA COMPANIES DISCLAIM ALL WARRANTIES OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, WITHOUT LIMITATION, IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT, EVEN IF THE AMERITAS ACACIA COMPANIES HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE. UNDER NO CIRCUMSTANCES SHALL THE AMERITAS ACACIA COMPANIES BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE OR EXEMPLARY DAMAGES ARISING FROM VIRUSES, WORMS, TROJAN HORSES OR OTHER CODE THAT HAS CONTAMINATING OR DESTRUCTIVE PROPERTIES OR YOUR REFERENCING, USING, ACCESSING, INABILITY TO USE OR ACCESS OR LINKING TO OR FROM THE WEB SITES OF THE AMERITAS ACACIA COMPANIES OR ANY ERRORS OR OMISSIONS IN THE CONTENT THEREOF. Some jurisdictions may not allow the exclusion of certain warranties or the limitation or exclusion of liability for consequential or incidental damages. If so, the liability of The Ameritas Acacia Companies is limited to the greatest extent permitted by law.

Governing Law: Severability
These Terms of Use are governed by the laws of the State of Nebraska without regard to that State’s principles of conflicts of laws. You consent to jurisdiction of the federal and state courts presiding in Lincoln, Nebraska, and agree to accept service of process by mail and hereby waive any and all jurisdictional and venue defenses otherwise available. This Web site is controlled and operated from the offices of The Ameritas Acacia Companies within the United States. The Ameritas Acacia Companies make no representation that the materials in this Web site are appropriate or available for use in other locations, and access to them from territories where their contents are illegal is prohibited.

In the event any of the provisions of these Terms of Use shall be determined by a court of competent jurisdiction to be invalid, any such provision determined to be invalid shall not effect the validity of all remaining provisions.

Copyright and Proprietary Rights in Marks, Logos and Materials
Copyright 2003, Ameritas Acacia Mutual Holding Company. Materials and intellectual property found on web sites of The Ameritas Acacia Companies are protected by copyright and other intellectual property laws and treaties in the United States and worldwide. Trademarks, service marks and logos used on web sites of The Ameritas Acacia Companies are registered and unregistered trademarks, subject to the laws of the United States and other countries worldwide. Trademarks, service marks and logos used on these web sites that have been provided by others are the property of their respective owners. You may not copy, modify, store, transmit, reproduce, or distribute any part of the information or content of or trademarks, service marks or logos used on these web sites without the specific written consent of The Ameritas Acacia Companies or their respective owners. If you would like to link to any website of The Ameritas Acacia Companies or use its logos on your site, please contact us.

Proprietary Marks and Logos
Ameritas, the bison symbol, Ameritas Managed Dental Care, EssentialDental, Freedom of Choice, A New Choice, Focus and Vision Perfect are registered service marks, and PDP, Preferred Dental Protection Plan, A New Choice Plus, and The Dental and Eye Care Experts are service marks, of Ameritas Life. First Ameritas and First Ameritas Life Insurance Corp. of New York are registered service marks of First Ameritas. All are used with permission.

How to Contact Us
Address inquiries concerning the use of any copyrighted material, trademarks, service marks, or other intellectual property to Ameritas Life Insurance Corp., Group Communications, 5900 O Street, Lincoln, NE 68510 USA.

UNIFI Companies Privacy and Legal Information
Privacy Policy
Legal Policy

Insurance Companies Licensing Information

Ameritas Life Insurance Corp.
NAIC #943-61301
Licensed in all States except New York

Ameritas Variable Life Insurance Company
NAIC #943-97977
Licensed in all States except New York

First Ameritas Life Insurance Corp. of New York
NAIC #943-60033
Licensed in the State of New York

Acacia Life Insurance Company
NAIC #437-60038
Licensed in all States except Alaska, Maine, New York, Vermont

Acacia National Life Insurance Company
NAID #437-85685
Licensed in all States except Alaska, Maine, New Hampshire, New York