Ameritas Life Insurance Corp. of New York Privacy Notices and Forms
English Gramm-Leach-Bliley Privacy Notice
Spanish Gramm-Leach-Bliley Privacy Notice
English HIPAA Privacy Notice
Spanish HIPAA Privacy Notice
Member Rights and Responsibilities
Member Rights and Responsibilities
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. of New York 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 Life Insuance Corp. of New York 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. of New York.
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. Send the completed form to:
PO Box 81889
Lincoln, NE 68510
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/insuredís 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
Product Issuers and Distributors
Ameritas Life Insurance Corp. of New York offers group dental, vision and hearing care products in the state of New York.
Your Acceptance of Terms
Products and Services
Products and services are offered through Ameritas Life. 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 website 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 Life affiliate offering the product, or your agent or representative through whom the product may be purchased, for detailed information about the productís benefits, costs, risks and suitability for your specific needs.
Links to Other Websites - Limitation of Liability
Ameritas Life may provide, for your convenience and information only, links to other Internet websites. Because Ameritas Life does not have control over these sites, you agree that Ameritas Life is not responsible for any liability resulting from the access or use of sites not owned by Ameritas Life and that Ameritas Life is not responsible for any content, advertising, product, or any other matter or issue, available through other Internet websites, whether linked to, or from, websites of Ameritas Life. Further, you agree that Ameritas Life 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 websites Ameritas Life owns.
This Website - 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, AMERITAS LIFE DISCLAIMS 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 AMERITAS LIFE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE. UNDER NO CIRCUMSTANCES SHALL AMERITAS LIFE 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 WEBSITES OF AMERITAS LIFE 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 Ameritas Life is limited to the greatest extent permitted by law.
Governing Law: Severability
Copyright and Proprietary Rights in Marks, Logos and Materials
Copyright 2012, Ameritas Life Insurance Corp.. Materials and intellectual property found on websites of Ameritas Life are protected by copyright and other intellectual property laws and treaties in the United States and worldwide. Trademarks, service marks and logos used on websites of Ameritas Life 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 websites 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 websites without the specific written consent of Ameritas Life or its respective owners. If you would like to link to any website of Ameritas Life or use its logos on your site, please contact us.
Proprietary Marks and Logos
The entire content of this website, including all text, graphics, images, photos, video, audio, logos, other material and the arrangement of such content, is owned by Ameritas Life or its affiliates and subsidiaries and is protected by copyright under United States and foreign laws, unless otherwise indicated. Ameritas and the bison symbol is a service mark or registered service mark of Ameritas Life Insurance Corp. Ameritas Life Insurance Corp. of New York is a registered service mark of Ameritas Life Insurance Corp. of New York. Other products and services described on this website are the marks of Ameritas Life unless otherwise indicated.
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.
Ameritas Life Privacy and Legal Information
Insurance Companies Licensing Information
Ameritas Life Insurance Corp.
Licensed in all States except New York
Ameritas Life Insurance Corp. of New York
Licensed in the State of New York
Acacia Life Insurance Company
Licensed in all States except Alaska, Maine, and New York
The Union Central Life Insurance Company
Licensed in all States