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Group Insurance Claims Management fax number

(402) 997-1878

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PFML Bonding - Group Insurance Claims Management

Used for: Bonding Statement submission for Paid Family and Medical Leave (PFML) to bond with a new child; use the Bonding Statement form.

Fax destination details

Department
PFML Bonding - Group Insurance Claims Management
Purpose
Bonding Statement submission for Paid Family and Medical Leave (PFML) to bond with a new child; use the Bonding Statement form.
Form
Bonding Statement — Bonding Statement for PFML (Paid Family Leave) / Bonding with a New Child
Address
3300 Mutual of Omaha Plaza, Omaha, NE 68175-0001

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Directions: Use this form for family leave to bond with a new child following birth. This form is not intended for family leave to bond with a child after adoption, foster care, or placement.

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