LIBERTY Dental Plan ELIGIBILITY FOR BENEFITS 
California Residents Only
Eligible Members and Eligible Dependents receive Benefits as soon as they are enrolled in LIBERTY Dental Plan. Liberty Dental Plan Coverage will activate typically within 48 hours from the time of purchase,
excluding Saturday and Sunday. Subject to cancellation as provided under this Program, enrollment of
Eligible Members and
Eligible Dependents is for a minimum period of one year. (Twelve Consecutive Months). All Members and Dependents must use a Dentist within the LIBERTY Dental Plan Network of California Dentists. A list of Network Dentists can be found on our website by clicking on the
FIND A DENTIST Link.
You are eligible to enroll as a LIBERTY Dental Plan Member if you are 18 years or older and you meet the eligibility requirements defined below. A Youth Dental-Care Product is available for children from birth up to their 18th birth date. Applicants/Subscribers must be California residents and reside within our service areas. Guardian of applicant must send a signed addendum to the application to LIBERTY Dental Plan
within 10 days of purchase. Membership will be activated upon receipt of addendum by LIBERTY Dental Plan of California.
Eligible Dependents include:
1. Spouse or Domestic Partner, and unmarried children from birth up to but not including the age of 18 years.
2. Unmarried children beyond the limiting age of 18 years and up to the age of 23 years if they are a Full-Time Student (minimum 12 units) wholly dependent on you for support.
3. Unmarried children beyond the limiting age of 18 years and he or she is incapable of self-support because of a physical disability or mental incapacity. Please fax proof of disability to (949) 387-3909
within 10 days of purchase.
Eligible Dependents become eligible on:
1. the date you, the primary member, are eligible for coverage;
2. as soon as an Eligible Dependent becomes your dependent, or at any time subject to a change in legal custody or lawful order to provide Benefits.
3. the date Liberty Dental Plan receives documentation to support full time student (minimum 12 units) or disability status. Documentation can be delivered by FAX, mail, or email. (Documents must be received by Liberty Dental Plan
within 10 days of purchase.)
Children include natural children, stepchildren, adopted children, foster children and children of a Domestic Partner provided all such children are dependent on you for support. Legally adopted children are eligible from and after the moment the child is placed in the physical custody of the Eligible Member for adoption.
An unmarried dependent child, over the age of 18, may continue eligibility if:
1. He or she is incapable of self-support because of a physical disability or mental incapacity.
2. Proof of dependent's disability or full time student status is provided within 10 days of request. Such requests will not be made more than once a year after this dependent reaches the limiting age. Eligibility will continue as long as the dependent relies on you for support because of a physical disability or mental incapacity that began before he or she reached the limiting age
Dependents in active military service are not eligible. Medicare eligibility shall not affect the eligibility of an Eligible Member or an Eligible Dependent.
CHANGING an ACTIVE POLICY:
Once your Liberty Dental Plan has been activated you will not be able to upgrade, downgrade, add dependents, or delete dependents. You will not be able to change your plan until it has expired and you choose to renew.
RENEWING YOUR POLICY:
Liberty Dental Plan will notify you by Email and or US Mail approximately 30 days prior to your membership’s expiration date. At that time you can make any changes to your plan including Adding or Deleting Dependents, Upgrading or Downgrading Plan.
The $20 enrollment and activation fee will be waived on all annual renewals if the membership has not lapsed for more than 6 months.
