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Please complete one form for each person in your family who would like to join a Healthy Behavior Program. If you have questions, please call LIBERTY, toll free at 1.833.276.0850. You can speak to a live person Monday through Friday, between 8:00 am and 7:00 pm. TDD/TTY users call 1.877.855-8039.


Please only click Submit once

By submitting this form, I confirm that I understand that I am joining a Healthy Behavior Program. I understand that rewards are only issued when eligibility and all the conditions mentioned above are met that is based on dental claims or other sources. I understand that final rewards given are based on supplies available.