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Enroll in a Healthy Behavior Program

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 while LIBERTY Dental Plan will make best efforts to give me my 1st or 2nd reward choice, final rewards given are based on supplies available and my selections are not guaranteed.