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Language Assistance Information | 語言協助信息 | Información sobre Asistencia en su Idioma

California Commercial Notice of Language Assistance (TAGLINES)

California Medi-Cal Notice of Language Assistance (TAGLINES)

LIBERTY Dental Plan of Florida Notice of Language Assistance Services

LIBERTY Dental Plan of Missouri Notice of Language Assistance Services

LIBERTY Dental Plan of Nevada Notice of Language Assistance Services

LIBERTY Dental Plan of New Jersey Notice of Language Assistance Services

LIBERTY Dental Plan of New York Notice of Language Assistance Services

LIBERTY Dental Plan of Oklahoma Notice of Language Assistance Services

For additional information, please call a LIBERTY Dental Representative
at 1-888-703-6999.

LIBERTY Dental Forms

ADA Claim Form	Spanish
Clinical Criteria and Practice Parameters
HIPAA Privacy Notice
PHI Disclosure Form
MVP - Dental Claim Reimbursement Request Form

The materials provided to you are guidelines used by this Plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

Member Handbooks & Evidence of Coverage (EOC)

California
Liberty Individual EOC Booklet	English	Spanish
Liberty CA Group EOC Booklet	English	Spanish
PHP GMC Medi-Cal Dental Member Handbook	English	Spanish	Arabic
	Armenian	Chinese	Farsi
	Hmong	Cambodian	Korean
	Russian	Tagalog
	Vietnamse

Nevada
NV-100 through NV-1000 NV Commercial DHMO - EPO
Patriot NV-100 through Patriot NV-900NV Commercial Patriot Plan
Elite PPO, Signature PPONV Commercial PPO Plans
NV-500 POS NV Commercial Point of Sales Plans
LIBERTY Dental Plan NV Member Handbook		Spanish
Florida
Individual FL Individual Plans
Group FL Group Plans
LIBERTY Dental Plan FL Member Handbook		Spanish
Missouri
Missouri – EOC Booklet