Forms & Literature
Language Assistance Information | 語言協助信息 | Información sobre Asistencia en su Idioma
For additional information, please call a LIBERTY Dental Representative at 1-888-703-6999.
LIBERTY Dental Forms
(All forms available for download in PDF format)
Evidence of Coverage (EOC)
Medi-Cal
Beginning on July 1, 2017, you will be required to use your dental plan’s appeal procedures before you will be able to file for a state fair hearing. Federal law has changed and now requires this new process. You are not losing your right to a state fair hearing.
Other Languages:
Other Languages:
Grievance Forms