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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)


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.

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Grievance Forms