Discrimination is against the law. LIBERTY Dental Plan (“LIBERTY”) complies with all applicable Federal
civil rights laws and does not discriminate, exclude people or treat them differently on the basis of race, color,
national origin, age, disability, or sex.
LIBERTY provides free aids and services to people with disabilities, and
free language services to people whose primary language is not English,
such as:
Qualified interpreters, including sign language interpreters
Written information in other languages and formats, including large
print, audio, accessible electronic formats, etc.
If you need these services, please contact us at 1-888-401-1128.
If you believe LIBERTY has failed to provide these services or has discriminated on the basis of race, color,
national origin, age, disability, or sex, you can file a grievance with LIBERTY’s Civil Rights Coordinator:
Phone: 888-704-9833
TTY: 800-735-2929
Fax: 888-273-2718
Email: compliance@libertydentalplan.com
Online: https://www.libertydentalplan.com/About-LIBERTY-Dental/Compliance/Contact-
If you need help filing a grievance, LIBERTY’s Civil Rights Coordinator is available to help you. You can also
file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Online at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
LIBERTY’s HIPAA Privacy Notice provides you with information about your rights and our legal duties and
privacy practices with respect to Protected Health Information (PHI), including how we use and disclose your
PHI. You can always request a written copy of our most current privacy notice from LIBERTY’s Privacy
Officer by calling 888.704.9833, or online at: www.libertydentalplan.com/HIPAA-Privacy-Notice.
Notice of Language Assistance
If you, or someone you support, have questions about LIBERTY Dental Plan, you have the right to get help and
information in your language at no cost. To speak to an interpreter, call 1-888-401-1128.
እርስዎ፣ ወይም እርስዎ የሚያግዙት ግለሰብ፣ ስለ LIBERTY Dental Plan ጥያቄ ካላችሁ፣ ያለ ምንም ክፍያ በቋንቋዎ እርዳታና መረጃ
የማግኘት መብት አላችሁ። ከአስተርጓሚ ጋር ለመነጋገር፣ 1-888-401-1128 ይደውሉ።). (Amharic)
          LIBERTY Dental Plan      
.       (Arabic) 1-888-401-1128
如果您,或您正在幫助的人,有關於LIBERTY Dental Plan 方面的問題,您有權利免費以您的母語得到
幫助和訊息 想要跟一位翻譯員通話,請致電 1-888-401-1128. (Chinese)
             LIBERTY Dental Plan        
       .          (Farsi) 1-888-401-1128
Si vous, ou quelqu'un que vous êtes en train d’aider, a des questions à propos de LIBERTY Dental Plan, vous
avez le droit d'obtenir de l'aide et l'information dans votre langue à aucun coût. Pour parler à un interprète,
appelez 1-888-401-1128. (French)
Falls Sie oder jemand, dem Sie helfen, Fragen zum LIBERTY Dental Plan haben, haben Sie das Recht,
kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen
Sie bitte die Nummer 1-888-401-1128 an. (German)
No dakayo, wenno maysa a tao a tultulunganyo, ket adda kayatyo a saludsoden maipanggep iti LIBERTY
Dental Plan, adda karbenganyo a dumawat iti tulong ken impormasion iti bukodyo a pagsasao nga awan ti
bayadanyo. Tapno makipatang iti maysa a mangipatarus iti pagsasao, tumawag iti numero nga 1-888-401-1128.
ご本人様、またはお客様の身の回りの方でもLIBERTY Dental Plan についてご質問がございましたら、ご希望
る場合1-888-401-1128までお電話ください (Japanese)
만약 귀하 또는 귀하가 돕고 있는 어떤 사람이 LIBERTY Dental Plan 관해서 질문이 있다면 귀하는 그러한
도움과 정보를 귀하의 언어로 비용 부담없이 얻을 있는권리가 습니다. 그렇게 통역사와 얘기하 위해서는
1-888-401-1128 전화하십시오.(Korean)
Если у вас или лица, которому вы помогаете, имеются вопросы по поводу LIBERTY Dental Plan, то вы
имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с
переводчиком позвоните по телефону 1-888-401-1128. (Russian)
Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de LIBERTY Dental Plan, tiene derecho
a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-888-401-
1128. (Spanish)
‘Afai olo’o iai se fesili iate oe, po o se tasi olo’o e fesoasoani i ai, e uiga i le LIBERTY Dental Plan polokalame,
o iai iate oe le aia tatau e maua atu ai i se fesoasoani po o se fa’atamalaga e uiga i lena polokalame i le gagana
fa’asamoa, auno ma se togiga o tupe. Ina ia talatalanoa i se tagata ua malamalama ai i le gagana fa’asoma, po o
se tagata fa’aliliu gagana, vili atu e lau telefoni 1-888-401-1128. (Samoan)
Notice of Language Assistance
Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa LIBERTY Dental Plan may
karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang
isang tagasalin, tumawag sa 1-888-401-1128. (Tagalog)
 
LIBERTY Dental Plan,
 
  1-888-401-1128. (Thai)
Nếu quý vị, hay người mà quý v đang giúp đỡ, có câu hi v LIBERTY Dental Plan, quý v s có quyền được
giúp và có thêm thông tin bng ngôn ng ca mình miễn phí. Để nói chuyn vi mt thông dch viên, xin gi
1-888-401-1128. (Vietnamese)