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 1-888-902-0407.
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-
Compliance.aspx
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
2
00 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
LDP_MO_EX
