Enroll in a Healthy Behavior Program

2017
HITRUST Certified

LIBERTY received HITRUST CSF v8.1 certified status for its Health Solutions Plus core application and supporting systems as of 11/20/17

2018
HEDIS NCQA Certified

LIBERTY Dental Plan was presented with a

2018 NCQA-Certified HEDIS^® Compliance Audit™

by AttestHealth Care Advisors, LLC, an NCQA certified audit group.

NCQA has reviewed and accredited LIBERTY’s Credentialing and Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.

Please complete one form for each person in your family who would like to join a Healthy Behavior Program. If you have questions, please call LIBERTY, toll free at 1.833.276.0850. You can speak to a live person Monday through Friday, between 8:00 am and 7:00 pm. TDD/TTY users call 1.877.855-8039.

Last Date of Update 12/22/2021

*Enrollee First Name

*Enrollee Last Name

*Date of Birth

*Medicaid ID Number

*Phone Number

*I agree to opt-in to LIBERTY's text messaging program

Yes

*Cell Phone Number

I agree to receive emails from LIBERTY or their gift card vendor

Yes

*Email

*Address

Delivery/Due Date (Pregnant Women)

*Person Filling out Form

*Relation to Enrollee

*Date of your dental check-up or service

Please only click Submit once

By submitting this form, I confirm that I understand that I am joining a Healthy Behavior Program. I understand that rewards are only issued when eligibility and all the conditions mentioned above are met that is based on dental claims or other sources. I understand that final rewards given are based on supplies available.