Submit your application

Once we receive and approve all of the completed documents, you will receive an email notification that you are contracted with Liberty Dental Plan. Included will be executed copies of your Agent Agreement and your assigned Broker/Agent number. We are unable to pay any commissions until all of these documents have been completed, received and approved.

If you have any questions regarding this process, please contact our Client Services Department at clientservices@libertydentalplan.com.

Liberty Dental Plan (“Liberty”) requires its Agents/Brokers who may, in the course of providing services for Liberty, have access to members’ Protected Health Information (PHI) to execute a Business Associate Agreement (BAA) and any updates thereto. The Business Associate Agreement sets forth all applicable privacy and security requirements under the Health Insurance Portability and Accountability Act of 1996 (“HIPPA”) and Health Information for Economic and Clinical Health Act (“HITECH Act”). In addition, Liberty requires its Agents/Brokers who may have access to its (or its clients’) confidential information to execute a Nondisclosure Agreement (NDA) and any updates thereto.

We look forward to working with you to provide quality dental benefits to your clients!