Notice of Non-Discrimination

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 because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation.

LIBERTY provides free aids and services to people with disabilities to help them communicate better, such as:

• Qualified interpreters, including sign language interpreters
• Written information in other languages and formats (large print, audio, accessible electronic formats, other formats)

Free language services to people whose primary language is not English, such as:

• Qualified interpreters, including sign language interpreters
• Information written in other languages

If you need these services, please contact us between 7:30 a.m. to 7:30 p.m. (EST) by calling 877-550-4436.
Or if you cannot hear or speak well, please call 877-855-8039.

HOW TO FILE A GRIEVANCE

If you believe that LIBERTY has failed to provide these services or unlawfully discriminated in another way on the basis of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you can file a grievance with LIBERTY's Civil Rights Coordinator. You can file a grievance by phone, in writing, in person, or electronically:

• Phone: 888-704-9833
• TTY: 877-855-8039
• Fax: 833-250-1814
• Email: CivilRightsComplaint@libertydentalplan.com
• Online: https://www.libertydentalplan.com/Members/File-a-Grievance-or-Appeal.aspx

OFFICE OF CIVIL RIGHTS - U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

If you believe you have been discriminated on the basis of race, color, religion, national origin, age, disability or sex, you can also file a civil rights compliant with the U.S. Department of Health and Human Services, Office for civil Rights by phone, in writing, or electronically:

• In writing: Fill out a complaint form and send a letter to:
    U.S. Department of Health and Human Services
    200 Independence Avenue, SW
    Room 509F, HHH Building
    Washington, D.C. 20201
  

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

• By Phone: 1-800-368-1019, 800-537-7697 (TDD)
• Online at: http://ocrportal.hhs.gov/ocr/portal/lobby.jsf

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 https://www.libertydentalplan.com/HIPAA-Privacy-Notice