Please fill out the form below to make a payment for your Healthcare Exchange dental coverage through LIBERTY Dental Plan. You also have the option to click here to print the form and mail your payment for 2018 coverage. Please note that checks should be made payable to LIBERTY Dental Plan.

**IMPORTANT: Initial payments are refunded if we are unable to verify your member ID. If you experience this, please review the member ID on your payment receipt and resubmit payment as necessary, or contact us if you have any questions.


Mail To:
LIBERTY Dental Plan of California
PO Box 26110
Santa Ana, CA 92799-6110