Skip to main content
English
English
Spanish
Log in
Member
Group
Office or vendor
Visit Liberty Dental Plan
Menu
Close menu
Visit Liberty Dental Plan
Log in
Member
Group
Office or vendor
English
English
Spanish
Florida Medicaid
Florida Medicaid
Coordination of benefits
Florida Medicaid coordination of benefits
Note: (Items marked with * are required fields)
*
Florida Medicaid member first name
*
Florida Medicaid member last name
*
Florida Medicaid ID number
Name of other insurance company
Other insurance address/phone
Name of family member insured through them
Relationship of family member to Florida Medicaid member
Effective date of other coverage
Group, policy, and member numbers of other coverage
Type of other coverage
Select
Submit
Last Updated:
12/21/2021
