Liberty Benefits
Secure Signup Form
Individual Plan
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Primary Member
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Spouse or Partner
Dependents
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Shipping Address
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Billing Address
Same As Shipping Address
Phone Numbers
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Email Address
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Individual Plan
Please select which Plans you would like to enroll in.
ProductMonthly FeeApp FeeTotal
$30.00 Liberty Prescription Plan$30.00$30.00$60.00
$50.00 Protector Plan$50.00$50.00$100.00
$25.00 Legal Access Plan$25.00$30.00$55.00
Liberty Prescription Plan, Protector Plan, and Liberty Legal Access Plan are available in all states.
Disclosures
I Agree *
I Agree with the disclosure below.
Click Here for Liberty Rx Prescription Plan
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Payment Information - Credit or Debit Card
Accepted Cards: Amex, Visa, Mastercard, Discover
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Payment Total
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Total:
$0.00