MAHSPA2018 Promo Code:__________________ with SAFELINK WIRELESS to offer members this special federal LifeLine program MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA, INC. is proud to be working at no cost to you! WITH SAFELINK HEALTH SOLUTIONS®, YOU WILL GET: • A SMARTPHONE,1GB of data and 1,000 monthly minutes** • UNLIMITED text messages • FREE CALLS to MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA, INC. Member Services will not count towards your 1,000 minutes • Text messages with HEALTH TIPS and REMINDERS There are no bills so there are no surprises! ALREADY HAVE YOUR OWN PHONE? APPLY TODAY! Select the KEEP YOUR OWN SMARTPHONE* program. THERE ARE 3 WAYS TO ENROLL INTO THE MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA, INC. SAFELINK PHONE PROGRAM TODAY: Visit SafeLink.com to apply online Fill out the application in this envelope and mail it back (no postage necessary) Call SafeLink at 1-877-631-2550 Please make at least one phone call or send a text message each month in order to keep your Lifeline benefits. Si desea información en Español visite www.SafeLink.com para llenar la inscripción en línea o Llame a SafeLink al 1-877-631-2550 para completar una solicitud por teléfono. * To Keep Your Own Smartphone, you must have a compatible GSM phone (which includes T-Mobile and AT&T compatible phones). Your phone must also be unlocked. Several other carriers also use GSM networks. To confirm yours is included, call your carrier. **Unused minutes and data will not Carryover from month-to-month. A month equals 30 days. PLEASE COMPLETE AND RETURN ALL PAPERS IN THE MAILER ENVELOPE 2019 MAHC.indd 1 12/10/2018 9:22:52 AM
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WITH SAFELINK HEALTH SOLUTIONS®, YOU WILL GET...SAFELINK WIRELESS to offer members this special federal LifeLine program MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA, INC. is proud
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MAHSPA2018 Promo Code__________________
with SAFELINK WIRELESS to offer members this special federal LifeLine program MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA INC is proud to be working
at no cost to you
WITH SAFELINK HEALTH SOLUTIONSreg YOU WILL GET bull A SMARTPHONE1GB of data and 1000 monthly minutes
bull UNLIMITED text messages
bull FREE CALLS to MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA INC Member Services will not
count towards your 1000 minutes
bull Text messages with HEALTH TIPS and REMINDERS
There are no bills so there are no surprises
ALREADY HAVE YOUR OWN PHONE APPLY TODAY Select the KEEP YOUR OWN SMARTPHONE program THERE ARE 3 WAYS TO ENROLL INTO THE MAGELLAN BEHAVIORAL HEALTH OF PENNSYLVANIA INC SAFELINK PHONE PROGRAM TODAY
Visit SafeLinkcom to apply online
Fill out the application in this envelope and mail it back (no postage necessary)
Call SafeLink at 1-877-631-2550
Please make at least one phone call or send a text message each month in order to keep your Lifeline benefits Si desea informacioacuten en Espantildeol visite wwwSafeLinkcom para llenar la inscripcioacuten
en liacutenea o Llame a SafeLink al 1-877-631-2550 para completar una solicitud por teleacutefono To Keep Your Own Smartphone you must have a compatible GSM phone (which includes TshyMobile andATampT compatible phones) Your phone must also be unlocked Several other carriers also use GSM networksTo confirm yours is included call your carrierUnused minutes and data will not Carryover from monthshytoshymonth A month equals 30 days
PLEASE COMPLETE AND RETURN ALL PAPERS IN THE MAILER ENVELOPE
2019 MAHCindd 1 12102018 92252 AM
Select Only One PlanPhone Option Keep-Your-Own-Smartphone SafeLink Smartphone
Receive 1000 minutes and Receive 1000 minutes and 15GB of FREE data for the OR 1GB of FREE data first 3 months every month1GB thereafter
To Keep Your Own Smartphone you must have a compatible GSM phone(which includes T-Mobile and ATampT compatible phones)Your phone must also be unlockedSeveral other carriers also use GSM networks To confirm yours is included call your carrierUnused data will not Carryover from month-to-month A Month equals 30 Days
I consent to provide enrollment information including my new phone number to Magellan Behavioral Health of Pennsylvania Inc and anyone acting on Magellan Behavioral Health of Pennsylvania Incrsquos behalf and consent to calls or text messages generated by automated technology being sent to that number that provide information regarding your health plan or health-related issues (including nutritional medical and healthcare information and reminders) Consent to these messages is not a requirement to enroll in the SafeLink program If you do not want to consent to such calls you may enroll by calling our customer service department at 1-800-Safelink (723-3546)
Magellan Behavioral Health of Pennsylvania Inc will confirm your eligibility I hereby certify that I participate in the following public assistance program
PMedicaid (Please provide your 9 Digit Social Security number) - -
(By providing your Social Security number we can attempt to validate your Medicaid eligibility electronically)
Telephone number provided above
By submitting this application you authorize social service agency representatives to discuss with andor provide information to SafeLink Wirelessreg verifying your participation in benefit programs that qualify you for Lifeline assistance You have the right to revoke this authorization Social service agencies will not condition treatment payment enrollment or eligibility for benefits on your signing of this authorization
PLEASE COMPLETE AND RETURN ALL PAPERS IN THE MAILER ENVELOPE
2019 MAHCindd 2 12102018 92254 AM
1233672
Select Only One PlanPhone Option Keep-Your-Own-Smartphone SafeLink Smartphone
Receive 1000 minutes and Receive 1000 minutes and 15GB of FREE data for the OR 1GB of FREE data first 3 months every month1GB thereafter
To Keep Your Own Smartphone you must have a compatible GSM phone(which includes T-Mobile and ATampT compatible phones)Your phone must also be unlockedSeveral other carriers also use GSM networks To confirm yours is included call your carrierUnused data will not Carryover from month-to-month A Month equals 30 Days
I consent to provide enrollment information including my new phone number to Magellan Behavioral Health of Pennsylvania Inc and anyone acting on Magellan Behavioral Health of Pennsylvania Incrsquos behalf and consent to calls or text messages generated by automated technology being sent to that number that provide information regarding your health plan or health-related issues (including nutritional medical and healthcare information and reminders) Consent to these messages is not a requirement to enroll in the SafeLink program If you do not want to consent to such calls you may enroll by calling our customer service department at 1-800-Safelink (723-3546)
Magellan Behavioral Health of Pennsylvania Inc will confirm your eligibility I hereby certify that I participate in the following public assistance program
PMedicaid (Please provide your 9 Digit Social Security number) - -
(By providing your Social Security number we can attempt to validate your Medicaid eligibility electronically)
Telephone number provided above
By submitting this application you authorize social service agency representatives to discuss with andor provide information to SafeLink Wirelessreg verifying your participation in benefit programs that qualify you for Lifeline assistance You have the right to revoke this authorization Social service agencies will not condition treatment payment enrollment or eligibility for benefits on your signing of this authorization
PLEASE COMPLETE AND RETURN ALL PAPERS IN THE MAILER ENVELOPE