Contact Me YesI would like to speak with a LifeWorks Advantage representative to discuss the LifeWorks Advantage (HMO SNP) Special Needs Plan that includes a prescription drug benefit. You have my permission to contact me at the phone number, or email address, below. Please leave this field empty.Resident’s Full Name Beneficiary or Authorized Representative (if applicable): Phone Number Email Best Time to Call By signing and returning this reply card, you are agreeing to a meeting with a LifeWorks Advantage representative to discuss the LifeWorks Advantage Special Needs Plan. By signing this form, you are also agreeing to be contacted by phone and/or email. You may opt out of email at any time by replying STOP. Signing this form does not obligate you to enroll in the plan, automatically enroll you in the plan, or affect your current or future Medicare enrollment status. Signature:SignedChecking this box provides your electronic signature. Today's Date: I agree. Please ask a LifeWorks Advantage Representative to contact me.