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Questions about prescription coverage

Can I get help paying for my

any of your qualified additional residents,

prescription drugs?

check the correct box requesting

Pharmaceutical Assistance on Step 1 of

Each person who wants prescription coverage

Schedule B.

must meet the requirements on Page 2 (“Who

A person who we approve for prescription

should apply?”). If you apply for prescription

coverage will receive coverage under his or her

coverage and you qualify, you will receive

own name and Social Security number.

prescription coverage through either the

If your spouse or qualified additional resident

Pharmaceutical Assistance program or

applying for coverage is disabled,

SeniorCare.

you must attach proof of disability

If you have the MediPlan card, you are not

— see Page 17.

eligible for prescription coverage. If you are on

Spenddown, you can use Pharmaceutical

What if I already have a

Assistance or SeniorCare’s prescription

Pharmaceutical Assistance or

coverage until you receive a MediPlan card.

SeniorCare card?

What if I have other insurance

If you want to continue to have Pharmaceutical

that pays for my drugs?

Assistance or SeniorCare prescription coverage,

you must re-apply every year. Your current

By signing Form IL-1363, you are allowing your

coverage will end June 30, 2003.

insurance company to pay us for prescription

To help avoid a break in your prescription

benefits we paid on your behalf.

coverage, send us your completed 2002

May I choose between SeniorCare

Form IL-1363 by March 31, 2003.

and Pharmaceutical Assistance

How long does my coverage last?

prescription coverage?

All coverage we issue in 2003 will be effective

No. A person who qualifies for prescription

through June 30, 2004.

coverage will only qualify for one type of

For renewal coverage: If we receive your

coverage. We will send you a prescription card

completed 2002 Form IL-1363 by March 31, 2003,

and information about your coverage. See

and you qualify, your new prescription coverage

Page 8 for more details about which prescription

will become effective July 1, 2003, and it will end

coverage you may receive.

June 30, 2004. If you apply later than March,

How do I (the claimant) apply?

your coverage will start on the first or sixteenth

To apply on Form IL-1363 for prescription

of the month after we approve your completed

coverage for yourself, you must check the box on

2002 Form IL-1363, and it will end on

Line 5a. If you are 65 years old or older or you

June 30, 2004.

will become 65 years old during 2003, you must

For new coverage: If you qualify, your coverage

also complete Line 5b or 5c.

will start on the first or sixteenth of the month

How do I apply for coverage for my

after we approve your completed 2002

spouse and my qualified additional

Form IL-1363, and it will end June 30, 2004.

residents?

How will I know if and when my

Your spouse or qualified additional resident

coverage has been approved?

must meet the requirements listed on

For renewal coverage: We will mail a new

Page 2 (see “Who should apply?”).

prescription card to you confirming renewal of

To apply for prescription coverage for

your coverage about seven days before your

your spouse, check the box on Line 12a on

current coverage is scheduled to expire.

Form IL-1363. If your spouse is 65 years old

For new coverage: We will send you a

or older (or will become 65 years old during

prescription card approximately 8 weeks after we

2003), you must also complete

receive your completed Form IL-1363 and have

Line 12b or 12c.

approved your coverage.

Avoid a delay

Apply by March 31

IL-1363 instructions (R-12/02)

Instructions And Benefits Information For Form Il-1363 - Illinois Department Of Revenue - 2002 Page 4

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