Instructions And Benefits Information For Form Il-1363 - Illinois Department Of Revenue - 2002 Page 5
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20Questions about prescription coverage
(continued)
How may I check on my coverage?
How do I know if my drugs are covered?
You can find out the status of your coverage by
You may check with a participating pharmacy or
visiting our Web site at or
your doctor. For information about
calling “Customer Connection,” our automated
SeniorCare’s covered drugs, visit
telephone service (see Page 19).
How can I get the most benefit
the Pharmaceutical Assistance program’s
from these programs?
covered drugs, visit our Web site at
File as soon as you have the information you
What if my prescription coverage
need to complete Form IL-1363.
card is lost or stolen?
File over the Internet if you qualify (see
Page 2).
If you lose your card or it is stolen, and you wish
Ask your doctor if he or she can prescribe a
to receive a replacement card, you should notify
generic drug for you. Generic drugs are
us at the addresses or telephone numbers
below.
usually less expensive than name brand
drugs.
Ask your doctor to prescribe your medicine in
monthly supplies (for as many as 34 days).
Check with your pharmacist to make sure
PHARMACEUTICAL ASSISTANCE
your coverage will be honored. Most Illinois
ILLINOIS DEPARTMENT OF REVENUE
pharmacies participate in the Pharmaceutical
PO BOX 19021
Assistance program and SeniorCare. We
SPRINGFIELD IL 62794-9021
encourage you to use only one pharmacy.
Should I send any payments with
1 800 624-2459 or
my application?
1 800 544-5304 TDD
(telecommunications device for the
No. If you owe any money to us, we will send you
deaf)
a bill. Do not send us any payment with your
Form IL-1363. We will return any payments to
you that we receive with your application.
Questions about the SeniorCare rebate
What is the SeniorCare rebate?
your spouse, you must check the box on
Line 12a and complete Line 12b or 12c
If you or your spouse receive a SeniorCare
Second, if you qualify, you will receive a
prescription card and you have insurance that
SeniorCare prescription card and form that you
pays for prescription drugs, you can choose to
must complete and return to us. On this form,
use that insurance and get a $25 monthly rebate
you must cancel your SeniorCare prescription
check instead of SeniorCare’s prescription
coverage and tell us about any other insurance
coverage. You can have either the prescription
you have that helps you pay for prescription
coverage or the rebate option, but not both.
drugs .
How do I get the SeniorCare rebate for
When will I begin to get the rebate
myself or my spouse?
check?
First, you must complete Form IL-1363 and if
Your first rebate check will be sent in
you want the SeniorCare rebate for
approximately six to eight weeks after we cancel
yourself, you must check the box on Line 5a
your SeniorCare prescription coverage.
and complete Line 5b or 5c
5
Avoid a delay
Apply by March 31
IL-1363 instructions (R-12/02)
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