Form Il-1363 - Application For Circuit Breaker Grant, License Plate Discount, And Optional Help Paying For Drugs (Pharmaceutical Assistance Or Seniorcare) - 2004 Page 20
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20Where may I get help or more forms?
Visit our Web site at
Email us at ilsenior@aging.state.il.us
Visit a local office (senior health
Call us toll-free (24-hour automated
assistance program or area agency on
information). Have your Social Security
aging).
number ready when you call.
1 800 624-2459 or
To find an office near you, see Page 19 or
call toll-free:
1 800 544-5304
TTY
Senior HelpLine
Write to us at
1 800 252-8966 (voice and TTY)
ILLINOIS DEPARTMENT ON AGING
PO BOX 19003
Before visiting, call first.
SPRINGFIELD IL 62794-9003
Make sure the place you go
is ready to help you.
Illinois Rx Buying Club
What is the Illinois Rx Buying Club?
Seniors eligible for the SeniorCare program
are not eligible to participate in the Illinois Rx
Members enjoy discounts on prescription
Buying Club.
drugs, both brand name and generic.
There is an average 20% savings.
How do I apply for the Illinois Rx Buying
Individual discounts may vary.
Club?
It’s accepted at more than 50,000
You can apply for the new Illinois Rx Buying
pharmacy locations. Check with your
Club in three ways:
pharmacy or call toll-free
Call toll-free 1 866-215-3462 or
1 866-215-3462.
1 866-215-3479 TTY
There are no limits, no income restrictions,
Download an Illinois Rx Buying Club
and no paperwork after enrollment.
application form at
There is also a mail order service for
greater savings on the prescription drugs
Contact the Senior HelpLine at
you take every day.
1-800-252-8966 (Voice & TTY)
Do I qualify for the Illinois Rx Buying
Monday through Friday
Club?
8:30 a.m. to 5:00 p.m.
You must be an Illinois resident who
NOTE: When you are enrolled in Circuit
is age 65 or older, or
Breaker Pharmaceutical Assistance, you
has an Illinois Disabled Person
will be automatically enrolled in the Illinois
Identification card and a Class 2 disability
Rx Buying Club. You do not need to apply
or
separately or pay another fee. The
is disabled and receiving benefits through
Pharmaceutical Assistance card will contain
the Social Security Administration.
all necessary information for the Illinois Rx
Buying Club program.
There is no income requirement.
Remember, if you qualify for Form IL-1363 benefits (see Page 2), apply using Form IL-1363 to
get signed up for the most help paying for your drugs. If you are over the income limits, apply to
the Illinois Rx Buying Club for discounts on prescribed medications. Do not apply on both forms.
PRINTED ON RECYCLED NEWSPRINT - SOY BASE INK
BY AUTHORITY OF THE STATE OF ILLINOIS
20
(250,000 copies - 12/04 - Number 1076249)
IL-1363 instructions (R-12/04)
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