Form Il-1363 - Application For Circuit Breaker Grant, License Plate Discount, And Optional Help Paying For Drugs (Pharmaceutical Assistance Or Seniorcare) - 2004 Page 7
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20Questions about help paying for drugs
(continued)
When may I expect to get my drug card?
If you applied
When to expect card*
Coverage effective*
by March 31
for a renewal card
by July 1
July 1, 2005 - June 30, 2006
for a card for the first time
by June 1
June 1, 2005 - June 30, 2006
between March 31 and June 1
in about 12 weeks
Renewals expect a break in your coverage
Example: applied April 1
by July 16
July 16, 2005 - June 30, 2006
Example: applied June 1
by September 1
Sept. 1, 2005 - June 30, 2006
between June 2 and December 31
in about 8 weeks
Renewals expect a break in your coverage
Example: applied August 1
by October 1
October 1, 2005 - June 30, 2006
Example: applied December 1
by March 1
March 1, 2006 - June 30, 2006
*
Your coverage will start on the first or sixteenth of the month after we approve your completed
2004 Form IL-1363. Your card will be delayed if we need to request additional information from you. The
dates in this table are approximate.
SeniorCare requirements for noncitizens
These requirements only apply to persons who are
6 identified by the federal Office of Refugee Re-
age 65 or older and who want to apply for
settlement as a victim of trafficking;
SeniorCare. There are no citizenship requirements
7 a member of Hmong or Highland Laotian tribe
for the Circuit Breaker grant, license plate discount,
during the Vietnam era between August 5, 1968,
or Pharmaceutical Assistance.
and May 7, 1975 (this includes the person’s
To check the “qualified noncitizen” box in Line 5b
spouse, widow, or widower who has not remar-
(Line 12b for your spouse), you must be a
ried);
noncitizen who is also one of the following:
8 an American Indian born in Canada to whom
1 a lawful permanent resident who has lived in
Section 289 of the Immigration and Nationality
the U.S. for at least five years;
Act applies or a member of an Indian tribe
2 a refugee, an asylee, or a parolee;
defined in Section 4e of the Indian Self-Determi-
nation and Education Assistance Act;
3 a U.S. veteran or the spouse of a U.S.
veteran;
9 a victim of domestic abuse; or
4 a national of Cuba or Haiti admitted to the
10 your deportation is being withheld by INS under
U.S. on or after April 21, 1980;
Section 243(h) or Section 241(b)(3).
5 an Amerasian from Vietnam admitted through
You may need to attach proof of your qualified
the Orderly Departure Program beginning on
noncitizenship status — see Page 17.
March 20, 1988;
These requirements are only for SeniorCare, not other Circuit Breaker benefits.
7
Apply every year
Renew by March 31
IL-1363 instructions (R-12/04)
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