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State of Illinois Pat Quinn, Governor Illinois Department on Aging John Holton, Director. UPDATES 2011 Circuit Breaker and Illinois Cares Rx IL-1363 and Related Schedules. Online Filing Application. 235,326 in 2009 283,284 in 2010 303, 556 to date in 2011 .

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State of Illinois Pat Quinn, Governor Illinois Department on Aging John Holton, Director

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State of illinois pat quinn governor illinois department on aging john holton director

State of Illinois

Pat Quinn, Governor

Illinois Department on Aging

John Holton, Director


Updates 2011 circuit breaker and illinois cares rx il 1363 and related schedules

UPDATES2011 Circuit Breaker and Illinois Cares Rx IL-1363 and Related Schedules


Online filing application

Online Filing Application

  • 235,326 in 2009

  • 283,284 in 2010

  • 303, 556 to date in 2011

BENEFITS OF ONLINE FILING

  • Reduces the number of errors

  • Reduces processing time

Seniors

Ride Free


Form il 1363 booklet

Form IL-1363 Booklet

Seniors

Ride Free


Pages 1 and 2

Pages 1 and 2

Page 1

  • The Senior Ride Free was added

    Page 2

  • In the “Contents” section removed the “Filing

    on the Internet” and the Rebate Information

  • In the “When May you Expect to Receive

    your Benefits” section a question was added regarding the transit card


Section a page 3

Section A Page 3

  • Personal information about claimant

Removed the People with Disabilities Ride Free Transit card at the top of the page in the heading and now call the benefit the Ride Free Transit Card.

Added civil unions to the status information on

2 & 3 of Line 6.


Section c

Section C

  • Income, losses and deductions for claimant and spouse


Section c continued page 4

Section C (continued) page 4

  • Moved Line 24 from the 1st page of the application to the top of the second page

  • In Line 24b we added the word out


Section d

Section D

The words “Line 2” were added after Schedule B.


State of illinois pat quinn governor illinois department on aging john holton director

Section E

  • Two notes were combined into one


State of illinois pat quinn governor illinois department on aging john holton director

Section F page 5

  • All rebate information was removed for the claimant


State of illinois pat quinn governor illinois department on aging john holton director

Section G

  • Removed all rebate information for the spouse


Section h

Section H

Section H

  • Changed the amount for a married couple from $25,010 to $25,260

  • Changed the amount for single individual from $12,516 to $12640

  • Bolded the portion of the statement “If you are not married or you do not live with your spouse


Section i

Section I

Section I

  • Added Seniors Ride Free


State of illinois pat quinn governor illinois department on aging john holton director

Section J page 6

  • Added the note under the preparer to attach proof of authority if

    Someone else signs for you or your spouse


Page 7

Page 7

The amounts In the second column were changed to reflect the new dollar amounts for income to qualify for IL Cares Rx


State of illinois pat quinn governor illinois department on aging john holton director

Page 8

In the chart at the bottom of the page the numbers have all been changed to reflect the ½ grant amount

Under Item 1 on the chart “Line 25” should say Line 23


State of illinois pat quinn governor illinois department on aging john holton director

Page 9

Added the second question to explain civil unions and IL Cares Rx


State of illinois pat quinn governor illinois department on aging john holton director

Page 10 and Page 11

  • Page 10

  • No changes

  • Page 11

  • Removed all of the rebate information


Pages 12 and 13

Pages 12 and 13

The stand alone coordinating plans remained the same.

New Medicare Advantage Plans have been added and some have been removed. Be sure to recheck the advantage plans if you are enrolling someone


Page 14 and page 15

Page 14 and Page 15

Page 14

  • Under #6 in the second column, status1 and 2 have the words “civil union” added

  • Page 15

  • No changes


Page 16 and pages 17 18 and 19

Page 16 and Pages 17,18 and 19

Page 16

The $250 rebate when you reached the coverage gap has been removed

Pages 17,18 and 19

No changes


Page 20 and page 21

Page 20 and Page 21

Page 20

  • Removed the instructions regarding the rebate in both Section F and Section G

    Page 21

  • Added the Senior Ride Free to Section I


Pages 22 23 and 24

Pages 22,23 and 24

  • No changes


Schedule a

Schedule A

Seniors

Ride Free


Schedule a pages 25 and 26

Schedule A pages 25 and 26

  • In the 1st statement under the heading “civil union partner” was added


State of illinois pat quinn governor illinois department on aging john holton director

Schedule C

Seniors

Ride Free


Schedule c pages 27 28 29 and 30

SCHEDULE C pages 27,28,29 and 30

Page 27

  • “Parties to a civil union must each file a separate Schedule C” was added to the statement after the heading.

    Pages 28,29 and 30

  • No changes


Pages 31 and 32

Pages 31 and 32

Page 31

  • The address on PSA 1 has changed

    Page 32

  • No changes


State of illinois pat quinn governor illinois department on aging john holton director

Schedule B

Seniors

Ride Free


Schedule b

Schedule B:

  • Removed the monthly Rebate questions


Schedule p

Schedule P

Seniors

Ride Free


Schedule p pages 1 2 and 3

Schedule P pages 1,2,and 3

  • Pages 1 and 2

  • No changes

  • Page 3

  • The dollars amounts to apply for prescription coverage were changed


Schedule p note

Schedule P note

  • A Schedule P will no longer cause a person who files one to be eliminated from the other benefits of Circuit Breaker. If you qualify for IL Care Rx you will also qualify for all the other benefits because the income guidelines for IL Cares Rx are lower.


Adad 16

ADAD-16

Seniors

Ride Free


Adad 16 step 1

ADAD-16 step 1

All rebate information has been removed.


Adad 16 step 2

Adad-16 Step 2

All rebate information has been removed for the spouse.


Adad 16 step 3

Adad-16 step 3

The savings, investments or real estate for a married couple has changed from $25,010 to $25,260 and for a single individual from $12,510 to $12,640


Adad 16 step 4

Adad-16 step 4

All rebate information has been removed for the QAR.


State of illinois pat quinn governor illinois department on aging john holton director

Amended Application IL 1363X

Seniors

Ride Free


Il 1363 x note

IL-1363 X note

An IL-1363X should not be used to change the in formation in Section A of the form or to apply for pharmaceutical coverage. Only in the case where an individual has made an error in the numbers he originally reported should an IL-1363X be used.

Changes to Section A should either be phoned , e-mailed or mailed to us.

Rx coverage can be applied for on the ADAD 16 form.


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