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

2. UPDATES 2011 Circuit Breaker and Illinois Cares Rx IL-1363 and Related Schedules

3. 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

4. Form IL-1363 Booklet Seniors Ride Free

5. 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

6. FORM IL -1363 Section A Page 3 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.

7. FORM IL -1363 Section C –Income, losses and deductions for claimant and spouse

8. FORM IL -1363 Section C (continued) page 4 Moved Line 24 from the 1 st page of the application to the top of the second page In Line 24b we added the word out

9. FORM IL -1363 Section D The words “Line 2” were added after Schedule B.

10. FORM IL -1363 Section E Two notes were combined into one

11. FORM IL -1363 Section F page 5 All rebate information was removed for the claimant

12. FORM IL -1363 Section G Removed all rebate information for the spouse

13. FORM IL -1363 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 H

14. FORM IL -1363 Added Seniors Ride Free Section I

15. FORM IL -1363 Section J page 6 Added the note under the preparer to attach proof of authority if Someone else signs for you or your spouse

16. Page 7 The amounts In the second column were changed to reflect the new dollar amounts for income to qualify for IL Cares Rx

17. 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 Page 8

18. Page 9 Added the second question to explain civil unions and IL Cares Rx

19. Page 10 and Page 11 Page 10 No changes Page 11 Removed all of the rebate information

20. 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

21. FORM IL -1363 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

22. FORM IL -1363 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

23. FORM IL -1363 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

24. FORM IL -1363 Pages 22,23 and 24 No changes

25. Schedule A Seniors Ride Free

26. Schedule A pages 25 and 26 In the 1st statement under the heading “civil union partner” was added

27. Schedule C Seniors Ride Free

28. FORM IL -1363 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

29. FORM IL -1363 Pages 31 and 32 Page 31 The address on PSA 1 has changed Page 32 No changes

30. Schedule B Seniors Ride Free

31. FORM IL -1363 Schedule B: Removed the monthly Rebate questions

32. Schedule P Seniors Ride Free

33. 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

34. FORM IL -1363 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.

35. ADAD-16 Seniors Ride Free

36. ADAD-16 step 1 All rebate information has been removed.

37. Adad-16 Step 2 All rebate information has been removed for the spouse.

38. 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

39. Adad-16 step 4 All rebate information has been removed for the QAR.

40. Amended Application IL 1363X Seniors Ride Free

41. FORM IL -1363 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.