Ill. Admin. Code tit. 86 § 530.115

Current through Register Vol. 48, No. 50, December 13, 2024

Section 530.115 - Eligibility Qualifications

a) 1998 and 1999 Claim Years

1) In order to be eligible to participate in this program for the 1998 and 1999 claim years, each claimant must:

A) be 65 years of age or older or disabled prior to January 1 of the year in which a claim is filed, or be the surviving spouse ofa claimant, who at the time of death received or was entitled to receive pharmaceutical assistance benefits, which surviving spouse will become 65 years of age within the 24 months immediately following the death of a claimant and which surviving spouse, but for his or her age, is otherwise qualified to receive pharmaceutical assistance benefits;

B) be domiciled inIllinoisat the time he or she filesaclaim;

C) have a maximum household income ofless than $16,000;

D) obtainacard from the Department; and

E) at the timeacard is obtained, execute an assignment to the Department of all benefits which might be claimed under any private insuranceplanin purchasing covered prescription drugs. [320 ILCS 25/4(f) ]

2) If two or more persons living in the same household are eligible to participate inthis program, all the requirements of subsection (a)(1)above must be met by eachperson. [320 ILCS 25/4(f)

3) Persons who participate in some other program of public assistance are ineligible to participate in this program to the extent that the other program provides pharmaceutical assistance benefits for a covered prescription drug under this program. [320 ILCS 25/4(f) ]

b) 2000 Claim Year and Later Claim Years

1) In order to be eligible to participate in this program for the 2000 claim year and later claim years, each applicant must:

A) file a timely claim in accordance with the dates designated in Section 530.117(a)(1); and

B) meet one of the following requirements:

i) be 65 years of age or olderprior to January 1 ofthe calendar year in whichaclaim is filed; or

ii) become 65 years of age during the calendar year in which a claim is filed; or

iii) be the surviving spouse of an applicant, who at the time of death received or was entitled to receive pharmaceutical assistance benefits, which surviving spouse will become 65 years of age within the 24 months immediately following the death of an applicant and which surviving spouse, but for his or her age, is otherwise qualified to receive pharmaceutical assistance; or

iv) be disabled prior to January 1 of thecalendaryear in whichaclaim is filed; and

C) be domiciled in Illinois at the time he or she files a claim; and

D) have a current income of less than $21,218 for a household consisting of one person, $28,480 for a household consisting of either two persons or one person and one additional resident, or $35,740 for a household consisting of either two persons and one or more additional resident or one person and two or more additional residents; and

E) authorize the release of medical, pharmaceutical, and Social Security records for audit or verification purposes; and

F) obtain a card from the Department; and

G) execute an assignment to the Department of all benefits which might be claimed under any private plan of assistance, including any insurance plan or public assistance program, or from a third party in purchasing covered prescription drugs. [320 ILCS 25/4(f) ]

2) If more than one person in a household or any additional resident is eligible to participate in this program, all the requirements of subsection (b)(1) above must be met by each applicant. [320 ILCS 25/4(f) ]

Ill. Admin. Code tit. 86, § 530.115

Amended at 26 Ill. Reg. 8437, effective May 24, 2002