Insurance Coverage of Rehabilitative and Habilitative Devices

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1. Do you have health insurance through your employer (or through the employer of a spouse, parent, or member of your household)?
2. The policy holder’s place of work has:

3. Your health insurance coverage can best be described as:

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4. In the last ten years, have you (or another person covered under the same insurance policy) had a healthcare condition requiring rehabilitative or habilitative services (Physical Therapy, Occupational Therapy, Speech Therapy, etc) and/or devices (durable medical equipment , orthotics, prosthetics or other assistive device)?

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5. Rehabilitative or habilitative services you (or another person covered under your insurance) have required include (choose all that apply):
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6. The assistive device(s) you use the most in your daily living is:
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7. You generally find your insurance coverage:
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8. Are there limits, restrictions or caps in your insurance coverage that prevent you from getting your rehabilitation needs met? (For example, a limit on the number of sessions per year, or dollar limits on services or policies that require referrals before going to a specialist.)

9. Please estimate how much you spend out of pocket each year for medical supplies and devices:
10. Please provide below any additional significant information about your experience with employer-sponsored health insurance coverage for disability-related healthcare services. Give us your contact info if you would like a copy of the results.
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