Insurance Coverage of Rehabilitative and Habilitative Devices

1.

* 1. Do you have health insurance through your employer (or through the employer of a spouse, parent, or member of your household)?

Yes

No (There is no need to complete the survey. Thank you for your time.)

Not sure (please elaborate)

* 2. The policy holder’s place of work has:

Less than 100 employees

Greater than 100 employees

Not sure (please elaborate)

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

Full insurance (A plan where the employer contracts with another organization to assume financial responsibility for the enrollees' medical claims and for all incurred administrative costs)

Self Insured Plan (A plan offered by employers who directly assume the major cost of health insurance for their employees)

Catastrophic coverage with Health Savings Account

Other (please describe)

* 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)?

Yes

Not sure (Please elaborate)

* 5. Rehabilitative or habilitative services you (or another person covered under your insurance) have required include (choose all that apply):

Inpatient rehabilitation (Hospital based Intensive rehabilitation services)

Skilled Nursing Facility services (based in outpatient therapy settings, such as physical therapy, occupational therapy or speech therapy)

Home Care services

None

Other (please specify)

* 6. The assistive device(s) you use the most in your daily living is:

Wheelchair (manual or power)

Scooter

Prosthetic limb or limbs

Braces of the arm, leg, back or neck

Oxygen therapy at home

Speech generating device for communication

Support cane, crutch or walker

Video magnifier, monocular or other low vision devices

Long white cane or other related mobility device

Hearing aid

Braille, large print, or audio system to manage medications

Voice output glucose analyzer

None

Other (please specify)

* 7. You generally find your insurance coverage:

Is adequate to cover your needs

Is inadequate to cover your needs

Is overly generous

Forces you to go without services

Other (please explain)

* 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.)

Yes (please explain below)

Please explain limits

* 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.