Phase II: Access to Care

Survey

Thank you for taking a moment to fill out the Lupus Foundation of America's Health Insurance Marketplace survey about your insurance coverage and use. This survey enables the Foundation to gather the experiences of people with lupus who have chosen a health insurance plan through the Marketplace. The information you share will help the Foundation to better understand the Marketplace’s impact on people with lupus which, in turn, will help us talk to Members of Congress about ways to enhance access to care in the future.

Your answers will remain anonymous and no personally identifiable information will be shared with anyone other than staff at the Lupus Foundation of America. If you have questions about the survey, please contact advocacy@lupus.org.

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* 1. Contact Information

Name:

Address 1:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. Which health plan and level did you choose?

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* 3. Have you used your health insurance plan services yet?

Yes

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* 4. If yes, when did you first try to use your services?

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* 5. Have you hit your annual out-of-pocket cap?

Yes

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* 6. If so, when?

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* 7. What is your out-of-pocket cap?

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* 8. Were all your recommended medical procedures covered?

Yes

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* 1. Contact Information

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* 2. Which health plan and level did you choose?

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* 3. Have you used your health insurance plan services yet?

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* 4. If yes, when did you first try to use your services?

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* 5. Have you hit your annual out-of-pocket cap?

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* 6. If so, when?

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* 7. What is your out-of-pocket cap?

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* 8. Were all your recommended medical procedures covered?

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* 9. If no, which ones were NOT covered?