TOYOTA HAWAI'I MOBILITY ASSISTANCE PROGRAM

Supports the mobility needs of Toyota Hawai’i owners and/or family members with physical disabilities

Reimbursement Application Form

PROGRAM ELEMENTS


TOYOTA HAWAI'I MOBILITY ASSISTANCE

Provides retail buyers/lessees{1} of new Toyota vehicles or wheelchair-accessible converted Toyota Siennas with a cash reimbursement of up to $1,000 (paid directly to the retail buyer) to help offset expenses incurred for the following:

  • Purchase and/or installation of qualifying adaptive mobility equipment
  • The conversion of a new Sienna for wheelchair accessibility with less than 799 miles.

Refer to guidelines below and reimbursement application form for detailed requirements; maximum $1,000 per Vehicle Identification Number (VIN).

A PROVEN PROCESS FOR GAINING FREEDOM ON THE ROAD

Toyota Hawai’i supports the U.S. Department of Transportation’s recommended process, which is detailed in the brochure “Adapting Motor Vehicles for People with Disabilities.” Copies are available by calling (888) 327-4236 or at www.nhtsa.gov.

The Process Includes These Steps:


1. Determine your state's driver's license requirements


2. Evaluate your needs

Contact a mobility equipment dealer in your area to identify the adaptive equipment most suited to your needs.


3. Select the right vehicle

Consult with your evaluator, an adaptive equipment installer and your local Toyota dealer to determine the best Toyota model to meet your needs.


4. Choose a qualified mobility equipment installer

Shop around and ask about qualifications, capabilities, experience, warranty coverage and service. Confirm they are members of the National Mobility Equipment Dealers Association (NMEDA) or another organization that has established vehicle conversion standards.


5. Obtain training on the user of the new equipment

When this process is complete, follow the guidelines and complete and submit the attached application for assistance to recover up to $1,000 of the cost of your adaptive equipment and/or conversion.

GUIDELINES


Toyota Hawai’i will provide a reimbursement of up to $1,000 to each eligible, original retail customer, for the exact cost they paid to purchase and/or install qualifying adaptive driving or passenger equipment for transporting persons with physical disabilities. Leased vehicles require advance written lessor approval of adaptive equipment installations.{2}


  • Only new vehicles sold or leased and delivered to a retail customer by an authorized Toyota Hawaiʻi dealer are eligible for reimbursement. New Toyota Siennas converted for wheelchair access with less than 799 miles qualify for reimbursement. Fleet incentive recipients and Commercial entities (including nonprofit organizations and trusts) are not eligible to participate in this program.
  • Reimbursement not to exceed $1,000 per qualifying Vehicle Identification Number (VIN). 
  • The adaptive equipment must be purchased and installed within 12 months of vehicle purchase or lease. A Reimbursement Application form must be submitted to Toyota Hawai'i within 90 days of complete installation of adaptive equipment.
  • Note: Toyota Hawaiʻi will reimburse the labor cost and required materials for transferring existing equipment from a used vehicle to a new Toyota. Toyota recommends the transfer be performed by an NMEDA Dealer with Quality Assurance Program (QAP) certification. Refer to www.nmeda.org for information on QAP certified dealers. 
  • Qualifying adaptive equipment or conversion is defined as any aftermarket alteration or equipment installation on an eligible Toyota vehicle that provides the disabled user convenient access and/or the ability to drive the vehicle. Equipment installed must be within vehicle weight limits and any hitch-mounted device must be within hitch load and tongue weight limits as identified in the vehicle’s Owner’s Manual. 
  • A prescription or note from a licensed medical doctor on physician’s letterhead is required for reimbursement, except as noted below. For some adaptations, such as a hand controls, no medical note or prescription is required. Modifications not listed on this application but represent obvious mobility adaptations must have a written document from a licensed medical doctor describing the customer’s disability/limitation. Toyota dealer-installed accessories are not reimbursable under the Toyota Hawaiʻi Mobility Assistance Program. For pedal extender reimbursement, the customer must be medically diagnosed with a physical condition. Questions about other adaptations should be directed to Servco Quality Division at (888) 272-5514.
  • To obtain reimbursement, the Reimbursement Application form must be completed in its entirety and signed by the customer and the selling dealership. It should be mailed along with a copy of the vehicle sales or lease agreement, the adaptive equipment company's paid invoice showing payment by the vehicle owner{1}, a Lessor Letter of Authorization (for leased vehicles) and a prescription or note from a licensed medical doctor on physician's letterhead (when required) to the following address:

Servco Quality Division

2850 Pukoloa St., Suite 202 

Honolulu, HI 96819 


Payment to the individual Mobility Assistance Program customer will be mailed within 

6–8 weeks after receipt of an approved claim form and all required documentation. 

Please call Servco Quality Division with any questions: 

(888) 272-5514

ELIGIBLE MOBILITY ADAPTATIONS FOR DRIVERS/PASSENGERS 


Toyota Hawai’i dealer-installed accessories are not reimbursable under the Toyota Hawai’i Mobility Assistance Program. 


The following adaptations would be considered obvious mobility adaptations and, as such, do not require a doctor’s note, or completion of the LICENSED MEDICAL DOCTOR VALIDATION section of the Reimbursement Application Form or other documentation, to qualify for reimbursement. 


Note: Toyota Hawai’i cannot be responsible for the quality, safety or efficiency of adaptive equipment supplied by others. Consumers should obtain complete information and references prior to purchasing such devices and having a vehicle adapted. 


Running boards and trailer hitches are reimbursable only if they are not available to order as a factory option or as a Toyota Accessory.


Toyota Hawai’i Mobility will not reimburse for hitch loads greater than specified maximum tongue weight.


Reimbursement Application Form