Managing your blood sugar will help you keep your diabetes in check, so let health insurance help you manage the costs. Most insurers will cover your insulin pump, glucose monitor, dietary education and medication, and you don't even need the highest level of cover.
How will my private health fund cover me if I need an insulin pump?
The Private Health Insurance Act 2007 stipulates that private health funds can cover the cost of insulin pumps under either their hospital cover or general treatment cover policies. However, the level of cover provided varies depending on whether you receive the pump is provided as part of hospital treatment or not.
For example, if you are hospitalised due to diabetes and receive an insulin pump, and if you have an adequate level of hospital cover in place, your health fund is required to provide cover for:
The cost of the insulin pump
Your hospital accommodation fees
Your doctor’s fees
However, in many situations you will not need to be hospitalised in order to receive an insulin pump, so you’ll need to check whether your fund covers the cost of an insulin pump where hospitalisation is not required. If cover is offered, the amount of benefits available and any terms and conditions that apply vary from one fund to the next - for example, benefits may be restricted to a limited time period. It’s also worth pointing out that you will need to have served any relevant waiting periods before you can claim a benefit.
If you have private health insurance and you need an insulin pump, check with your health fund to find out whether insulin pumps are covered, what benefit limits apply and whether you will have any out-of-pocket expenses. Most funds also require you to apply for pre-approval before receiving a pump, so check what is required to obtain pre-approval before receiving an insulin pump.
How much is health insurance with insulin pumps included?
Below are health insurance policies from Finder partners that cover insulin pumps in hospital cover. All have a 12 month wait period for pre-existing conditions, and a 2 month wait period if not.
Under the new tier structure for health insurance, insulin pumps are listed under a Gold tier.
*Quotes are based on a single individual with less than $90,000 income, $500 excess and living in Sydney.
Compare more health insurance options
Am I covered if my insulin pump needs replacing?
If you need to replace an insulin pump, most funds will only pay benefits if you have used your existing pump for a specified period of time. Although those time limits vary between funds, they’re commonly around four or five years. With this in mind, check with your fund to find out what benefits you are eligible for before you have an insulin pump replaced.
If your pump needs to be repaired it may be under warranty, so get in touch with the manufacturer to find out whether it will be covered. If the warranty period has ended or the repair is simply not covered, check with your private health fund to see if they will provide the financial support you need.
Are insulin pumps on the Protheses List?
Insulin pumps were included in Section C of the Australian Government’s Prostheses List at the end of 2011, meaning they are guaranteed a permanent place on the list. Private hospital cover from Australian health funds which includes cover for prostheses must pay a benefit for an insulin pump on the Prostheses List when:
The pump is provided during a service for which Medicare offers a benefit
The service is provided by a consultant health care professional
The service is a certified Type C procedure for which hospitalisation was necessary due to your medical condition or other circumstances
What other diabetes treatment are covered by health insurance?
Depending on the health fund and the level of extras cover you have in place, your health fund may offer rebates to help cover the cost of a self-blood glucose monitoring device. The cost of consumables or sensors is not included in this cover, but some health funds will also cover the cost of services you receive from an accredited diabetes educator. Consult your health fund for details of the cover available.
Getting health cover with diabetes case study: Caitlin
Question: What type of diabetes do you have?
I have type 1 diabetes since I was 13 years old (26 now)
Question: How do you treat your diabetes?
With an Insulin Pump. So I take a short acting insulin intravenously throughout the day, administered via an insulin pump.
Question: Do you have health insurance?
I am with AHM and have their Silver Plus Hospital and Lifestyle Extras cover. Currently looking at changing this policy as after the price increase it will be costing me a fair bit each month – over $140 a month.
Question: Was your Insulin Pump covered by your health fund?
My current insurance policy covers the cost of an insulin pump every four years, if my health professional says its a necessary item and completes all the paperwork.
Question: Did you have any issues with getting health insurance?
Not so far. The only issues I've had are the cost of the pump and understanding the fine print of each policy (i.e. finding out information specific to the insulin pump).
Type 1 diabetes is a hereditary auto-immune condition that affects around one in 10 Australians. Also known as insulin-dependent diabetes, type 1 diabetes sees the body attack insulin-producing cells in the pancreas. Symptoms include:
Unexplained weight loss
Fatigue and weakness
Skipping a meal or exercising heavily can also cause the patient’s blood sugar levels to fall, which can lead to hypoglycaemia.
Type 1 diabetes is typically diagnosed before the age of 30 and those with the condition require insulin injections in order to effectively process glucose. While there is no cure for type 1 diabetes, it can be managed with insulin injections as well as proper diet and exercise.
Type 2 diabetes
Type 2 diabetes is a much more common condition in Australia, representing up to 90% of all cases of diabetes. Also referred to as non-insulin-dependent diabetes, it is a progressive auto-immune condition that occurs as the body stops responding to the effects of insulin. This means carbohydrates and sugars are not properly metabolised, and the condition usually occurs in adults over 45 years of age.
Obesity, insufficient exercise and poor diet are all contributing factors to the onset of type 2 diabetes, but there is currently no cure for the condition. Many people with type 2 diabetes have no symptoms, but some symptoms to keep an eye out for include:
Excessive thirst and urination
Feeling tired and lethargic
Feeling hungry all the time
Dizziness and mood swings
Itching and skin infections
Gradually putting on weight
Type 2 diabetes can be managed with healthy eating, regular exercise and sometimes medication.
Gestational diabetes is diabetes that occurs during pregnancy. It affects between 5 and 10% of pregnant women but usually goes away once the baby has been born.
A woman’s likelihood of developing gestational diabetes is influenced by a range of factors, including a family history of type 2 diabetes, being overweight, and being from certain ethnic backgrounds.
Gestational diabetes can be managed through healthy eating, regular exercise and monitoring your blood glucose levels. Most women with gestational diabetes have a normal pregnancy and a healthy baby, if the condition is not properly managed it can lead to a large baby, miscarriage or stillbirth.
Once the pregnancy is over, blood glucose levels return to normal and gestational diabetes disappears, but women who suffer from the condition have an increased risk of developing type 2 diabetes later in life.
Pre-diabetes refers to a condition where the body has higher-than-normal blood glucose levels, although not high enough for you to be diagnosed with full diabetes. While pre-diabetes does not have any signs or symptoms, sufferers are more likely to develop type 2 diabetes or cardiovascular disease later in life. Treatment involves sustained lifestyle changes, including regular exercise and healthy eating.
How can I manage my diabetes?
Although there is no cure for diabetes, there are several treatment options available. Treatment revolves around controlling blood glucose levels, reducing blood pressure and cholesterol levels, and maintaining a healthy weight.
Treatment depends on the type of diabetes you have but can include:
Insulin injections or the use of an insulin pump
Eating healthy, including foods that are low in fat, high in fibre and low GI
Self-monitoring blood glucose levels
Maintaining a healthy weight
Having regular doctor’s check-ups for any complications
Complications related to diabetes
The long-term effects on your health of high blood glucose levels can be significant. Common complications include:
Heart disease and stroke. People with diabetes often tend to have high blood pressure and high cholesterol levels, which all combine to result in an increased risk of cardiovascular problems such as heart attack or stroke.
Eye disease. High blood glucose levels damage the blood vessels that supply the retina, leading to impaired vision and potentially blindness. This is known as diabetic retinopathy.
Kidney disease. Roughly 30% of people with diabetes develop kidney problems as high glucose levels affect the kidneys’ ability to regulate and filter blood.
Peripheral neuropathy and peripheral vascular disease. Long-term diabetes can lead to numbness and lack of feeling in your lower limbs, which can eventually result in amputation.
Erectile dysfunction. Diabetes causes vascular problems which can in turn lead to erectile dysfunction.
Richard Laycock is Finder's insurance editor, and has spent the last five years wrangling insurance product disclosure statements. His musings about insurance have appeared on Money Mag, Yahoo Finance, and Travel Weekly. When he’s not helping people make sense of insurance fine print, he is testing the quality of cocktails in his newfound home of New York. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance.
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