Closeup of a hand holding an insulin pump isolated on a white background

Insulin pumps, diabetes and health insurance

Are insulin pumps covered by private health insurance? Compare the benefits offered to people living with diabetes from Australian health funds.

If you suffer from diabetes, your doctor or other medical specialist may recommend that you use an insulin pump. Worn 24 hours a day, an insulin pump delivers a constant supply of insulin and helps blood glucose levels remain stable.

Happily, if you have an appropriate level of hospital or extras cover in place, the cost of your insulin pump may be covered by your private health fund. Consult your health insurer to find out what level of cover is available to you.

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 insurer 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 insurer 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 insurers 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.

Which insurers cover insulin pumps?

Health fundWhat diabetes related services are covered?Waiting periods*
hif
    • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Education
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for Diabetes Education
Peoplecare
  • Insulin pump treatment
  • Health management benefit 
  • 2 months if not a pre-existing condition
  • 6 months for health management programs
health.com.au
  • Insulin pump benefit
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
CBHS Health Fund
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Action Program
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the Diabetes Action Program
ahm
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Disease management benefit 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the disease management benefit
Australian Unity
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Action Program
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the Diabetes Action Program
GMHBA
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic Disease Management program
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for Chronic Disease Management
HCF
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic conditions program 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the chronic conditions program
nib
  • Insulin pump treatment
  • 2 months if not a pre-existing condition
Transport Health
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors

*If you suffer from an illness, ailment or condition (such as type 2 diabetes) that existed in the six months prior to joining a health fund, it will typically be classified as a pre-existing condition. In this case, the standard insulin pump waiting period will be extended from 2 months to 12 months.
See the full list of diabetes benefits from health funds in Australia

Am I covered if my insulin pump needs replacing?

If you need to replace an insulin pump, most insurers will only pay benefits if you have used your existing pump for a specified period of time. Although those time limits vary between insurers, they’re commonly around four or five years. With this in mind, check with your insurer 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 insurer 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 basic 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).

What are the different types of diabetes?

Type 1 diabetes

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:

  • Excessive thirst
  • Excessive urination
  • Unexplained weight loss
  • Fatigue and weakness
  • Blurred vision

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
  • Blurred vision
  • Itching and skin infections
  • Gradually putting on weight
  • Leg cramps

Type 2 diabetes can be managed with healthy eating, regular exercise and sometimes medication.

Gestational diabetes

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

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
  • Exercising regularly
  • Self-monitoring blood glucose levels
  • Medications
  • Quitting smoking
  • 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.

State-by-state membership costs

AssociationMembership CostLink to association
Diabetes ACTOne year:

  • Introductory concession/senior $25
  • Introductory single $50

Two years:

  • Introductory concession/senior $25
  • Introductory single $50

Five years:

  • Introductory concession/senior $95
  • Introductory single $195
Go to site
AssociationMembership CostLink to association
Diabetes NSWOne year:

  • Concession or person under 18 $25
  • Adults with diabetes, carer or supporter $50
  • Health professionals such as doctors, dietitians, educators, exercise physiologists and nurses $75
Go to site
AssociationMembership CostLink to association
Healthy Living NTMembership fees are due 12 months from your joining date each year and are GST free.One year:

  • Additional family member of a person who is already a member $16 per year
  • Pensioners and concession card holders $22 per year
  • Adults with diabetes, carers or supporters $32 per year
  • Affiliate membership $50 per year
Go to site
AssociationMembership CostLink to association
Diabetes QueenslandMembership renewal is 1 July each year. Your membership fee will be calculated depending on the month in which you join.One year:

  • Pensioner or concession card holder $34
  • Adult $69
  • Health professional individual $125
  • Health professional organisation $242
Go to site
AssociationMembership CostLink to association
Diabetes SAOne year:

  • Single concession $28
  • Single adult $39
  • Family concession $40
  • Family adult $59
  • Affiliate $72

Two years:

  • Single concession $43
  • Single adult $69
  • Family concession $66
  • Family adult $103
  • Affiliate $131
Go to site
AssociationMembership CostLink to association
Diabetes TasmaniaOne year:

  • New family $55
  • New single $45
  • New concession $35
  • Renew family $46
  • Renew single $37
  • Renew concession $25
  • Health professional $56
Go to site
AssociationMembership CostLink to association
Diabetes VictoriaOne year:

  • Kids $0
  • Concession $33
  • Family $55
  • Adult $54
  • Health professional $58
Go to site
AssociationMembership CostLink to association
Diabetes WAOne year:

  • Concession member $26
  • Adult member $50

Two years:

  • Adult member $90
  • Concession member $46
Go to site

Speak with an adviser about your cover options or apply online

Rates last updated December 3rd, 2016
Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
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Premier Package
Premier Package
Top tier combined hospital and extras policy that covers you for an extensive range of hospital and general treatment services.
  • All the benefits of HCI's Premier Hospital policy
  • All the benefits of HCI's Premier Extras policy
  • Cover for pregnancy and IVF treatment
  • Cover for general and major dental
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Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
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GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
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Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
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Prestige
Prestige
Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
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Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
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Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
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Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
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Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
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Complete list of providers

Health fundWhat diabetes related services are covered?Waiting periods*
ahm
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Disease management benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the disease management benefit
Australian Unity
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Action Program
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the Diabetes Action Program
Budget Direct
  • Insulin pump treatment
  • Blood glucose monitor benefit 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Bupa
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Self-Management Programs
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for Self-Management Programs
CUA Health
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Frank Health Insurance
  • Insulin pump treatment
  • Chronic Disease Management Program 
  • 2 months if not a pre-existing condition
  • None for Chronic Disease Management
GMF
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12-36 months for blood glucose monitors
GMHBA
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic Disease Management program 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for Chronic Disease Management
GU Health
  • Insulin pump treatment
  • Diabetes Action Program
  • 2 months if not a pre-existing condition
  • None for the Diabetes Action Program
HBF
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • HBF Coach
  • 2 months if not a pre-existing condition
  • 2-12 months for blood glucose monitors
  • None for HBF Coach
HCF
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic conditions program 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the chronic conditions program
health.com.au
  • Insulin pump benefit
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Health Care Insurance
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Life Choices 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for Life Choices
Health Partners
  • Insulin pump treatment .
  • Blood glucose monitor benefit
  • Health management benefit 
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for the health management benefit
hif
    • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Education
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for Diabetes Education
Latrobe Health Services
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Medibank
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 24 months for blood glucose monitors
Mildura Health Fund
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 36 months for blood glucose monitors
onemedifund
  • Insulin pump treatment
  • 2 months if not a pre-existing condition
nib
  • Insulin pump treatment 
  • 2 months if not a pre-existing condition
Peoplecare
  • Insulin pump treatment
  • Health management benefit 
  • 2 months if not a pre-existing condition
  • 6 months for health management programs
Phoenix Health Fund
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Healthy Lifestyle Program benefit
  • 2 months if not a pre-existing condition
  • 2 months for blood glucose monitors
  • 2 months for the Healthy Lifestyle Program
Transport Health
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Westfund
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic Disease Association benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for Chronic Disease Association
ACA Health
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Additional services
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for Chronic Disease Association
CBHS health fund
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Diabetes Action Program
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for the Diabetes Action Program
Defence Health
  • Restricted health fund
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic care and risk programs
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • None for chronic care and risk programs
Doctors Health Fund
  • Restricted health fund
  • Insulin pump treatment 
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Navy Health
  • Restricted health fund
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Chronic disease management program
  • 2 months if not a pre-existing condition
  • 6 months for blood glucose monitors
  • None for chronic disease management
Police Health
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Reserve Bank Health Society
  • Restricted health fund 
  • Insulin pump treatment
  • 2 months if not a pre-existing condition
rt health fund
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
Teachers Health Fund
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit 
  • Disease management subscriptions
  • 2 months if not a pre-existing condition
  • 2 months for blood glucose monitors
  • 6 months for disease management subs
TUH Health Fund
  • Restricted health fund 
  • Insulin pump treatment
  • Blood glucose monitor benefit
  • Health and wellness benefit
  • 2 months if not a pre-existing condition
  • 12 months for blood glucose monitors
  • 2 months for the health and wellness benefit

*If you suffer from an illness, ailment or condition (such as type 2 diabetes) that existed in the six months prior to joining a health fund, it will typically be classified as a pre-existing condition. In this case, the standard insulin pump waiting period will be extended from 2 months to 12 months.

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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