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 fund to find out what level of cover is available to you.

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. This guide will explore the conditions of when insulin pumps will and will not be covered.

Compare health funds and enquire for cover for insulin pumps

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.

Which funds cover insulin pumps?

_{*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 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.

What are the different types of diabetes?

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes
• Pre-diabetes

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

• Diabetes ACT
• Diabetes NSW
• Healthy Living NT
• Diabetes Queensland
• Diabetes SA
• Diabetes Tasmania
• Diabetes Victoria
• Diabetes WA

Complete list of funds

_{*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.}

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