Recent changes to private health insurance policies are a timely reminder to check your level of cover, especially for those undergoing pump therapy.
We asked Princess Margaret Hospital diabetes educator and pump coordinator Jaimee Paniora about private health insurance and diabetes:
My child has recently been diagnosed with Type 1 Diabetes. Should I get private health insurance or upgrade my policy?
Private health insurance (hospital cover) is necessary to have access to an insulin pump for anyone with Type 1 Diabetes. Currently, insulin pumps are fully covered by private health insurance. There is usually a 12-month maturation period after joining. This may also be the case if changing from another health fund so you will need to check with the individual health fund. Costs do vary and some health funds may require a top level of hospital cover, while others may cover an insulin pump on a basic or moderate level. Do your research to save on costs.
Currently, most pump companies will loan a pump for up to 12 months while waiting on the maturation period from your health fund. This means you may not have to wait 12 months before your child can commence insulin pump therapy. The pump company will need to see evidence of the health cover and an adequate level of cover for a pump.
It is also important to ensure you have ambulance cover for a child with Type 1 Diabetes. This may be included in your health fund, or consider separate ambulance cover.
How do you keep up to date with inclusions/exclusions to your health fund?
It is important to keep up to date with changes to your health fund to ensure you have the necessary cover. Currently, insulin pumps have a four-year warranty from the manufacturer. After four years the pump will need to be upgraded. As long as you continue to have adequate health insurance, the cost should be totally covered through your health fund. It is important to check this as some funds may have a five-year replacement/upgrade policy, and the pump warranty is only four years. Should anything happen after the warranty period, the pump will not be covered by the manufacturer for replacement.
What is the out of pocket cost if you don’t have pump cover in your insurance policy?
Insulin pumps are worth approximately $8500-9500. It is much more affordable to purchase private health insurance than buy a pump outright. Additional costs associated with pump therapy include the consumables (pump cannulas and reservoirs) and these are not covered by private health insurance. NDSS does subsidise consumables (as long as you have Medicare and an NDSS registration), however the cost remains approximately $30-40/month.
Why are some insurers altering their policies now?
Recently, some health insurance companies increased the level of hospital cover required to cover an insulin pump. Shop around to get the best price and cover you can. Not all covers will require you to have top hospital cover.
It is important to consider whether insulin pump therapy might be something you and your child/adolescent might be interested in for the future. Private health insurance cover will help to ensure this can happen.