Obtaining insulin pump therapy

Thursday, July 17, 2014 - 02:16

Navigating private health insurance for people living with insulin dependent diabetes

Given our commitment to providing appropriate access to insulin pump therapy, we are often approached by community members wanting advice on how pumps are made available in Australia. While the Insulin Dependant Diabetes Insulin Pump Program administered by the JDRF and funded by the Federal Government (www.jdrf.org.au/our-community/insulin-pump-grants) provides means-tested subsidies for people under the age of 18 with Insulin Dependant Diabetes, not all Australians will qualify for the program.


Australians holding private health insurance covering insulin pumps will generally be eligible for full reimbursement of their pump by their health fund, assuming the appropriate waiting period has been served. In choosing the health fund that’s best for you, it doesn’t necessarily have to involve the most expensive level of cover. If you or a member of your family has insulin dependent diabetes, it’s important to make sure you know answers to the following:

  • Does my level of health cover include insulin pump technology? It’s not about having the most expensive cover – just one that suits your needs, so check that insulin pump therapy is included. You can log on to: www.privatehealth.gov.au to compare health funds and if in doubt, check with your health fund that your policy meets your needs.

  • What about consumables – how are they covered? The National Diabetes Service Scheme (NDSS) offers consumable medical products at a subsidised rate for those with an Australian Medicare card and a formal diagnosis of Insulin Dependant Diabetes by their medical specialist. For people with Insulin Dependant Diabetes, insulin syringes are free. Insulin pump consumables (IPCs) and blood testing strips are subsidised equating to a cost of about $26 per month. The cost of consumables for people with Type 2 diabetes is not covered by the NDSS and costs approximately $270 per month. See http://www.ndss.com.au/en/About-NDSS/Product-and-Supply for more details.

  • Who’s included on my health fund policy? It’s not as strange as you think. People don’t always change their level of health cover to reflect a change in circumstance. Remember, children can be covered on family policies until their late teens or early 20s depending on the policy.

  • Have I served the relevant waiting periods? Waiting periods apply to your ability to access many aspects of private health insurance coverage. If you’re in the interim ‘waiting period’ for private health cover benefits, Medtronic hosts a ‘Bridging the Gap’ loan pump program meaning you can go on insulin pump technology straight away. Information on this program is available by speaking with a Diabetes Educator or Medtronic Australasia.

  • Are there any special requirements around qualifying for private health insurance benefits when I go on insulin pump therapy? Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits towards devices that are listed on the Prostheses List when provided as part of an episode of hospital treatment, for which a member has an appropriate level of hospital cover and has met any requirements by their individual health fund, e.g. waiting periods. Diagnosis of diabetes may follow a hospital admission or GP/specialist consultation, when a hospital admission is not required. Many health funds approve funding for an insulin pump in an ‘outpatient’ setting.

  • What happens if my pump ‘breaks’ out of warranty? Health fund policies vary, however our commitment is always to ensuring the health of people using Medtronic therapies. If a person’s pump malfunctions ‘out of warranty’, the Medtronic Helpline (which is available 24/7 by calling 1800 777 808) will seek to determine the cause of the malfunction. A ‘product observation report’ can then be provided as evidence the pump is not working (assuming a malfunction) to a patient for their healthcare team. Medtronic will provide short-term loan pumps in this instance to ensure continuity of care while the patient waits for their health fund to approve provision of a new pump.

  • Are any other parts of my diabetes treatment covered by private health insurance? Dependent on the health fund, “extras” cover may include rebates for a self glucose monitoring device. However, this does not include the cost of consumables or sensors. Some health funds also cover the cost of services provided by a credentialed diabetes educator under their “ancillary” cover. Please check with your health insurance provider for details.