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:
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.
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 Type 1 diabetes by their medical specialist. For people with Type 1 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.
It is important to always change your level of health cover to reflect changes in circumstance. Remember, children can be covered on family policies until their late teens or early 20s depending on the policy.
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.
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. The MiniMed® 640G Insulin Pump is listed on the Prostheses List. 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.
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.
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.
Transmitters and sensors for the Medtronic Insulin Pump System can be purchased directly from Medtronic. A rebate may be provided for the transmitter under ancillary or general (‘extras’) health insurance, depending on your level of cover. Please contact Medtronic Diabetes support services or your health fund for more information. For more information about the benefits you are entitled to under your policy, contact your private health insurer.
The Private Health Insurance Ombudsman provides an independent service to help with health insurance problems and inquiries. You can contact the Ombudsman on 1800 640 695 (free call anywhere in Australia) or email at firstname.lastname@example.org
Information on private health insurance is also available at www.privatehealth.gov.au