Can I claim for an insulin pump?

If you suffer from diabetes, your GP may advise that you need to use an insulin pump to help your blood glucose level remain stable.

Is this covered by HIF?

If you have an appropriate level of Hospital Cover in place, you can certainly claim an insulin pump through HIF if you’re treated as an outpatient. For example, if you are not hospitalised due to diabetes and still require insulin pump it’s included under Top Hospital covers only i.e. Gold & Goldstar Hospital cover, we will pay a benefit towards:

  • The cost of the insulin pump
  • Your doctor’s fees (up to the MBS amount)
  • 12 month waiting period applies for pre-existing conditions
  • 2 month waiting period applies for general hospitalisation
  • Insulin pumps fittings as outpatient are included on Gold & Gold star Hospital cover only
  • Insulin Pumps as outpatient are excluded on Gold Vital, Gold Starter & Gold Saver Hospital cover

Important please note:

Payment relating to insulin pump claim is not subject to the patient being formally admitted to hospital. However, the following conditions apply to payment of a benefit for insulin pumps:

  • Request form needs to be completed by diabetes educator, HIF will require referral letter from treating endocrinologist
  • Benefits are only payable for insulin pumps included on the Department of Health and Ageing’s Prostheses List as at the date of service.
  • The insulin pump must be clinically necessary for the member
  • The member’s cover must include benefits for the insulin pump; and the insulin pump must not be replacing a pump which is within the relevant warranty period (replacement eligibility/warranty is from date of fitting) except in the case of requests for an upgrade for a clinical reason.
  • If a replacement is because the pump is no longer functioning, we require a supplier report as evidence.
  • A request to upgrade to a more recent model is an insufficient reason to claim for insulin pump.
  • If upgrade doctors letter must include evidence such as BSL and clinical history.

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