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 inpatient. For example, if you're hospitalised due to diabetes and require an insulin pump, we'll pay a benefit towards:
- The cost of the insulin pump
- Your doctor’s fees (up to the MBS amount)
Insulin pump fittings as an inpatient are included on Gold Top and all Overseas Visitors Hospital & Medical Covers. Insulin pump fittings are excluded on all other domestic hospital cover options, or when the service is provided in an outpatient capacity.
The following conditions apply to benefit payments for insulin pumps:
- 12 month waiting period applies for pre-existing conditions
- 2 month waiting period applies for general hospitalisation
A request form needs to be completed by a diabetes educator. HIF will also require a referral letter from your 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 insulin pumps, 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 required because a pump is no longer functioning, we'll require a supplier report as evidence.
A request to upgrade to a more recent model is an insufficient reason to claim for an insulin pump.
If upgrading, a doctor's letter must include evidence such as blood safety levels and clinical history.