01

Jan

PRIVATE INSURANCE COVERAGE FOR DIABETES PATIENTS

Posted at 7 months ago in blog by M Lederman

 

Diabetes affects the lives of many Canadians – it is estimated that one in four are living with the disease and an untold many are experiencing symptoms without being diagnosed, known as “pre-diabetes”. This disease is particularly cumbersome to manage as daily monitoring and treatments are required to keep it under control.

 

While provincial governments have programs for financial aid to assist those in need of care, funding levels differ by province and not everyone is guaranteed to qualify. Most provinces adjust funding for age and income - some supplies will not be covered at all.

 

For more information, here is a detailed list of the different funding arrangements by province:

 

Funding arrangements by Province

 

Private, employer-sponsored group insurance can provide massive assistance to employees with diabetes, but limitations on coverage are imposed to offset the insurance companies’ exposure, relying on provincial programs to fill the gap.

 

The following is a brief overview of different funding options for diabetes patients on a company insurance plan.

 

Your insurance card will cover all day to day diabetes maintenance supplies, including but not limited to:

  • Blood glucose test strips
  • Urine test strips
  • Lancets
  • Syringes
  • Needles
  • Therapeutic shoes

 

In most cases, you can expect any insurance company to cover the minor expenses and supplies listed above.

 

When it comes to more expensive devices, there are differences between insurance companies on what is covered. These include:

 

  • Blood glucose monitors
  • Insulin pumps and related supplies

 

For example – FreeStyle Libre is a relatively new glucose monitor solution that many diabetics have become reliant on. When new medical solutions enter the market the insurance companies have to amend policies to offer coverage. In the case of FreeStyle Libre, most insurance companies have decided that they will now cover it as recently as the summer of 2018.

 

Here is the Great West Life press release on the topic for a sense of the insurance company reaction as new treatments enter the market:

Great West Life Press Release - Freestyle Libre

 

Insulin pumps represent the level of cost where insurance companies will defer to the provincial program for funding. In the case that one is denied provincial coverage for an insulin pump, a special accommodation may be made on a group insurance plan to include coverage, if:

 

  • You provide proof of denial from the provincial program, and
  • Your company insurance plan covers enough employees (threshold number is subjective depending on the insurance company).

 

Insulin pumps can cost from $4,500 to $6,500, so in a small group scenario there would not be enough premium coming in to offset the cost due to an offside Target Loss Ratio (for more on this, see our TLR article).