Diabetes the insurance options

Diabetes the insurance options

Continuing the discussion around diabetes I started in this article about the reality People with Type I Diabetes deal with and what the associated costs are like.

Some of this will cross over for context, but not enough. If you don't know the detail you may want to read this first.

And while Diabetes in the insurance realm is nothing new, it has typically focused on the top-level diagnosis for underwriting rather than the reality people are going through. 

Which is typically a case of "no" for a lot of benefits.

With the opportunity to understand what this looks like for those living with Type I Diabetes, the insulin-dependant type of Diabetes, it's been an eye-opener.

The equipment and cost associated with living with Type I Diabetes is significant.

I've nicknamed this the Diabetes Tax because it is.

When it comes to managing Type I Diabetes, most people will have the idea of pricked fingers to test blood glucose levels and injections for insulin. And for a good number of Type I people, this is what their daily routine consists of.

However, like most things in medicine, technology has impacted and is improving lives, and it is doing some incredible things. But it comes with a cost, a pretty significant one.

  • Insulin pumps that give accurate and measured insulin doses at the right time. ($8,000 per pump)
  • Continuous Glucose Monitoring (CGM), though this is more every 5 minutes than constant like your heart rate tracker in your watch. (Monthly subscription basis for $4,560 per annum or purchase as you go at $6,360 per annum.)

These newer tools give people a significant level of everyday independence too.

And there are some neat improvements the community have added, which I discussed in my previous article 

  • The clinical reports provided to those using these added tools show they have a significantly better medical journey than the traditional needles and syringes approach.

And this is the rub, and you've probably heard about the US issues with the cost of insulin; the pharmaceutical companies are milking their patients because Type I's have little choice if they want to remain healthy. 

  • Yup, that's the cost to have good monitoring to ensure you stay as healthy as possible. Currently, none of this is subsidised.

So it's pretty expensive to have diabetes, and like most chronic conditions, it has limited support from the public system.

So what is subsidised with the new tech? 

  • Insulin Pumps and consumables are funded by Pharmac under certain criteria. High Hba1c or severe Hypos (Hypoglycemia), and A new pump is funded every 4 years.
  • The MoH supplies the tubes and connectors for insulin delivery with the insulin pumps. With a consumables re-application is every 2 years

And that's about it. 

So what's the insurance point?

Not a huge one presently when it comes to what I have discussed above.

  • Having medical insurers step up on the additional costs of continuous glucose monitoring, and the loop systems, for the pumps to be more effective is needed, because the public system is not.
  • Having better control should mean fewer medical events for Type I's, which means fewer claims for the medical insurers.

This is especially pertinent with the impact on kidneys and the significant costs of dialysis. Not to mention the impact of blindness, cardiac issues and more extreme amputations that happen. 

  • An area I will be raising with providers to see if we can do better. 

Presently the only support from insurance for Type I's is a more traditional medical specialist and testing support. 

  • Even this has its moments when some of the best people to support day to daycare in NZ are GPs with a specialty that many insurers won't cover. 

Specialists like endocrinologists are typically covered under specialists and testing, as are the things that hospitalise Type I's.

  • But there is a rub. Many People with Type I Diabetes have their condition before applying for medical insurance, which means most insurers will exclude diabetes and related conditions. 
  • Exclusions here are not great for a metabolic disorder, as an exclusion has a wide-ranging impact.

I have one insurer, just the one, where we can get pre-existing Type I Diabetes covered, including those with congenital diagnosis. 

  • It has a stand-down period of three years, after that almost everything pre-existing is covered.

In terms of the congenital cover, this is unique for the NZ market. And is something that has application to a wide range of other conditions for people 

We have a couple of other insurers that will cover pre-existing conditions; however, there are some fish hooks in the terms and conditions.

  • One of these providers has a regular campaign to attract people for pre-existing conditions, in regard to Diabetes, engage with caution.
  • When you dig into the terms and conditions for pre-existing cover for Diabetes, Type's I & II, on these other covers, the criteria for the cover of pre-existing conditions is conditional on several points many people with diabetes will struggle to avoid triggering. This means many of the pre-existing conditions offered for Diabetes aren't what they may seem.

This is where working with an adviser like J-P is essential to ensure the cover you think you are getting is the cover you get. 

Jon-Paul Hale

Written by : Jon-Paul Hale

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