What You Need to Know About Diabetes and Health Insurance

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Medically underwritten health insurance plans ask questions about your medical history and may not cover pre-existing conditions. But if you have diabetes, you do have options for coverage.

According to the 2019 Diabetes Canada Cost Model, one in three Canadians has diabetes or pre-diabetes and the numbers continue to rise. Even so, fewer than half of us can identify even half of the early warning signs of diabetes. We are not fully aware that stroke and heart disease are complications of diabetes.

For those who do have diabetes, having health insurance is vital to limiting out-of-pocket healthcare costs. Why? Coverage for diabetic medical supplies like insulin and insulin pumps under provincial healthcare programs can be very limited.

Coverage for Diabetic Medical Supplies Under an Individual Health Insurance Plan

If you want benefits that cover prescription insulin and the other medical supplies you need to use regularly, you can purchase an individual health insurance plan to cover yourself, and your family. There are two main types of individual health insurance plans: medically underwritten and guaranteed issue.

When you apply for a medically underwritten health insurance plan, you will need to answer a medical questionnaire. With many insurers, your pre-diabetes or diabetes will be considered a pre-existing condition. You may not qualify for coverage, or the medically underwritten plan offered to you may be charged a higher amount for your premium (this is referred to as being ‘rated’) and/or have exclusions related to your diabetes, such as

  • Insulin will not be covered
  • Needles and test strips will not be covered
  • Medications related to diabetes will not be covered.

The great news is that SBIS offers other great plan options if you have diabetes:

  • GMS Personal Health insurance is medically underwritten and will be issued without exclusions related to your diabetes
  • Manulife, Green Shield and GMS guaranteed-acceptance (also known as a guaranteed-issue) plans will be issued with no medical questions asked (and no exclusions or ratings).

You can get 100% coverage for diabetic medical supplies like test strips and lancets, needles and syringes, sensors and insulin infusion sets (used in conjunction with an insulin pump) up to the yearly maximum benefit level (typically from $1000 to $3000 each year).

Diabetic stockings and glucometers are usually not covered under your health insurance plan, but you may have access to a provincial health plan that can help, and individual health insurance plan options that cover insulin pumps (like GMS Personal Health).

Insulin will be covered under your plan’s drug coverage. There is usually a percentage that you need to pay out of pocket, and a yearly dollar maximum for claims.

And remember, your health insurance plan can cover so much more than out-of-pocket costs for diabetes, including:

  • Prescription drug coverage
  • Dental care
  • Vision care
  • Extended healthcare
  • Travel emergency services
  • Hospital accommodation (optional)

Health Insurance Provides Diabetes Preventative Support Too

Did you know that pre-diabetics who don’t take steps to improve their health face up to a 30% chance of developing diabetes in five years? On the bright side, you have a good chance of preventing Type 2 diabetes with testing and a focus on good health practices. That’s important, because Type 2 diabetes, left untreated, can lead to

  • Eye problems, even blindness
  • Hearing loss
  • Skin infections
  • Problems with your feet, which, if left untreated, can lead to amputations
  • Kidney problems
  • Nerve damage
  • Stomach problems
  • Twice the risk of gingivitis and gum disease
  • Depression
  • Heart disease
  • Risk of stroke – 1.5 times higher than normal

Understanding the importance of good health, SBIS offers health insurance plans that have support tools built in to help you manage or avoid diabetes:

  • Green Shield Prism health insurance plans include support for cardiovascular health and smoking cessation, as well as dietician health coaching to support you by promoting and encourage healthier food choices. They also assist with achieving and/or maintaining a healthy weight.
  • Manulife Vitality is available to new applicants on FlexCare and FollowMe plans and offers an interactive, personalized wellness program that rewards you with savings up to 10% on your (and your family’s) health insurance premiums, and also gives you discounts on services like hotel bookings and gym memberships and gift cards!
  • GMS Personal Health plans offer LifeWorks, an award-winning total wellness program that can help you improve your mental, physical, financial and social wellbeing using a wealth of resources and tools through an app, by phone, or on your desktop.

Don’t Manage Your Diabetes Alone. Let Your Health Insurance Help.

Want to ask a question or talk to an expert so you can put your individual health insurance plan in place? At SBIS, we are ready to help. Give us a call today. 1-800-667-0429 Monday to Friday, 8:45 a.m. to 4:45 p.m. ET.


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