Cover for continuous glucose monitoring for type 1 diabetes
Members who are registered for type 1 diabetes on the Chronic Illness Benefit have cover for continuous glucose monitoring (CGM) according to their health plan's benefits.
At Discovery Health Medical Scheme, we update our benefits so you can have access to the healthcare and devices you need to be in your best possible health. We offer cover for continuous glucose monitoring sensors from Scheme benefits. Your cover depends on your health plan and is subject to limits.
What's so exciting about continuous glucose monitoring (CGM)?
Continuous glucose monitoring uses technology which will help you and your treating doctor better monitor and manage your blood sugar levels. A continuous glucose monitoring sensor can automatically measure your blood glucose levels.
This means that you don't have to keep pricking your finger to take a blood glucose measurement. Instead continuous glucose monitoring (CGM) typically uses a sensor that is inserted just under skin and this is left in place for a number of days (depending on the manufacturer). The sensor uses interstitial fluid (the fluid that surrounds cells in the body) to measure your blood glucose level, providing you with a glucose reading every 5 -15 minutes. Some CGM devices are able to alert you or your caregiver when your blood glucose levels are low.
This not only gives you and your doctor more data about your glucose levels, with this technology, you don't have to put activities on hold while you stop to take your glucose readings.
All you need to do is replace the sensor from time to time. How long the sensor lasts depends on your device.
What do you need to know about your cover for a CGM sensor?
We offer cover for continuous glucose monitoring sensors up to a monthly amount on all health plans except KeyCare plans. To qualify for cover, you have to be registered for type 1 diabetes on the Chronic Illness Benefit and a CGM network doctor has to prescribe the device.
Depending on your health plan and age, you might have to pay part of the cost of the sensor from your Medical Savings Account and/or from your own pocket. We cover continuous glucose monitoring transmitters and readers from your available day-to-day benefits.
- Where CGM sensors are funded from the Chronic Illness Benefit, required glucometer strips and lancets will fund up to the maximum of the Chronic Drug Amount (CDA) and any co-payments due, you will have to pay yourself.
- All claims will accumulate to the monthly CDA/CGM limit. Any costs in excess of this associated to the CGM sensors will be funded from the member's available day-to-day benefits, where applicable.
- CGM transmitters and readers will continue to fund from available day-to-day benefits for all plans providing an External Medical Items (EMI) benefit.
To find out more about your cover for continuous glucose monitoring sensors read the benefit guide.
Find a network doctor
You can find a doctor here or click on Find a healthcare provider using your Discovery app.
How can I get more cover and additional tools to manage diabetes?
Your cover for diabetes management and treatment starts when you register for the Chronic Illness Benefit. You can get even more cover and additional support if you visit a Premier Plus GP and they register you for the Diabetes Care Programme.
If you register for the Diabetes Care Programme, we pay for these additional benefits without using your day-to-day benefits:
- One additional consultation with a dietitian a year
- One consultation with a biokineticist a year
- For qualifying members, access to a diabetes educator
Diabetes.co.uk. Continuous glucose monitoring, 15 January 2020. Accessed 12 January 2021.
healthline. What is a CGM (continuous glucose monitor) and how do I choose one? Updated 30 September 2020. Accessed 12 January 2021.
National Institute of Diabetes and Digestive and Kidney Diseases. Continuous glucose monitoring. Accessed 12 January 2021.
The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
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