Below are some of the most commonly asked questions about insurance coverage. If you still need help understanding your insurance coverage, Abbott Diabetes Care has a number you can call to find out what diabetes supplies your insurance plan covers. Call our reimbursement specialists at (866) 246-COVERAGE or (866) 246-2683.

• What Are "Diabetes Supplies"?
• What Diabetes Supplies Does My Health Plan Cover?
• Which Benefit Covers My Supplies?
• What are Group, Individual and Private Health Insurance or Plans?
• What is an Employer Self-Funded Plan?
• How Are These Plans Different?
• What Questions Should I Ask My Health Plan Provider?
• Insurance Coverage Glossary

What Are "Diabetes Supplies"?

Most health plans define diabetes supplies as: the blood glucose monitor, test strips, lancets (the small needle inserted into the spring-loaded device), monitor batteries, replacement spring-loaded devices and control solution or chips. As you know, your testing strips are the largest ongoing expense. You only need a new monitor once in a while — for instance, when a monitor comes out with a new feature or technology that helps your diabetes control.

What Diabetes Supplies Does My Health Plan Cover?

Most plans cover some of the cost of diabetes supplies but each plan is different in how your supplies are covered. In general, coverage for diabetes supplies is now better than ever for two reasons:

1. Most health plans realize that blood glucose monitoring is necessary to manage and control diabetes and prevent costly complications.
2. Many State and Federal (Medicare) laws now require health plans to cover diabetes supplies. This doesn't mean your health plan must entirely foot the bill. Some require you to pay up front and you get reimbursed for a certain percentage. Others charge you a co-pay or start providing coverage only after you meet your annual deductible.

To figure out what your health plan covers, it's important to know what type of plan you have. General information about various types of plans and coverage is provided below. It is also advised to call your insurance or plan provider for details regarding your benefits.

Which Benefit Covers My Supplies?

In addition to knowing what supplies are covered, you may also need to know which benefit they're covered under. For example, has this ever happened to you? You're at the pharmacy counter paying for your prescription medicines and test strips. The person at the pharmacy tells you that your medicines are covered, but your strips are not.

Keep this in mind: Your strips are likely to be covered, but not under your pharmacy or prescription benefit. Diabetes supplies, like test strips, are often covered under the major medical or Durable Medical Equipment coverage of your health plan. If you are having trouble getting reimbursed for your diabetes supplies, ask your insurance provider which benefit covers your supplies.

It's up to you to be "in the know." If you have specific questions about what your plan covers, call the 800 number on the back of your health plan card. If you don't feel you are getting correct information, ask for a supervisor. We've included a list of questions to help you get the information you need (see below). If a claim is denied, don't forget you have the right to appeal.

What are Group, Individual and Private Health Insurance or Plans?

Most Americans with health coverage are covered by one of these plans. Your employer contracts with a large health plan to manage employees' health benefits. As an employee, you may have health plan options, such as a choice between a fee-for-service, Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO). The options usually have different costs. When you take a new job and/or opt for new health coverage during open enrollment, check what the coverage is for diabetes supplies. Good people to ask are the benefits and human resources managers.

What is an Employer Self-Funded Plan?

These plans are similar to group or individual private health plans. Large companies use these plans with employees all over the country or world. The plans don't have to follow state laws. This doesn't mean they don't cover diabetes supplies, but they aren't required to do so by law.

How Are These Plans Different?

• Which types of monitors and strips are covered:
  Some plans only allow care providers to prescribe one or two types of monitors and strips. If you are told you can only get a particular monitor, but you want a different one because it has special features, then you might need your care provider to write a prescription and/or letter.
• Which benefit your diabetes supplies are covered under:
  Some plans cover diabetes supplies under your prescription benefit and some cover them under your Durable Medical Equipment (DME) benefit (see above).
• How you get reimbursed:
  Some plans require you to pay for your supplies up front and submit a claim for reimbursement. Some charge a co-payment at the time of purchase.
• Mail-order requirement:
  Some plans may require you to order supplies from a mail-order company, or it may save you money to do so. Ask your health plan about ordering options.
• Limit on the number of strips you can get at one time:
  Some plans only allow you to get a certain number of test strips (and other supplies) to cover a specified period of time–e.g., 30 days.

What Questions Should I Ask My Health Plan Provider?

Ask these questions if you are choosing a health plan, enrolling in a new health plan or have questions about your diabetes supplies:

• Do you cover diabetes supplies?
• What are the supplies you cover?
• What quantity of supplies do you cover within a given time frame?
• Are diabetes supplies covered as a prescription benefit or under another benefit (e.g.,DME)?
• Do I need a prescription from my care provider?
• What needs to be specified?
• Will I have to pay up front and submit the claim for reimbursement, or just pay a co-pay?
• What do I need to submit for coverage (e.g., claim form, copy of prescription)?
• Can I save money and/or get a larger amount of supplies if I use a mail-order company? If yes, how do I sign up?

Insurance Coverage Glossary

Care providers
The professionals who provide your health care, such as physicians, nurse practitioners or diabetes educators.

Co-pay
The amount of money your health plan requires you to pay as part of the cost of a service or benefit. This must be paid when the service is provided. Your health plan might use different co-pays for different services, medications or supplies.

Deductible
The sum of money you must pay for medical services, medications or supplies before your health plan begins to cover the cost during an annual period. It might be referred to as "meeting your deductible."

Durable Medical Equipment (DME)
Supplies you need to care for your health in your home that are not medications or services provided by your care provider. Diabetes supplies are often considered DME.

Health Maintenance Organization (HMO)
There are various types of HMOs. In staff-model HMOs, such as Kaiser Permanente, you typically choose from the care providers they have on staff. In other HMOs, you choose your care providers from listings of independent care providers with whom the health plan has negotiated rates.

Preferred Provider Organization (PPO)
There are various types of PPOs. Generally, you choose your care providers from listings of independent care providers with whom the health plan has negotiated rates.

Prescription (Pharmacy) Benefit
The part of your health plan that covers medications.