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Friday Diabetes Benefits and Coverage
Diabetes is a significant problem in the United States, affecting one in ten or 37.3 million people. One in five people who have diabetes don’t even know they have it. You or someone you know, or love could already struggle with this condition.
What is diabetes?
Diabetes is a chronic (long-lasting) disease that limits the body's ability to regulate blood glucose (or blood sugar) levels through insulin production. This inability can lead to heart, blood vessels, eye, kidney, and nerve damage. People without diabetes can naturally produce and regulate the insulin levels in their bodies. Insulin helps convert the food we eat into energy and manage the sugar in the body. There are two types of diabetes:
- Type 1 diabetes means the body cannot make insulin at all. That means those diagnosed with this will need insulin every day to survive.
- Type 2 diabetes means the body doesn’t use insulin very well. This is more manageable than type 1 and can be prevented or delayed with lifestyle changes.
- Prediabetes is the step before developing type 2 diabetes and is a stage where diabetes can be managed and prevented.
Preventative Diabetes Care
You can take steps to prevent diabetes. Talk to your doctor about whether they believe screenings would be appropriate for you.
All Friday plans cover diabetes type 2 screenings for adults 40 to 70 years who are overweight/obese for $0 per the Affordable Care Act.
For pregnant individuals, Friday also covers gestational diabetes screenings at 24 weeks or late and those at high risk of developing gestational diabetes.
Friday also covers screenings and services for people not meeting those categories at a cost. Contact the Friday Care Crew for more information.
Friday is here to help you manage your diabetes diagnosis. Here’s what you need to know.
In Oklahoma and Colorado, there are insulin caps to keep costs affordable, regardless of the insulin tier, if it is part of the formulary for the state. The cap for Oklahoma is $30, and Colorado's is $100 for a 30-day supply. In North Carolina, Georgia, and Nevada, insulin cost would be subject to what Tier it is in our drug formulary. Search for your insulin.
Diabetics in Friday Health Plans’ Explanation of Coverage (EOC):
When you doubt coverage, look at your plan's EOC or Evidence of Coverage. This outlines the exact details of coverage. Here is what it states about diabetes:
The plan's coverage of an Enrollee's diabetes includes:
- New or improved treatment or monitoring equipment.
- Outpatient self-management training and education.
All supplies, including medications and equipment for controlling diabetes, must be dispensed as written, including brand name products, unless a substitution is approved by the physician or practitioner who issues the written order for the supplies or equipment.
Such items, when obtained for a Qualified Participant, shall include but not be limited to the following:
- Blood glucose monitors (including noninvasive glucose monitors and monitors for the blind);
- Insulin pumps (both external and implantable) and associated appurtenances, which include insulin infusion devices, batteries, skin preparation items, adhesive supplies, infusion sets, insulin cartridges, and durable and disposable devices to assist in the injection of insulin; and
- Podiatric appliances, including up to two pairs of therapeutic footwear per Calendar Year, for the prevention of complications associated with diabetes.
- Test strips specified for use with a corresponding blood glucose monitor, lancets and lancet devices, visual reading strips, and urine testing strips and tablets.
- Insulin and insulin analog preparations; Injection aids, including devices used to assist with insulin injection and needleless systems, insulin syringes.
- Biohazard disposable containers.
- Prescriptive and non-prescriptive oral agents for controlling blood sugar levels, and
- Glucagon emergency kits.
Diabetes Self-Management Training for the Qualified Participant will include the development of an individualized management plan that is created for and in collaboration with the Qualified Participant (and/or family) to understand the care and management of diabetes, including nutritional counseling and proper use of Diabetes Equipment and Diabetes Supplies.
Qualified Participant means an individual eligible for coverage under this Policy who has been diagnosed with
- Insulin-dependent or non-insulin-dependent diabetes,
- elevated blood glucose levels induced by pregnancy, or
- another medical condition associated with elevated blood glucose levels.
Have Questions/Need Help?
The Friday Care Crew is here to help answer questions and help you understand your coverage. We know diabetes is no easy task to treat and live with. Contact us today.