How diabetes is covered in critical illness plans

The condition causes raised sugar levels in the bloodstream which can lead to problems like cardiovascular disease, nerve damage, kidney damage and eye damage among other major health issues.

Saturday 14 November marks World Diabetes Day. This year it focuses on the importance of nurses and the understanding and treatment of the condition.

In support of this we have asked our doctors to explain the different types, how it is evolving and how this condition is covered within critical illness plans.

As most people will know there are two main types of diabetes, which are more likely to affect people at different ages and affect the body in slightly different ways as our doctors explain.

Type one diabetes

Type one diabetes is usually seen in children and young adults.

It is an autoimmune disease, which is where the body’s immune system inappropriately attacks healthy body tissues, in this case the parts of the pancreas that produce a hormone called insulin.

Insulin, keeps the blood sugar levels at healthy levels and also helps the body’s tissues to enter into the cells and use sugar as an energy source. Therefore, this condition is treated through replacing insulin with regular injections.

Type two diabetes

Type two diabetes is more common in adults, although there are increasing numbers of adolescents becoming affected as it is strongly linked with obesity and a diet high in sugar, which is a worsening problem in many countries around the world.

In type two diabetes, the body’s tissues become resistant to insulin.

Gestational diabetes and type two diabetes are excluded from all wordings and some insurers also include a specific exclusion for Latent Autoimmune Diabetes of Adulthood (Lada).

Therefore, sugar cannot enter the cells to be used as energy and sugar levels build up in the blood stream.

The pancreas initially responds by trying to producing more and more insulin, but in the long run can become “burnt out” and then levels will begin to fall.

In type one diabetes, treatment is usually through tablet medications to control sugar levels, although insulin injections can also be needed in addition at a later stage.

Perhaps less familiar to many however, is that understanding of diabetes is evolving and the classification system for the condition is evolving with it as our doctors explain.

The understanding of diabetes is evolving and splitting the condition into only two distinct forms is not reflecting the diversity that exists in this condition.

It is anticipated that there will be a change in the classification system, or that further subtypes of type one or type two will occur in the future.

Latent Autoimmune Diabetes in adults

As the name suggests, Latent Autoimmune Diabetes of Adulthood (Lada) is similar to type one diabetes as it is an autoimmune disease, but occurs later in adult life, typically after 35 years of age.

Initially, sufferers do not require insulin but will progress to requiring this after several months or years.

It is therefore commonly misdiagnosed as type two, although generally people with Lada tend to be in a healthy weight range and they do not respond well to the usual tablet forms of medications.

Some consider this a subset of type one diabetes, although it seems more likely to straddle both type one and type two, often being coined “type 1.5 diabetes”.

Critical illness plans

All insurers currently classify type one diabetes as an additional payment condition and as such the amount that would be paid in the event of meeting the criteria would differ depending on the sum assured at point of claim.

As might be expected, critical illness plans do not cover the less severe diabetes type two, however many plans do cover type one.

Who is covered between the life assured and children does present some variations however.

In terms of the coverage for type one diabetes the market is pretty consistent as insurers will generally cover a “definite diagnosis” of Type one diabetes as long as the patient is insulin dependent.

Gestational diabetes and type two diabetes are excluded from all wordings and some insurers also include a specific exclusion for Lada.

Even where this is not specifically excluded however, diagnosis of Lada is unlikely to result in a claim based on current definitions and medical classifications as our doctors explain: 

"Currently, from insurers' latest wordings, it is unlikely that a claim for Lada will be successful as it is not a definite diagnosis of type one diabetes and is not clearly defined into a specific category by current classification systems.

"This may well change in the future though as more is learnt on this subject.”

All insurers currently classify type one diabetes as an additional payment condition and as such the amount that would be paid in the event of meeting the criteria would differ depending on the sum assured at point of claim.

*The AIG YourLife Plan will pay 100 per cent to a maximum of £35,000 of the child cover sum assured (can be different to the life assured)

**Guardian will pay 25 per cent to a maximum of £50,000 of the child cover sum assured (can be different to the life assured)

***Vitality will pay 15 per cent of the child cover sum assured (can be different to the life assured).

With so many people in the UK living with diabetes, it is important that awareness of the condition is increased.

Type two diabetes is largely preventable by living a healthy and active lifestyle while type one is  not.

The work that nurses do all over the country to help those with diabetes is amazing and it is only fitting that this year’s World Diabetes Day focuses on promoting their role in the prevention and management of the condition.

Adam Higgs is head of research at Protection Guru