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Saskatchewan Pediatric Insulin Pump Program Application

Saskatchewan Aids to Independent Living (SAIL) uses this two-page application to register children under 18 with type 1 diabetes in its Insulin Pump Program, which funds one pump every five years and gives access to covered supplies. The SHA pediatric diabetes education program or an authorized pediatric diabetes specialist submits it after the family completes the provincial pump assessment process and a pump trial.

Who completes it

A pediatric endocrinologist or pediatrician with diabetes expertise, associated with the SHA Pediatric Diabetes Program and experienced with pumps in children, signs the physician certification; an SHA diabetes educator from the pediatric program signs the educator and trial certifications. A parent or guardian signs the consent.

Submitting and payment

How to submit it
The pediatric diabetes program registers the child with SAIL by email, marked for pediatric registration and sent to the address on the form, and should allow at least 72 hours for confirmation.
Who pays
SAIL funds one insulin pump every five years through a program grant, while pump supplies are paid through the family's Drug Plan coverage, such as the Children's Drug Plan; the form lists no fee for clinicians.

Good to know

  • The family must complete every step of the provincial pediatric pump assessment, including a Pediatric Diabetes Pump Information Session or the Is Pump Therapy for Me? online modules and quiz.
  • Criteria include parent or guardian involvement, glucose checks four or more times daily or CGM use, carbohydrate counting, hypoglycemia management and A1C monitoring every 3 to 6 months.
  • The pump trial of up to three months must confirm the pump is medically appropriate; unlike the adult form, the pediatric version prints no waiver for replacement pumps.
  • CGM and flash glucose monitor supplies are not Insulin Pump Program benefits, even when integrated with the pump, according to SAIL's Insulin Pump Program Q&A.

Get the official form

Download the current version from the source each time; forms change without notice.

Saskatchewan Insulin Pump Program Pediatric Application Form

Official pagePDF

Fill it with Vero

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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who certifies eligibility on the pediatric insulin pump application?

A pediatric endocrinologist or pediatrician with diabetes expertise who is associated with the SHA Pediatric Diabetes Program and has experience managing insulin pumps in children. An SHA diabetes educator who works with the pediatric diabetes education program certifies the criteria and the completed pump trial.

What is the Is Pump Therapy for Me? requirement?

Part of the provincial pediatric insulin pump assessment process is attending a Pediatric Diabetes Pump Information Session or completing the Is Pump Therapy for Me? online modules and quiz. The form asks the clinician to confirm the child, youth and family completed all steps of that assessment process.