Health Plan Resources for Group Members

Health Plan Resources for Group Members - Argus Bermuda

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We're here for you when you need us. If you still have questions about your plan after reading through the resources below, call us at 290-0888.

Health Renewal FAQs

How will my premium be calculated this year?

This year’s premium calculations remain the same as in previous years. Your total premium will be inclusive of the Standard Premium Rate (SPR) and your Supplementary Premium.

Standard Premium Rate (SPR)

The SPR, which includes the Mutual Reinsurance Fund Premium (set and charged by Government and paid directly to Government on your behalf), remains at $400.31 per month per insured adult. This is unchanged from last year.

Supplementary Premium

The premiums for supplemental medical, dental, and vision care benefits are administered by Argus. Premium adjustments to your policy may vary by company and/or account, and are based on factors such as:

General medical inflation – the overall increase in healthcare costs due to factors like medical technology advancements, higher service demand, and increasing labour and supply costs. Worldwide healthcare costs have seen a reported increase of approximately 10%, as noted in the AON Medical Trends Rate Report
Utilisation trends – the patterns or changes in how often healthcare services are being used by the insured population. This year, utilisation was at an all-time high.
The overall claims experience – the collective claims history across all Argus policies, including frequency, amounts, and the demographics of your employees and their dependents. These demographics encompass age, gender, lifestyle, and employee turnover rates.
Plan-specific claims history – the detailed claims history of your company’s plan over the past three years, including the number, type, and cost of claims.
Benefit plan details – specific coverage details, including the types of benefits, coverage limits, and the scope of coverage, which can influence premium adjustments according to the assessed risk level, claim potential, and coverage breadth.

What are the 2024 benefit enhancements to my health plan?

Every year we review benefits[1] to ensure that they meet the unique healthcare needs of our members. This year’s new benefits are as follows:

No Co-Pay at Argus Medical Practices:
Argus Members enjoy no co-pay at Island Health Services and Family Practice Group for GP and specialist services. This includes annual physicals. We are committed to removing financial barriers to promote preventive and chronic care and will ensure annual exams are scheduled in a timely manner.
Increased Benefits:
- Immunisations and Injections: increased to $50 from $30, $1000 maximum for children under the age of 19
- GP Office Visits: increased to $130 from $125 (or 100% at Argus Medical Practices)
- Specialist Office Visits: increased to $150 from $125 (or 100% at Argus Medical Practices)
- Well Baby Exam: increased to $150 from $107
Other Benefit Changes:
- Major Medical lifetime maximum is $5,000,000 (from unlimited)
- Overseas Psychiatric & Substance Abuse Treatment: maximum 90 days per policy year
- Hearing aids: 1 every 5 policy years
- Orthotics: 1 every 2 policy years
- CPAP: 1 every 5 policy years, up to a maximum of $5,000

[1] Depending on your healthcare plan

Who should I contact if I require medical treatment overseas?

Argus, in partnership with One Team Health, Inc. (‘OTH’), provides seamless overseas healthcare management, while helping to reduce and control costs. The OTH staff of doctors, nurses, and case managers work together to provide access to appropriate and high-quality care, allowing you to focus on your health, not logistics. Please call 298-0429 to speak to an OTH representative.

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