Health Plan Resources for Providers

Every year we review our benefits* to ensure that they meet the unique healthcare needs of our members. This year, we have introduced meaningful changes to our benefits plans that include:

• Diabetes Rewind Programme – We have partnered with Island Health Services, the Family Practice Group, the Bermuda Diabetes Association, Cavan Health and Oviva to offer two very different approaches to rewind diabetes that include an online and offline track. All Argus insured members are covered in full for the in-person and online programmes, apart from Safeguard Plus and Essential Plan members. Click here to learn more about the programme.
• Prescription Drugs for Sexual Dysfunction – Coverage provided in respect of sexual dysfunction drugs, post radical prostatectomy, for insured members with prescription drug benefits.
• COVID-19 Coverage Changes
• In-office COVID-19 PCR Sample Collection – Effective June 1, 2022, charges relating to private medical practice COVID-19 PCR test sample collection, handling, personal protective equipment (PPE), and patient assessment charges will be covered at 50% of the Bermuda Health Council’s (BHeC) scheduled amount in accordance with Home & Office (HO) benefits. Reimbursement for PPE may only be considered in association with the collection of COVID-19 test samples and if the provider submits supporting documentation that their business purchased the PPE and the associated costs of PPEused for the sample-collection encounter. Argus Health will cover lab fees for local diagnostic PCR tests processed at approved private labs at 100% of the BHeC fee schedule in accordance with the usual diagnostic services (PD) benefit.
• Testing for medical travelers - If your patient is traveling for non-elective medical reasons (i.e. treatment not available in Bermuda) PCR and observed antigen testing are covered locally and overseas in accordance with their with Preventive & Diagnostic (PD) and Major Medical (MM) benefits.
• FDA-approved COVID-19 Vaccine Administration - Argus Health will cover the administering of FDA-approved COVID-19 vaccines at 100% of the BHeC Fee schedule for insured members.

*Depending on each member’s healthcare plan

Argus, in partnership with our overseas care management company, One Team Health (‘OTH’), provides seamless overseas healthcare management while helping to reduce and control costs. To ensure that our members receive the maximum reimbursement under their insurance plans, please contact OTH for pre-approval. Please refer to the Argus website for the most up to date facility listings. OTH administrators are also available to assist you in locating specialists within our network for overseas care. To contact an OTH representative email overseascare@argus.bm or call 1-905-532-2954.

Claims can be submitted electronically via the Provider Portal, either via our Online Claims submission feature or scanned into PDF format and uploaded. This ensures the fastest turnaround time and best traceability for claims adjudication and payment.

To assist us in paying claims quickly and accurately, please ensure that claim forms are (i) completed in full, (ii) contain current policy and certificate numbers, and (iii) include the total billed amount.