Health Plan Resources for Providers

Health Plan Resources for Providers - Argus Bermuda

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We’re here for you when you need us. If you still have questions after reading through the resources below, call us at 298-0888.

Health Renewal FAQs

What are the 2023 benefit enhancements to Argus health plans?

Every year, we review our benefits^[1] to ensure that they meet the unique healthcare needs of our members.

Effective 1 June 2023, we have introduced meaningful changes to our benefit plans, noted below:

Non-solid Organ Transplant Network – to provide world-class care while reducing costs for Bone Marrow, Stem Cell, and CAR-T therapies. The network features a new partnership with the Royal Marsden Hospital in the UK.
Allergy Testing – increased from $600 lifetime to $900 every five (5) years.
Physical Medicine and Supplementary Therapies: now inclusive of Complimentary & Alternative Therapies (e.g., massage, chiropractic, osteopathy, acupuncture, and naturopathy) increased the maximum from $75 to $85 per visit and a combined maximum of $3,600 per policy year.
- Individual Visit – increased the maximum from $75 to $85
- Group Session – increased the maximum from $35 to $40
Chiropody/Podiatry – increased the maximum from $75 to $85 per visit.
Specialist Consultations at Island Health Services and Family Practice Group - 100% of billed charges covered for Endocrinology and Internal Medicine consultations.
Student Mental Health Hotline - available to students studying overseas.
Neuropsychological Testing (NPT) - one test every two policy years with a maximum benefit of $5,000. The implementation of NPT to evaluate cognitive and behavioral abilities is available on the island. Psychologists utilize a set of standardized tests that can be completed in several hours. Argus is pleased to provide access to testing through our pre-certification process, as noted below:

Pre-certification NPT Guidelines for Providers
1. The primary care physician or pediatrician refers their Argus member to the testing provider/psychologist. The referral must include the provisional diagnosis and symptoms.
2. The psychologist’s visit/interview must be complete at the time of the pre-certification request. If NPT is indicated after the psychologist’s visit, complete the NPT Request Form and submit it to insurance@argus.bm, attention ‘Provider Relations’.
3. The psychologists as the testing provider must submit the NPT Request along with the primary physician’s referral and any supporting documentation.
Upon review, Argus will reply in 3 to 5 business days. The response will be given in writing to the Psychologist to conduct testing.

^[1]Depending on your patient’s healthcare plan

Who should I contact if an Argus member requires medical assistance overseas?

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.

How do I submit claims?

Claims can be submitted electronically and securely 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.

Claims can also be submitted through Electronic Data Interchange (EDI) if your Practice Management software has the capability. Integration steps are required to enable this option. Please contact our Provider Relations Manager, Karima Smith, RN at ktsmith@argus.bm for next steps and to discuss timelines if this option is of interest.

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