Local Benefits   Argus Pays

Room & Board, Psychiatric Ward, Hospice, Hospital Outpatient and Emergency Department, Physicians’ Services, Approved Diagnostic Imaging Facilities, Ground Ambulance, Home Medical Services, Dialysis and Anti-rejection Drugs

 

As specified under The Health Insurance Act

Artificial Limbs

 

$30,000 lifetime maximum

Home and Office Medical Benefits   Argus Pays

General Practitioner

Office Visit

Home Visit

$105

$160

Specialist

Consultation

Office Visit

$275 (max 5 per policy year)

$105

In Office Medical/Surgical

  Bermuda Fee Schedule

Physical Medicine and Supplementary Therapies (Manipulations, Speech Therapy, Chiropractic, Osteopathy)

 

$60

Physical & Occupational Therapy

Individual Office Visit

Group Session

$60

$30

Combined Maximum

All Services

$2,880 per policy year

Chiropody/Podiatry

 

$60

Maximum 12 visits per policy year

Complementary Alternative Therapies

Massage (Provider must be approved by the Bermuda Massage Therapy Association)

Acupuncture

Naturopathic Doctors (Must be approved by Argus)

 

 

$50

$350 combined maximum per policy year

Psychiatrist

Clinical Psychologist/Group Therapy

Substance Abuse Counselling - Pathways Bermuda

  • Individual Visit
  • Group Session

Combined Maximum Psychiatrist/Psychologist

 

$180

$130

 

$75

$15

$4,500 per policy year

Sclerotherapy

 

 

Bermuda Fee Schedule

$1,000 per policy year

Lymphedema Treatment

 

 

$110

28 visits per policy year

Chronic Kidney Disease Management
(Programme must be pre-approved by Argus)

 

$3,900 per policy year

     

 

 

Dental Benefits   Argus Pays
Basic Dental Services (DE01)    
Preventive and Diagnostic

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride

 

Policy Year

Lifetime

100% of Fee Schedule

$1,200

Unlimited

Surgical and Minor Restorative

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Endodontics

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Periodontics

 

Policy Year

Lifetime

50% of Fee Schedule

$2,000

Unlimited

Major Restorative Services (DE02)

 

Policy Year

Lifetime

80% of Fee Schedule

$4,000

Unlimited

Orthodontic Services (DE03)

Only Insured Persons up to age 19 are covered

 

Policy Year

Lifetime

50% of Fee Schedule

N/A

$3,000

Vision Benefits   Argus Pays

Prescription Eye Glasses or Contact Lenses

 

$400 per policy year payable at 100%

Elective Surgical Treatment for Vision Correction

 

$2,000 per lifetime payable at 100%, subject to a 12-month waiting period

 

Prescription Benefits   Argus Pays

Prescription Drugs, Birth Control, Medicines and Sera available only by prescription

 

80% for brand name drugs
100% for generic drugs

Preventive and Diagnostic Benefits   Argus Pays

Asthmatic, Audiologic & Allergy Counselling


Initial Consultation

 

Subsequent Visits

 

Combined Maximum

 

$140, 1 per policy year for each type of service

 

 

$60

$500 per policy year

Medical Nutritional Therapy (Provider must be a registered Dietitian)

Initial Consultation

Subsequent Individual Visit

Subsequent Group Session

Combined Maximum

$140, 1 per policy year

$60

$30

$800 per policy year

Diabetes Self-Management Education (Programme must be pre-approved by Argus)

 

Individual Visit

Group Session

Combined Maximum

$60

$30

7 visits/sessions per policy year

Allergy testing

 

Our Fee Schedule, $600 per lifetime

Allergy Injections

 

$20 per injection and serum combined

Voluntary Annual Health Exam Maximum

 

General Practitioner

Pediatric (2-18 years)

1 examination per policy year

$265

$175

Annual Specialist/Gynaecologist Exam (all ages)

 

 

$275, maximum 1 examination per policy year

Routine Diagnostic Testing in conjunction with Annual Exams

 

Bermuda Fee Schedule

Well-Baby Routine Health Examination (under 2 years)

  $105

 

Annual Eye Exam

 

$105 - maximum 1 examination per policy year

Routine Diagnostic Testing in conjunction with Annual Eye Exam (Provider must be approved by the Bermuda Health Council)

 

$100 per policy year

Immunisations and Injections

 

$30 per injection

Diagnostic Services in Private Testing Facilities

 

Bermuda Fee Schedule

 

Supplementary In-Hospital Benefits   Argus Pays

Surgical, Obstetrical, Anaesthetic, Diagnostic and Medical Care

 

Bermuda Fee Schedule

Ground Ambulance to Home

 

 

As specified under The Health Insurance Act

Chronic Disease Management Programme

 

80%

$2,880 maximum per policy year

Medical Equipment & Prosthetics   Argus Pays

Durable Medical Equipment, Accidental Dental Services and Cardiac Rehabilitation/Exercise Programme, Medical/Surgical Supplies

 

80% of Usual and Customary Charges

Hearing Aids, Surgical Support Hose, Surgical Brassieres, Wigs and Orthotics

 

80%, $2,500 combined maximum per policy year

Prosthetic Devices and Appliances

 

80%

$25,000 maximum per lifetime

 Medical Alarm Device  

80% of Usual and Customary Charges

$200 maximum per policy year

 

Overseas Coverage Benefits   Argus Pays

Major Medical Benefits – MM

Eligible Expenses are payable at a percentage of the lesser of Usual and Customary Charges or Discounted Rates.

   

Maximum benefit for Employees and eligible Retirees

 

 

Unlimited

Dependent Children over age 19 and under age 26 who are not fulltime students

 

Unlimited per one 12-month period

Emergency Treatment

Insured calls Argus Health within 48 hours of incident

Insured does not contact Argus Health within 48 hours of incident

100% Coinsurance

80% Coinsurance

Treatment Not Available in Bermuda

Argus Pre-Approves

Argus does not Pre-Approve

100% Coinsurance

80% Coinsurance

Treatment Available in Bermuda

Argus Pre-Approves and treatment is obtained in Argus Network

Argus does not Pre-Approve

100% Coinsurance

 

80% Coinsurance

Neonatal Treatment

Charges related to neonatal, congenital birth defects and high-risk pregnancy

Argus Pre-Approves and treatment obtained within the Canadian Argus Network  

100% Coinsurance

The following services must be pre-approved by Argus Health in order to receive maximum reimbursement

   

Inpatient Care

Semi-private accommodation

Intensive Care, Outpatient and Emergency Care

Unlimited

Surgical, Obstetrical, Anaesthetic, Diagnostic and Medical Care

  Unlimited
Physician Services, Home or Office Visit  

 

Unlimited

Rehabilitation/Skilled Nursing Facility Semi-private Up to 60 days per policy year

Home Healthcare

 

Unlimited

Transplant Services

 

  Unlimited

The following services apply only for Psychiatric and Substance Abuse services and services indicated in the chart above and must be pre-approved by Argus Health in order to be eligible

   

Commercial Economy Airfare (excludes preferred/priority seating and baggage fees)

 

$22,500 combined maximum per policy year

Hotel or Rental Accommodation

In the ‘Preferred Provider’ Network

 

 

All other facilities and providers outside 'Preferred Provider' Network

 

Without Hotel or Rental Accommodation

Insured Person or Insured Person and Approved Travelling Companion:* $250 per day

 

Insured Person or Insured Person and Approved Travelling Companion:* $180 per day

 

50% of Above

* Benefits for a travelling companion are approved in the following circumstances: When the Insured Person is a minor Dependent Child, or has surgery or mental incapacity or otherwise requires a travelling companion due to medical necessity, subject to medical documentation and pre-approval by Argus

The following services must be pre-approved by Argus Health in order to be eligible***

Ground Ambulance and Air Ambulance   Unlimited

Air Ambulance Return to Bermuda

 

 

Based on Medical Necessity

Psychiatric Hospital or Substance Abuse Treatment Facility

 

Maximum

$850 X 45 days

$38,250 per policy year

Psychiatric Professional Services   $4,000 per policy year
Repatriation of remains   $10,000 for return of remains
The following services are payable at 100% of the lesser of Usual and Customary charges or Discounted Rates    
Voluntary Annual Health Exam and related Diagnostic Testing   $3,000 per policy year

Physical Medicine and Supplementary Therapies

(Nutritional/Diabetic, Asthmatic, Audiologic and Allergy Counselling Services, Well-baby Care, Immunisations and Injections, Allergy Testing, Annual Eye Exam, Physical and Occupational Therapy, Chiropractic, Osteopathy, Chiropody, Podiatry, Speech Therapy)
 

$1,200 combined maximum per policy year

Complementary Alternative Therapies (Massage and Acupuncture)   $350 combined maximum per policy year

*** Airfare and accommodation do not apply to these services, consultations and 2nd opinions.

Benefits explained on this website provide a brief summary of our standard Group Health Plan and are subject to limitations and policy maximums. Full terms and conditions are provided in the Master Policy.