Guardian Group Health Insurance Plans

Our premium policy offering, the Guardian Group Health Insurance Plan offers Argus members a high level of local and overseas healthcare coverage with access to top doctors and hospitals through our provider network.


Coverage
Premium
$$$

Health Insurance Act (HI)

As specified under The Health Insurance Act 1970 and its regulations, orders and rules

 

 

Ancillary Hospital Services
Bermuda Hospitals Board Fee Schedule

 
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 Alarm Device
80% | $200 maximum per policy year

 

 

Asthmatic, Audiologic, Allergy & Chronic Obstructive Pulmonary Disease (COPD) Counselling:
  • Initial Consultation: $160, 1 per policy year for each type of service
  • Subsequent Visits: $65
$1,100 combined maximum per policy year

 
Medical Nutritional Therapy (Provider must be a registered Dietitian approved by Argus):
  • Initial Consultation: $160, 1 per policy year for each type of service
  • Subsequent Visits: $65
  • Subsequent Group Session: $35
$1,395 combined maximum per policy year

 
Weight Loss Management Programme (Programme & provider must be pre-approved by Argus):
$127, 26 visits per policy year

 
Diabetes Prevention Programme (Programme & provider must be pre-approved by Argus):
  • Group Session: $30, maximum 12 sessions per policy year
 

Diabetes Reversal Programme:
  • Initial programme: $4,650, 1 per lifetime (Programme & provider must be pre-approved by Argus)
  • Maintenance programme following completion of initial programme:
    • Office visits with physician: $125, 2 visits per policy year
    • Group sessions: $35 per session, 2 sessions per policy year
 

Annual Foot Exam:
$150, maximum 1 exam per policy year
For persons with type I or II diabetes or diabetic neuropathy


 
Allergy testing:
Our Fee Schedule, $600 per lifetime

 
Allergy Injections:
$20 per injection and serum combined

 
Annual Health Exam:
Maximum 1 exam per policy year
  • General Practitioner: $325
  • Pediatric (2-18 years): $195
 

Annual Specialist / Gynaecologist Exam (all ages):
$325, 1 exam per policy year

 
Routine Diagnostic Testing in conjunction with Annual Exams:
Bermuda Fee Schedule

 
Well-Baby Routine Health exam (under 2 years):
$107

 
Annual Eye Exam:
$115, maximum 1 exam per policy year
Routine Diagnostic Testing in conjunction with Annual Eye Exam (Provider must be approved by the Bermuda Health Council):
 
$200 per policy year

 
Immunisations and Injections:
$30 per injection

 
Diagnostic Services in Private Testing Facilities:
Includes Genetic Testing and Sleep Studies (These services must be pre-certified by Argus):
Bermuda Fee Schedule
 

 

General Practitioner
  • Office Visit: $125
  • Home Visit: $170
 

Specialist
  • Consultation: $315, max 5 per policy year
  • Office Visit: $125
 

Telemedicine Office Visit (Services must be pre-certified by Argus)
$125
 

In Office Medical / Surgical Treatment
Bermuda Fee Schedule

 
Physical Medicine and Supplementary Therapies:
Manipulations, Speech Therapy, Chiropractic, Osteopathy:
  • Individual Visit: $75
Physical & Occupational Therapy/TENS:
  • Individual Visit: $75
  • Group Session: $35
$3,600 combined maximum, all services, per policy year

 
Chiropody / Podiatry:
$75, maximum 12 visits per policy year

 
Behavioural Therapies for Autism Spectrum & Attention Deficit Disorders (Services must be pre-certified by Argus):
Individual and family applied behavioural therapies 100% of billed charges, $2,500 maximum per policy year

 
Complementary Alternative Therapies:
  • Massage (inclusive of Reflexology) (Provider must be approved by the Bermuda Massage Therapy Association): $70
  • Acupuncture: $70
  • Naturopathic Doctors (Provider must be approved by Argus): $70
$600 combined maximum per policy year

 
Psychiatrist: $190
Clinical Psychologist/Group Therapy Session: $140
Counselling:
  • Individual Visit: $100
  • Group Session: $45
Smoking Cessation Counselling:
  • Individual Visit: $100
  • Group Session: $45
$5,500 combined maximum, all services, per policy year

 
Sclerotherapy:
Bermuda Fee Schedule
$1,000 per policy year


 
Lymphedema Treatment:
$110, 28 visits policy year

 

 

Major Medical Benefits are applicable to overseas treatment and services.
Eligible Expenses are payable at a percentage of the lesser of Usual and Customary Charges, claim amounts reduced by the Argus claims editing process or Discounted Rates.

 
Maximum benefit for Active Employees, Dependents other than Dependent Children noted below and eligible Retirees:
Unlimited

 
Dependent Children 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: 100% Coinsurance
Insured does not contact Argus Health within 48 hours of incident: 80% Coinsurance


 
Treatment not Available in Bermuda not specified below:
Insured must call Argus in advance and treatment currently not available in Bermuda must be pre-certified by Argus in order to receive 100% coinsurance; otherwise, benefits are payable at 80%

 
Treatment Available in Bermuda:
Insured must call Argus in advance and treatment must be pre-certified by Argus and obtained within the Argus Network in order to receive 100% coinsurance; otherwise, benefits are payable at 80%

 
Neonatal Treatment, Congenital Birth Defects & High-Risk Pregnancy:
Charges related to neonatal, congenital birth defects and high-risk pregnancy will only be payable at 100% if they are pre-certified by Argus and treatment is obtained within the Argus Canada Network; otherwise, benefits are payable at 80%

 
Spinal Treatment:
Charges related to spinal care, services and treatment will only be payable at 100% if they are pre-certified by Argus and obtained within the Argus Spinal Care Network; otherwise, benefits are payable at 50%. Spinal care, services and treatment are subject to a mandatory second opinion review.

 
Paediatric Assessment of Autism Spectrum & Attention Deficit Disorders:
Charges related to paediatric assessment of autism spectrum and attention deficit disorders will only be payable at 100% if they are pre-certified by Argus and obtained within the Argus Preferred Provider Network; otherwise, benefits are payable at 80%

 
Specialty Prescription Drugs:
Physician and facility charges related to the administration of specialty prescription drugs will only be payable at 100% if they are tier one drugs, pre-certified by Argus and obtained within the Argus Specialty Prescription Drug Network; otherwise, benefits are payable at 50%

 
Psychiatric Disorders & Substance Abuse Disorders:
Charges related to psychiatric and substance abuse disorders will only be payable at 100% if they are pre-certified by Argus and obtained within the Argus Psychiatric & Substance Abuse Disorders Network; otherwise, benefits are payable at 80%
 
   

The following services are payable at a percentage of the lesser of Usual & Customary charges, claim amounts reduced by the Argus claims editing process or Discounted Rates, and must be pre-certified by Argus 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 Health Care:
Unlimited

 
Transplant Services:
Unlimited

 
Psychiatric & Substance Abuse Disorders (Must be pre-certified by Argus in order to be eligible and receive maximum reimbursement):
Inpatient Care: Unlimited
Psychiatric Professional Services: Unlimited

 
Hotel or Rental Accommodation are only eligible for services indicated in the chart above and must be pre-certified by Argus in order to be eligible:
  • In the Argus Preferred Provider, Argus Canada, Argus Spinal Care, Argus Specialty Prescription Drug and Argus Psychiatric & Substance Abuse Disorders Networks:
    • Insured Person or Insured Person and Approved Travelling Companion:* $300 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
  • All other facilities and providers:
    • Insured Person or Insured Person and Approved Travelling Companion:* $200 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
Combined Maximum with commercial Economy Airfare: $35,000 per policy year

Commercial Economy Airfare (Excludes preferred/priority seating and baggage fees):
Combined Maximum with Hotel or Rental Accommodation: $35,000 per policy year

 
*Benefits for one travelling companion are approved for one episode of care 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-certified by Argus in order to be eligible:

Ground Ambulance and Air Ambulance:
Unlimited (if Medically Necessary)

 
Air Ambulance Return to Bermuda:
Unlimited (if Medically Necessary)

 
Behavioural Therapies for Autism Spectrum & Attention Deficit Disorders:
Individual and family applied behavioural therapies 100% of billed charges, $2,500 maximum per policy year

 
Genetic Testing:
Unlimited

 
Telemedicine Office Visit:
Unlimited

 
Repatriation of remains (inclusive of cremation):
Unlimited for return of remains or ashes

 
   

The following services are payable at 100% of the lesser of Usual and Customary charges, claim amounts reduced by the Argus claims editing process or Discounted Rates. Airfare and accommodation do not apply to these services, consultations and second opinions. Pre-certification of these services is not required.

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)
$3,360 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.

 

Supplementary Miscellaneous Benefits are applicable Worldwide.**

Hearing Aids, Surgical Support Hose, Surgical Brassieres, Wigs, Orthotics:
80% $4,000 combined maximum every 5 policy years

 
Prosthetic Devices and Appliances:
80% $25,000 maximum per lifetime

Durable Medical Equipment, Accidental Dental Services and Cardiac Rehabilitation/Exercise Programme, Medical/Surgical Supplies:
80% of usual and customary charges

**Airfare and accommodation do not apply to Worldwide Treatment and Services

 

Vision Care Benefits are applicable Worldwide.**

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%

**Airfare and accommodation do not apply to Worldwide Treatment and Services


 

 

Benefits are payable in accordance with the Bermuda Dental Fee Schedule. Amounts charged by a provider which exceed the scheduled amounts are your responsibility. Please obtain a pre-estimate of benefits from your dentist prior to undergoing extensive dental procedures.

Basic Dental Services (DE01):

Preventive and Diagnostic:
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride:
100% of Fee Schedule
Policy Year: $1,400
Lifetime: Unlimited


 
Surgical and Minor Restorative:
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Endodontics: 
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Periodontics:
50% of Fee Schedule
Policy Year: $2,000
Lifetime: Unlimited
 
   

Major Restorative Services (DE02):
50% or 80% of Fee Schedule
Policy Year: $5,000
Lifetime: Unlimited
 
   

Orthodontic Services (DE03):
Only Insured Persons up to age 19 are covered
50% of Fee Schedule
Policy Year: N/A
Lifetime: $4,000

**Airfare and accommodation do not apply to Worldwide Treatment and Services


 

 

Prescription Benefits are applicable Worldwide.**

Prescription Drugs, Birth Control, Medicines and Sera available only by prescription:
80% for brand name drugs
100% for generic drugs

**Airfare and accommodation do not apply to Worldwide Treatment and Services
 

 

Specialty Prescription Drugs (Must be pre-certified by Argus)

(High cost drugs, biologic and biosimilar drugs and specialty drugs approved by Argus to treat complex or chronic medical conditions)
100% for tier one drugs
50% for tier two drugs
 

 

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.