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As specified under The Health Insurance Act 1970 and its regulations, orders and rules |
| Ancillary Hospital Services Bermuda Hospitals Board Fee Schedule |
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| Surgical, Obstetrical, Anaesthetic, Diagnostic and Medical Care Bermuda Fee Schedule |
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| Ground Ambulance to Home As specified under The Health Insurance Act |
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| Chronic Disease Management Programme 80% | $2,880 maximum per policy year |
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| Medical Alarm Device 80% | $200 maximum per policy year |
Asthmatic, Audiologic, Allergy & Chronic Obstructive Pulmonary Disease (COPD) Counselling:
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Medical Nutritional Therapy (Provider must be a registered Dietitian):
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| Weight Loss Management Programme (Programme must be pre-approved by Argus): $127, 26 visits per policy year |
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Diabetes Prevention Programme (Programme must be pre-approved by Argus):
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Diabetes Reversal Programme:
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Annual Foot Exam: $150, maximum 1 exam per policy year For persons with type I or II diabetes or diabetic neuropathy |
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| Allergy testing: Our Fee Schedule, $600 per lifetime |
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| Allergy Injections: $20 per injection and serum combined |
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| Annual Health Exam: Maximum 1 exam per policy year
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Annual Specialist / Gynaecologist Exam (all ages): $325, 1 exam per policy year |
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| Routine Diagnostic Testing in conjunction with Annual Exams: Bermuda Fee Schedule |
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| Well-Baby Routine Health exam (under 2 years): $107 |
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| 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 |
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| Immunisations and Injections: $30 per injection |
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| Diagnostic Services in Private Testing Facilities: Includes Genetic Testing and Sleep Studies (Must be pre-approved by Argus): covered by approved fee schedule. |
General Practitioner
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Specialist
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Telemedicine Follow Up - Office Visit (Must be pre-approved by Argus) $125 |
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In Office Medical / Surgical Treatment Bermuda Fee Schedule |
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| Physical Medicine and Supplementary Therapies: Manipulations, Speech Therapy, Chiropractic, Osteopathy:
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| Chiropody / Podiatry: $75, maximum 12 visits per policy year |
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| Behavioural Therapies for Autism Spectrum & Attention Deficit Disorders (Must be pre-approved by Argus): Individual and family applied behavioural therapies 100% of billed charges, $2,500 maximum per policy year |
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Complementary Alternative Therapies:
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| Psychiatrist: $190 Clinical Psychologist/Group Therapy Session: $140 Counselling:
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| Sclerotherapy: Bermuda Fee Schedule $1,000 per policy year |
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| 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 or Discounted Rates. |
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| Maximum benefit for Employees and eligible Retirees: Unlimited |
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| Dependent Children over age 19 and under age 26 who are not fulltime students: Unlimited per one 12-month period |
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| 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 |
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| Treatment not Available in Bermuda: Argus Pre-Approves: 100% Coinsurance Argus does not Pre-Approve: 80% Coinsurance |
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| Treatment Available in Bermuda: Argus Pre-Approves and treatment is obtained in Argus Network: 100% Coinsurance Argus does not Pre-Approve / treatment not in Argus Network: 80% Coinsurance |
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| Neonatal Treatment: Charges related to neonatal, congenital birth defects and high-risk pregnancy will only be payable at 100% if they are pre-approved and treatment is obtained within the Argus Canada Network; otherwise, benefits are payable at 80% |
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| Spinal Treatment: Charges related to spinal care, services and treatment will only be payable at 100% if they are pre-approved and obtained within the Argus Spinal Care Network; otherwise, no benefits are payable |
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| 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-approved and obtained within the Argus Preferred Provider Network; otherwise, benefits are payable at 80% |
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The following services are eligible for airfare and accommodation and must be pre-approved by Argus in order to receive maximum reimbursement: |
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| Inpatient Care: Semi-private accommodation |
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| Intensive Care, Outpatient and Emergency Care: Unlimited |
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| Surgical, Obstetrical, Anaesthetic, Diagnostic and Medical Care: Unlimited |
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| Physician Services - Home or Office Visit: Unlimited |
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| Rehabilitation / Skilled Nursing Facility: Semi-private up to 60 days per policy year |
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| Home Health Care Unlimited |
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| Transplant Services: Unlimited |
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| Psychiatric Hospital or Substance Abuse Treatment Facility (must be pre-approved by Argus in order to be eligible): $1000 x 60 days $60,000 maximum per policy year |
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| Psychiatric Professional Services (must be pre-approved by Argus in order to be eligible): $4,500 per policy year |
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Hotel or Rental Accommodation:
Commercial Economy Airfare (excludes preferred/priority seating and baggage fees): Combined Maximum with Hotel or Rental Accommodation: $35,000 per policy year |
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| *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. |
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The following services must be pre-approved by Argus in order to be eligible: |
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| Ground Ambulance and Air Ambulance: Unlimited (if Medically Necessary) |
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| Air Ambulance Return to Bermuda: Unlimited (if Medically Necessary) |
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| Behavioural Therapies for Autism Spectrum & Attention Deficit Disorders: Individual and family applied behavioural therapies 100% of billed charges, $2,500 maximum per policy year |
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| Genetic Testing: Unlimited |
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| Telemedicine Follow Up: Unlimited |
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| Repatriation of remains (inclusive of cremation): Unlimited for return of remains or ashes |
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The following services are payable at 100% of the lesser of Usual and Customary charges or Discounted Rates:*** |
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| Annual Health Exam and related Diagnostic Testing: $3,000 per policy year |
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| 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 |
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| Complementary Alternative Therapies: (Massage and Acupuncture) $350 combined maximum per policy year |
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| ***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 |
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| Prosthetic Devices and Appliances: 80% | $25,000 maximum per lifetime |
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| 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% |
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| Elective Surgical Treatment for Vision Correction: $2,000 per lifetime payable at 100% **Airfare and accommodation do not apply to Worldwide Treatment and Services |
| Dental Benefits are applicable Worldwide.** Benefits are payable in accordance with the Bermuda Dental Fee Schedule. 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 |
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| Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride: 100% of Fee Schedule Policy Year: $1,400 Lifetime: Unlimited |
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| Surgical and Minor Restorative: 100% of Fee Schedule Policy Year: Unlimited Lifetime: Unlimited |
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| Endodontics: 100% of Fee Schedule Policy Year: Unlimited Lifetime: Unlimited |
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| Periodontics: 50% of Fee Schedule Policy Year: $2,000 Lifetime: Unlimited |
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Major Restorative Services (DE02): 50% or 80% of Fee Schedule Policy Year: $5,000 Lifetime: Unlimited |
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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 |
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