Signal Group Health Insurance Plan

The Signal Group Health Insurance Plan offers affordable healthcare coverage for Argus members. This is best for businesses who want lower-cost health benefits for their employees.


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

 

 

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
$745 combined maximum 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:
For persons with type I or II diabetes or diabetic neuropathy
$150, maximum 1 exam per policy year

 
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: $225
  • Pediatric (2-18 years): $195
 

Annual Specialist / Gynaecologist Exam (all ages):
$225, maximum 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, maximum 6 exams per policy year

 
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, 9 visits per policy year combined with Specialist
  • Home Visit: $170, maximum 3 per policy year
 

Specialist
  • Consultation: $315, maximum 2 per policy year
  • Office Visit: $125, 9 visits per policy year combined with General Practitioner
 

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

In Office Medical / Surgical Treatment:
Bermuda Fee Schedule

 
Physical & Occupational Therapy/TENS:
  • Individual Visit: $75
  • Group Session: $35
$900 combined maximum, all services, per policy year

 
Chiropractic:
$75, maximum 6 visits per policy year

 
Chiropody / Podiatry:
$75, maximum 6 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 per policy year

 
Psychiatrist: $190, maximum 6 visits per policy year

Clinical Psychologist/Group Therapy Session: $140, maximum 6 visits per policy year

Counselling Services:
  • Individual Visit: $100
  • Group Session: $45
6 visits/sessions per policy year combined maximum for Counselling Services

Smoking Cessation Counselling
  • Individual Visit: $100
  • Group Session: $45
Combined maximum, Smoking Cessation $370, 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.

 
All Insured Persons other than Dependent Children noted below:
Policy Year: $500,000
Lifetime:
$1,500,000

 
Dependent Children over age 19 and under age 26 who are not full-time students:
Policy Year: $500,000
Lifetime: $500,000

 
Emergency Treatment:
Insured calls Argus Health within 48 hours of incident: 100% Coinsurance
Insured does not contact Argus Health within 48 hours of incident: 10% Coinsurance for inpatient facility only and all other services will not be eligible.


 
Treatment not Available in Bermuda in Bermuda not specified below:
Insured must call Argus in advance and treatment must be pre-certified by Argus and obtained within the Argus Preferred Provider Network in order to receive 100% coinsurance; otherwise, benefits will be payable at 10% for inpatient facility only, and all other services will not be eligible.

 
Treatment Available in Bermuda:
10% for inpatient facility only, and all other services will not be eligible.

 
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 will be payable at 10% for inpatient facility only, and all other services will not be eligible.

 
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 will be payable at 10% for inpatient facility only, and all other services will not be eligible. 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 in an Argus Preferred Provider Facility; otherwise, benefits will be payable at 10% for inpatient facility only, and all other services will not be eligible.

 
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 will be payable at 10% for inpatient facility only, and all other services will not be eligible. 

 
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 will be payable at 10% for inpatient facility only, and all other services will not be eligible.  
 
   

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. Airfare and accommodation are only eligible for Psychiatric & Substance Abuse services, Emergency Treatment and treatment which is not available in Bermuda and must be pre-certified by Argus in order to be eligible:

 
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:**
  • Insured Person or or Insured Minor and Parent/Guardian jointly: $200 per day
  • Without Hotel or Rental Accommodation: 50% of above amount
Combined Maximum with commercial Economy Airfare: $15,000 per policy year

Commercial Economy Airfare:**
(Per Insured Person or per Insured Minor and Parent/Guardian jointly. Excludes preferred/priority seating and baggage fees)
Combined Maximum with Hotel or Rental Accommodation: $15,000 per policy year
 
   

The following services must be pre-certified by Argus in order to be eligible:

 
Ground Ambulance and Air Ambulance:
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

 
Cardiac Rehabilitation/Exercise Programme:
$2,000 per policy year

 
Telemedicine Office Visit:
Unlimited

 
Genetic Testing:
Unlimited

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

 

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
$7,500 maximum per policy year

**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.