|
As specified under The Health Insurance Act 1970 and its regulations, orders and rules |
| Ancillary Hospital Services 100%, Bermuda Hospitals Board Fee Schedule |
|
| Surgical, Obstetrical, Anaesthetic, Diagnostic and Medical Care 100%, 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 |
| 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. |
|
| All Insured Persons: Policy Year: $500,000 Lifetime: $1,500,000 |
|
| 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: Argus Pre-Approves and treatment is obtained in Argus Preferred Provider Network: 100% Coinsurance Argus does not Pre-Approve / treatment not in Argus Preferred Provider Network: 10% Coinsurance for inpatient facility only and all other services will not be eligible. |
|
| Treatment Available in Bermuda: No benefits are payable. |
|
| Neonatal Treatment, Birth Defects & High-Risk Pregnancy: Charges related to neonatal, 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-approved and obtained within the Argus Spinal Care Network; otherwise, no benefits will be payable. |
|
| 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 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 |
|
| COVID-19 Testing (Approved Tests): 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 or Substance Abuse Treatment Facility (Must be pre-certified by Argus in order to be eligible and receive maximum reimbursement): Inpatient Care: Unlimited Psychiatric Professional Services: $5,500 maximum per policy per year |
|
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: |
|
Hotel or Rental Accommodation:**
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-approved 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 |
|
| Genetic Testing: Unlimited |
|
| Cardiac Rehabilitation/Exercise Programme: $2,000 per policy year |
|
| Repatriation of remains (inclusive of cremation): $10,000 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. |
|
Covid-19 Vaccination: Unlimited |
Sign In
