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Essential Health Insurance Plan

Our Essential Individual Health Insurance Plan gives access to healthcare in Bermuda and overseas. However, this plan provides coverage for HI Act and SH Supplementary In-Hospital only.


Coverage
Premium
$

Health Insurance Act (HI)

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

$100,000 lifetime maximum

 

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

  

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 Network: 100% Coinsurance
Argus does not Pre-Approve / treatment not in Argus Network: 10% Coinsurance 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:
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 Canadian Argus 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 eligible for airfare and accommodation and must be pre-approved by Argus in order to receive maximum reimbursement. Airfare and accommodation are only eligible for Psychiatric and Substance Abuse services, Emergency Treatment and Treatment which is not available in Bermuda:
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 Hospital or Substance Abuse Treatment Facility (must be pre-approved by Argus in order to be eligible):
$850 x 45 days
$38,250 maximum per policy year

  
Psychiatric Professional Services (must be pre-approved by Argus in order to be eligible):
$1,200 per policy year

  
Hotel or Rental Accommodation:
  • In the ‘Preferred Provider’ Network:
    • Insured Person or Insured Minor and Parent/Guardian jointly: $250 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
  • All other facilities and providers:
    • Insured Person or Insured Minor and Parent/Guardian jointly: $180 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
Combined Maximum with commercial Economy Airfare: $14,500 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: $14,500 per policy year

  
   

The following services must be pre-approved by Argus in order to be eligible:
Ground Ambulance and Air Ambulance:
Unlimited

  
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:
$10,000 for return of remains		  
Benefits explained on this website provide a brief summary of our standard Individual Health Plan and are subject to limitations and policy maximums. Full terms and conditions are provided in the Master Policy.