For Employers: 2018 Health Renewal FAQs



As you know, every year, Argus reviews its current health policies and makes the necessary revisions.


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Did you Know?
2018 Frequently Asked Questions on Health benefits for employers

 

The Bermuda Health Council

 1. What is the role of the Bermuda Health Council?

The Bermuda Health Council Act was introduced to the House of Assembly in 2004 to establish the Bermuda Health Council with specific responsibility to regulate, coordinate and enhance the delivery of health services. For further information, visit www.bhec.bm.

 

Standard Health Benefit

 2. What is the Standard Health Benefit?

The minimum level of health insurance in Bermuda is called the Standard Health Benefit (“SHB”). By law, all employers and self-employed persons are required to provide this cover for their employees and non-working spouses and to cover at least half of the cost of this insurance. The SHB covers inpatient hospital care, services provided in the emergency and outpatient departments including diagnostic and laboratory tests, the ambulance service, care at Agape House and the Mid-Atlantic Wellness Institute, and specified services in the home and at approved facilities. Most employers provide benefits well in excess of the minimum for both employees and their insured dependents.

3. What are the Standard Health Benefit changes and when do the changes come into effect?

We anticipate the following SHB changes will take effect on July 1, 2018:

  • Increases in fees for MRI and CT scans, and dental and physicians’ services performed in the local hospital
  • New benefits include coverage for medical nutritional therapy under the Home Medical Services benefit, 3D mammography and multiple views of select x-rays.

See www.bhec.bm for more information on the Standard Health Benefit.

4. What is the Standard Premium Rate and will there be any changes?

Each year, the Government sets the Standard Premium Rate (“SPR”), which is the maximum premium that insurance companies may charge for the SHB.

Effective July 1, 2018 (typically May 1), Government has confirmed that the SPR will be increased from $334.00 to $355.31 per adult, per month; and the breakdown of premium associated with the Health Insurance Act benefits (“HI”) and the Mutual Reinsurance Fund (“MRF”) tax will be altered. The HI portion of the SPR will be reduced from $242.43 to $253.34, while the MRF levy collected by insurers for and on behalf of and remitted to Government will increase again this year from $91.57 to $101.97 per month per employee and non-working spouse.

 

Medical Inflation

5. What is medical inflation?

Health care premium increases are attributed largely to the rising cost of health care, which is referred to as medical inflation. Healthcare costs increase for a number of reasons, including:

  • increases in the price of general goods and services that affect all of us, including medical providers, who have to pay more for medical equipment, staff expenses, rent, electricity etc.
  • new and emerging technologies and treatment, such as stem cell transplants and biologic medications
  • the high incidence of chronic illness
6. Why are new medical therapies and drugs increasing the cost of healthcare?

Stem cell transplants and biologics, in particular, have gained traction over the past several years and are now being successfully utilised to treat a variety of diseases and conditions that include leukemia, multiple sclerosis and pulmonary disease. Deploying new advancements to market is a costly exercise, in the short term, for our insureds and overall book of business. We are however committed to supporting innovative technologies and emerging therapies that require upfront investment but ultimately improve the long-term health status of our clients and decrease the continuing surge in healthcare costs.

 

Mutual Reinsurance Fund

7. What is the Mutual Reinsurance Fund?

In the past, the MRF served as a risk equalisation scheme to spread risks across the entire working population; i.e., everyone in Bermuda shared equally in the cost instead of just a few. Cover for high dollar claims, including dialysis, kidney transplants and anti-rejection drugs, that were removed from the MRF in 2014, was returned in June 2017 to help spread the risk and reduce claims costs for private insurers. A portion of funds collected for the MRF is allocated to subsidise the cost of the government administered Health Insurance Plan (“HIP”) and FutureCare programmes; the Bermuda Hospitals Board (“BHB”) operational and administrative costs; and the funding of the Bermuda Health Council.

 

Health Insurance

8. Why has the renewal date changed from May 1 to July 1?

The Bermuda Government deferred the changes in legislated benefits and premiums to July 1 of this year. Argus changed its annual health renewal to July 1 to align with the changes in legislated benefits and premiums.

9. How will the change in renewal date affect my company?

Benefit changes and adjustments in renewal premium and payroll deductions will take place on July 1 this year, versus May 1.
Your policy year remained unchanged and the policy year benefits and maximums reverted to zero on May 1. For the months of May and June, claims will be paid in accordance with the 2017 benefit amounts. Effective July 1, claims will be paid per the 2018 benefit schedule. For example: claims for annual eye and health exams obtained in May and June will be considered under the 2018 policy year but paid at the 2017 benefit amount.

10. What is Argus doing to reduce the escalating costs of healthcare?
  • We are driving for increased efficiencies to keep our internal costs as low as possible
  • We are lobbying for change and sustainability, advocating for the best quality care at the lowest prices
  • We are working to prevent and manage chronic disease via our Thrive. Population Health and Nurse Case Management programmes
11. What are the benefits of using the Argus Health Employer and Member portals?

For seamless management of your company’s health benefits using a secure platform, the Argus Health Employer and Member portals serve as the primary hub for you and your employees to access important portfolio information, 24-hours a day, via any mobile device.

Benefits of Argus Health Employer Portal

  • Access benefit plan detail
  • Eliminate administrative time spent supporting employee requests
  • Create a digital footprint versus a paper trail

Benefits of Argus Health Member Portal

  • Submit claims and view claims history
  • View benefit accumulators
  • Access and submit forms
  • Print health I.D. cards
  • Access Thrive. solutions

 

Wellness Tools

12. What tools are available to help me better manage my healthcare?

As Argus continues to advocate for sustainable solutions to Bermuda’s healthcare challenges, we encourage you to take full advantage of the broad range of Thrive. tools and resources, which are available at no additional cost.

The following is a list of the Thrive. resources available:

  • Thrive. Case Management
    Thrive. In collaboration with Johns Hopkins Medicine International and local healthcare providers, Thrive. Case Management supports members with chronic conditions with comprehensive plans, guidance and encouragement to improve their self-management skills and health status.

  • Get Up & Thrive.
    Get Up & Thrive. is our online activity-based platform available year-round, via any mobile device. Powered by Virgin Pulse, this social wellness programme drives engagement by connecting people to physical and wellness challenges and rewards to maximise well-being.  

  • Thrive. Resources
    In support of our Thrive. total health and wellness strategy, we have appointed dedicated resources to lead and promote initiatives for preventive care.

    • Shakira Warner, MSc, Population Health Specialist – Our Population Health Specialist evaluates, implements and promotes innovative programmes and initiatives associated with the Thrive. Population Health & Wellness strategy.
      Direct line: 441 294-5736, Email: swarner@argus.bm

    • Karima Stevens, MSN, RN, Nurse Case Manager – In collaboration with healthcare professionals, our Nurse Case Manager provides chronically ill members with a comprehensive plan, guidance and encouragement, with the overall aim of creating selfmanagement skills and an optimised health status.
      Direct line: 441 298-0597, Email: kstevens@argus.bm

  • Health Risk Assessment (HRA)
    Our Health Risk Assessment (HRA) online tool, is designed to evaluate the health history and lifestyle habits of our members. The online questionnaire will help determine an employee’s overall health status and their potential risks for certain chronic diseases or illnesses. Although the individual employee results are confidential, employers have access to an anonymised Summary Report that can provide the following:

    • Employee Demographics: number of participants (% of total employees), male vs female (%) and average age
    • HRA Data: Average wellness score, top three health risks, percentage of: current smokers, persons who are overweight and obese (BMI ≥ 25), and those with high blood pressure, impaired glucose tolerance and high cholesterol

  • HealthyLearn Library
    Our resource library, available via our website (www.argus.bm), offers a robust supply of insightful and educational articles, newsletters and references that include healthy eating tips, chronic disease updates and investment planning advice.

 

If you have any further questions, please contact The Argus Customer Service Centre at 298-0888 or insurance@argus.bm


Thrive is intended to complement rather than substitute for proper medical advice or treatment. *Johns Hopkins Medicine International (JHI) provides consultation and advice on the Case Management Nurse Advocate program.