For Group Members: 2020 Health Benefits Frequently Asked Questions



Every year, Argus reviews its current health policies and makes revisions needed to keep up with Bermuda’s rapidly changing healthcare system to ensure that Argus members have top rate quality coverage. This year’s renewals are effective as of June 1, 2020 and this guide will help to answer your questions regarding this process.


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Group Members
Frequently Asked Questions
2020 Health Benefits

 

1. How is Argus supporting me during the COVID-19 pandemic?

The overall health and wellness of our members is our primary focus at this time. We understand the uncertainty caused by the COVID-19 pandemic and are here to help you through these challenges by offering flexible and meaningful solutions.

Please contact our Customer Service Centre on 298-0888 or email insurance@argus.bm to discuss your options.

To keep up to date on Argus policies, coverage information, and to find answers to frequently asked questions, visit our dedicated COVID-19 webpage at www.argus.bm/coronavirus.

2. Has the Bermuda Government made additional amendments to the Bermuda Health Plan?

As Government priorities have shifted to manage the COVID-19 pandemic, we anticipate minimal advances, if any, to the implementation of the Bermuda Health Plan and the resulting Standard Premium Rate (SPR). However, should Government mandate amendments that affect the SPR, those changes will be applied to your total premium at that time.

3. How will my premium be calculated this year?

This year’s premium calculations remain the same as in previous years. Your total premium will be inclusive of the Standard Premium Rate (SPR) and your Supplementary Premium as follows:

Standard Premium Rate (SPR)
The SPR, which includes the Mutual Reinsurance Fund levy that Argus pays to the Government on your behalf, remains at $355.31 per month per insured adult.

Supplementary Premium
The premiums for supplemental medical, dental and vision care benefits are administered by Argus and adjustments will vary by company and/or account under policy and are based on:

  • General medical inflation
  • Trends in utilisation of services
  • Claims experience for our entire book of business
  • Your benefit plan
  • The premium for your policy will also vary by age bands

4. What are the 2020 benefit enhancements to my health plan?

Every year we review benefits* to ensure that they meet the unique healthcare needs of our members. This year we have introduced minimal, but meaningful, enhancements.

  • Mental Health and Substance Abuse Treatments – We have removed the limits on overseas Mental Health and Substance Abuse Treatment. These treatments will now be considered like any other physical condition requiring treatment overseas at an Argus preferred network provider.

  • Specialty and High Cost Prescription Drugs - We have seen an increase in the use of breakthrough specialty medicines, like biologics. These are significantly more expensive than traditional prescription drugs but can ultimately decrease the debilitating effects of certain diseases and improve the quality of life of members. To provide greater and affordable access to these drugs, they will now be covered at 100% if pre-certified and approved by Argus’ overseas healthcare management partner, One Team Health (OTH); otherwise at 50%.

*Depending on your healthcare plan

5. What is Argus doing to reduce the escalating costs of healthcare?

Our mission is to support our members by offering greater access to affordable, high quality care, with services that help eliminate wasteful practices and create long-term, sustainable savings.

We have introduced cost containment services that include our free telenurse advice line (298-0430), which provides alternative access to medical advice and guidance that reduces out of pocket expenses.

6. Who should I contact if I require medical treatment overseas?

Argus, in partnership with One Team Health (OTH), provides seamless overseas healthcare management while helping to reduce and control costs. The OTH staff of doctors, nurses and case managers work together to provide access to appropriate and high quality care, allowing you to focus on your health, not logistics. Please contact our Customer Service Centre on 298-0888 to speak to an OTH representative.

7. What tools are available to help me better manage their healthcare?

Supporting your physical, emotional and financial wellbeing is our top priority. We encourage you to take full advantage of the broad range of Thrive. tools and resources, which are available at no additional cost.

8. What are the benefits of using the Argus Vantage portal?

With Vantage, using a single username and password, you, your dependents and spouse can obtain a total view of your Argus Health and Pensions (if applicable) accounts. Using your desktop, tablet or smartphone, Vantage provides easy access to the tools and resources needed to help you better manage your plan.

  • Access benefits information 24/7
  • Submit claims online
  • View and print ID cards from home
  • Access digital wellness tools and challenges with Get Up & Thrive.

9. Can I receive my Argus reimbursement payments via electronic funds transfer (EFT)?

Yes. EFT allows you to receive your Argus payments directly into your bank account. To complete the authorization form online click here.

 

10. Does my Argus health policy cover testing for COVID-19 (diagnostic swab test, antibodies blood test)?

The diagnostic swab test for COVID-19 falls under your usual diagnostic services benefit. Therefore, if a diagnostic test is deemed medically necessary and ordered by a medical professional, it will be covered in accordance with your current health plan benefits. Free voluntary diagnostic and antibodies testing (in conjunction) is currently being offered to the public by the Government. More details can be found here. Health plan coverage of voluntary testing and antibodies blood testing will be in accordance with pending Ministry of Health and Bermuda Health Council COVID-19 testing and back-to-work guidelines.

 

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