For Providers: 2021 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. This year’s renewals are effective as of June 1, 2021 and this guide will help to answer your questions regarding this process.


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Provider
Frequently Asked Questions
2021 Health Benefits

 

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

During this unprecedented time, Argus is here to help providers adapt to these new challenges by offering flexible and meaningful solutions. To learn more click here.

2. What are the 2021 benefit enhancements to Argus health plans?

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.

  • Oral Appliances – We have added coverage for oral appliances (used in the treatment of sleep apnea) at 80%, to a max of $3,000, every five policy years. The services must be pre-certified.
  • Neuropsychological Testing – A neuropsychological assessment is a formal comprehensive evaluation of cognitive abilities (e.g. memory, problem-solving, visual-spatial skills, attention, processing speed) that is done to understand brain-behaviour relationships (i.e. how the brain works) and is 100% covered for a maximum of one test, every 2 policy years.
  • COVID-19 Testing - Unlimited; details found here.
  • COVID-19 Vaccination - Unlimited; details found here

    * Depending on each member’s healthcare plan

3. Who should I contact if an Argus member requires medical assistance overseas?

Argus, in partnership with our overseas care management company, One Team Health (OTH), provides seamless overseas healthcare management while helping to reduce and control costs. To ensure that our members receive the maximum reimbursement under their insurance plans, please contact OTH for pre-approval. For the most up to date facility listings please click here. OTH administrators are also available to assist you in locating specialists within our network for overseas care. To contact an OTH representative email overseascare@argus.bm or call 1-905-532-2954

4. How do I submit claims? 

Claims can be submitted electronically via the Provider Portal, either via our Online Claims submission feature or scanned into PDF format and uploaded. This ensures the fastest turnaround time and best traceability for claims adjudication and payment.

To assist us in paying claims quickly and accurately, please ensure that claim forms are (i) completed in full, (ii) contain current policy and certificate numbers, and (iii) include the total billed amount.

5. What tools are available to help Argus members better manage their healthcare?

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

6. What are the benefits of using the Argus Provider Portal?

The Provider Portal offers easy access to tools and functionality that help you support our members and administer your Argus account:

  • Access benefits information 24/7
  • Submit claims online and receive payment within five to seven working days. Hardcopy claims submissions may experience longer processing times
  • View member accumulators/balances per benefit
  • View and print Explanation of Payments (EOP)

7. Can I receive my Argus payments via electronic funds transfer (‘EFT’)?

Yes. EFT allows you to receive your Argus payments directly into your bank account. To set up, please complete this form and email to insurance@argus.bm.

Once set up, funds will be transferred into your account typically on Tuesday or Wednesday and a PDF version of the associated Explanation of Payment (EOP) will be emailed to the specified email address.

 

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

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