Frequently Asked Questions
2022 Health Benefits
What are the 2022 benefit enhancements to Argus health plans?
Every year we review our benefits* to ensure that they meet the unique healthcare needs of our members. This year, we have introduced meaningful changes to our benefits plans that include:
- Diabetes Rewind Programme – We have partnered with Island Health Services, the Family Practice Group, the Bermuda Diabetes Association, Cavan Health and Oviva to offer two very different approaches to rewind diabetes that include an online and offline track. All Argus insured members are covered in full for the in-person and online programmes, apart from Safeguard Plus and Essential Plan members. Click here to learn more about the programme.
- Prescription Drugs for Sexual Dysfunction – Coverage provided in respect of sexual dysfunction drugs, post radical prostatectomy, for insured members with prescription drug benefits.
- COVID-19 Coverage Changes
- In-office COVID-19 PCR Sample Collection – Effective June 1, 2022, charges relating to private medical practice COVID-19 PCR test sample collection, handling, personal protective equipment (PPE), and patient assessment charges will be covered at 50% of the Bermuda Health Council’s (BHeC) scheduled amount in accordance with Home & Office (HO) benefits. Reimbursement for PPE may only be considered in association with the collection of COVID-19 test samples and if the provider submits supporting documentation that their business purchased the PPE and the associated costs of PPEused for the sample-collection encounter. Argus Health will cover lab fees for local diagnostic PCR tests processed at approved private labs at 100% of the BHeC fee schedule in accordance with the usual diagnostic services (PD) benefit.
- Testing for medical travelers - If your patient is traveling for non-elective medical reasons (i.e. treatment not available in Bermuda) PCR and observed antigen testing are covered locally and overseas in accordance with their with Preventive & Diagnostic (PD) and Major Medical (MM) benefits.
- FDA-approved COVID-19 Vaccine Administration - Argus Health will cover the administering of FDA-approved COVID-19 vaccines at 100% of the BHeC Fee schedule for insured members.
*Depending on each member’s healthcare plan
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. Please refer to the Argus website for the most up to date facility listings. OTH administrators are also available to assist you in locating specialists within our network for overseas care. To contact an OTH representative email email@example.com or call 1-905-532-2954.
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.
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.
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 benefit information 24/7
- Submit claims online and receive payment within five to seven working days. May experience longer processing times with hardcopy claims submissions
- View member accumulators/balances per benefit
- View and print Explanation of Payments (EOP)
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. Effective April 30, 2022, hard-copy health claim reimbursement cheques will no longer be printed. All reimbursements will be paid via EFT. Click here for EFT sign up.
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.
If you have any further questions, please contact the Argus Customer Service Centre at 298-0888 or firstname.lastname@example.org