Guardian

Our premium policy offering, the Guardian Group Health Insurance Plan offers Argus members a high level of local and overseas healthcare coverage with access to top doctors and hospitals through our provider network.


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

 

Asthmatic, Audiologic, Allergy & Chronic Obstructive Pulmonary Disease (COPD) Counselling:
  • Initial Consultation: $160, 1 per policy year for each type of service
  • Subsequent Visits: $65
$1,100 combined maximum per policy year

 
Medical Nutritional Therapy (Provider must be a registered Dietitian):
  • Initial Consultation: $160, 1 per policy year for each type of service
  • Subsequent Visits: $65
  • Subsequent Group Session: $35
$1,395 combined maximum per policy year

 
Weight Loss Management Programme (Programme must be pre-approved by Argus):
$127, 26 visits per policy year

 
Diabetes Prevention Programme (Programme must be pre-approved by Argus):
  • Group Session: $30, maximum 12 sessions per policy year
 

Diabetes Reversal Programme:
  • Initial programme: $4,650, 1 per lifetime (Programme must be pre-approved by Argus)
  • Maintenance programme following completion of initial programme:
    • Office visits with physician: $115, 2 visits per policy year
    • Group sessions: $35 per session, 2 sessions per policy year
 

Annual Foot Exam:
$150, maximum 1 exam per policy year
For persons with type I or II diabetes or diabetic neuropathy


 
Allergy testing:
Our Fee Schedule, $600 per lifetime

 
Allergy Injections:
$20 per injection and serum combined

 
Annual Health Exam:
Maximum 1 exam per policy year
  • General Practitioner: $295
  • Pediatric (2-18 years): $195
 

Annual Specialist / Gynaecologist Exam (all ages):
$325, 1 exam per policy year

 
Routine Diagnostic Testing in conjunction with Annual Exams:
Bermuda Fee Schedule

 
Well-Baby Routine Health exam (under 2 years):
$107

 
Annual Eye Exam:
$115, maximum 1 exam per policy year
Routine Diagnostic Testing in conjunction with Annual Eye Exam (Provider must be approved by the Bermuda Health Council):
 
$200 per policy year

 
Immunisations and Injections:
$30 per injection

 
Diagnostic Services in Private Testing Facilities:
Includes Genetic Testing (Must be pre-approved by Argus): covered by approved fee schedule.
 

General Practitioner
  • Office Visit: $115
  • Home Visit: $170
 

Specialist
  • Consultation: $295, max 5 per policy year
  • Office Visit: $115
 

In Office Medical / Surgical Treatment
Bermuda Fee Schedule

 
Physical Medicine and Supplementary Therapies:
Manipulations, Speech Therapy, Chiropractic, Osteopathy:
  • Individual Visit: $70
Physical & Occupational Therapy/TENS:
  • Individual Visit: $70
  • Group Session: $35
$3,360 combined maximum, all services, per policy year

 
Chiropody / Podiatry:
$70, maximum 12 visits per policy year

 
Behavioural Therapies for Autism Spectrum & Attention Deficit Disorders (Must be pre-approved by Argus):
Individual and family applied behavioural therapies 100% of billed charges, $2,500 maximum per policy year

 
Complementary Alternative Therapies:
  • Massage (Provider must be approved by the Bermuda Massage Therapy Association): $70
  • Acupuncture: $70
  • Naturopathic Doctors (Must be approved by Argus): $70
$600 combined maximum per policy year

 
Psychiatrist: $180
Clinical Psychologist/Group Therapy Session: $130
Counselling:
  • Individual Visit: $100
  • Group Session: $45
Smoking Cessation Counselling:
  • Individual Visit: $100
  • Group Session: $45
$5,500 combined maximum, all services, per policy year

 
Sclerotherapy:
Bermuda Fee Schedule
$1,000 per policy year


 
Lymphedema Treatment:
$110, 28 visits 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.


 
Maximum benefit for Employees and eligible Retirees:
Unlimited

 
Dependent Children over age 19 and under age 26 who are not fulltime students:
Unlimited per one 12-month period

 
Emergency Treatment:
Insured calls Argus Health within 48 hours of incident: 100% Coinsurance
Insured does not contact Argus Health within 48 hours of incident: 80% Coinsurance


 
Treatment not Available in Bermuda:
Argus Pre-Approves: 100% Coinsurance
Argus does not Pre-Approve: 80% Coinsurance

 
Treatment 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: 80% Coinsurance

 
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 are payable at 80%

 
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 are 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 are payable at 80%
 
   

The following services are eligible for airfare and accommodation and must be pre-approved by Argus in order to receive maximum reimbursement:

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):
$4,000 per policy year

 
Hotel or Rental Accommodation:
  • In the ‘Preferred Provider’ Network:
    • Insured Person or Insured Person and Approved Travelling Companion:* $250 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
  • All other facilities and providers:
    • Insured Person or Insured Person and Approved Travelling Companion:* $180 per day
    • Without Hotel or Rental Accommodation: 50% of above amount
Combined Maximum with commercial Economy Airfare: $30,000 per policy year

Commercial Economy Airfare (excludes preferred/priority seating and baggage fees):
Combined Maximum with Hotel or Rental Accommodation: $30,000 per policy year

 
*Benefits for a travelling companion are approved in the following circumstances: When the Insured Person is a minor Dependent Child, or has surgery or mental incapacity or otherwise requires a travelling companion due to medical necessity, subject to medical documentation and pre-approval by Argus.
 
   

The following services must be pre-approved by Argus in order to be eligible:

Ground Ambulance and Air Ambulance:
Unlimited

 
Air Ambulance Return to Bermuda:
Based on Medical Necessity

 
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

 
Repatriation of remains:
$10,000 for return of remains
 
   

The following services are payable at 100% of the lesser of Usual and Customary charges or Discounted Rates:***

Voluntary Annual Health Exam and related Diagnostic Testing:
$3,000 per policy year

 
Physical Medicine and Supplementary Therapies:
(Nutritional/Diabetic, Asthmatic, Audiologic and Allergy Counselling Services, Well-baby Care, Immunisations and Injections, Allergy Testing, Annual Eye Exam, Physical and Occupational Therapy, Chiropractic, Osteopathy, Chiropody, Podiatry, Speech Therapy)
$3,360 combined maximum per policy year


 
Complementary Alternative Therapies:
(Massage and Acupuncture)
$350 combined maximum per policy year


 
***Airfare and accommodation do not apply to these services, consultations and 2nd opinions.

Supplementary Miscellaneous Benefits are applicable Worldwide.**

Hearing Aids, Surgical Support Hose, Surgical Brassieres, Wigs, Orthotics:
80% $4,000 combined maximum every 5 policy years

 
Prosthetic Devices and Appliances:
80% $25,000 maximum per lifetime

Durable Medical Equipment, Accidental Dental Services and Cardiac Rehabilitation/Exercise Programme, Medical/Surgical Supplies:
80% of usual and customary charges

**Airfare and accommodation do not apply to Worldwide Treatment and Services

Vision Care Benefits are applicable Worldwide.**

Prescription Eye Glasses or Contact Lenses:
$400 per policy year payable at 100%

 
Elective Surgical Treatment for Vision Correction:
$2,000 per lifetime payable at 100%

**Airfare and accommodation do not apply to Worldwide Treatment and Services


 

Dental Benefits are applicable Worldwide.**
Benefits are payable in accordance with the Bermuda Dental Fee Schedule. Please obtain a pre-estimate of benefits from your dentist prior to undergoing extensive dental procedures.


Basic Dental Services (DE01):

Preventive and Diagnostic:
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride:
100% of Fee Schedule
Policy Year: $1,400
Lifetime: Unlimited


 
Surgical and Minor Restorative:
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Endodontics: 
100% of Fee Schedule
Policy Year: Unlimited
Lifetime: Unlimited


 
Periodontics:
50% of Fee Schedule
Policy Year: $2,000
Lifetime: Unlimited
 
   

Major Restorative Services (DE02):
50% or 80% of Fee Schedule
Policy Year: $4,000
Lifetime: Unlimited
 
   

Orthodontic Services (DE03):
Only Insured Persons up to age 19 are covered
50% of Fee Schedule
Policy Year: N/A
Lifetime: $4,000

**Airfare and accommodation do not apply to Worldwide Treatment and Services


 

Prescription Benefits are applicable Worldwide.**

Prescription Drugs, Birth Control, Medicines and Sera available only by prescription:
80% for brand name drugs
100% for generic drugs

**Airfare and accommodation do not apply to Worldwide Treatment and Services
 
Benefits explained on this website provide a brief summary of our standard Group Health Plan and are subject to limitations and policy maximums. Full terms and conditions are provided in the Master Policy.