Local Benefits   Argus Pays

Room & Board, Psychiatric Ward, Hospice, Hospital Outpatient and Emergency Department, Physicians’ Services, Approved Diagnostic Imaging Facilities, Ground Ambulance, Home Medical Services

 

As specified under The Health Insurance Act

Artificial Limbs

 

$100,000 lifetime maximum

Palliative Care in a Home Setting

 

Covered

Oral Chemotherapies

 

Covered

Supplementary In-Hospital Benefits Argus Pays

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

Preventive and Diagnostic Benefits Argus Pays

Medical Nutritional Therapy (Provider must be a registered Dietitian)

Initial Consultation

Subsequent Individual Visit

Subsequent Group Session

Combined Maximum

$140, 1 per policy year

$60

$30

$680 per policy year

Diabetes Self-Management Education (Programme must be pre-approved by Argus)

Individual Visit

Group Session

Combined Maximum

$60

$30

6 visits/sessions per policy year

Allergy testing

 

Our Fee Schedule, $600 per lifetime

Allergy Injections

 

$20 per injection and serum combined

Voluntary Annual Health Exam Maximum

 

General Practitioner

Pediatric (2-18 years)

1 examination per policy year

$190

$180

Annual Specialist/Gynaecologist Exam (all ages)

 

$190, maximum 1 examination per policy year

Routine Diagnostic Testing in conjunction with Annual Exams

 

Bermuda Fee Schedule

Well-Baby Routine Health Examination (under 2 years)

  $107

Maximum 6 examinations per policy year

Annual Eye Exam

 

$107 - maximum 1 examination per policy year

Routine Diagnostic Testing in conjunction with Annual Eye Exam (Provider must be approved by the Bermuda Health Council)

 

$100 per policy year

Immunisations and Injections

 

$30 per injection

Diagnostic Services in Private Testing Facilities

 

Bermuda Fee Schedule

Home and Office Medical Benefits   Argus Pays

Office Visit

General Practitioner

Specialist

Combined Maximum

$107

$107

9 visits per policy year

General Practitioner

Home Visit

$165 (max 3 per policy year)

Specialist

Consultation

$280 (max 2 per policy year)

In Office Medical/Surgical

  Bermuda Fee Schedule

Physical & Occupational Therapy

 

Combined Maximum

Individual Office Visit

Group Session

All Services

$60

$30

$720 per policy year

Chiropractic

 

$60

Maximum 6 visits per policy year

Chiropody/Podiatry

 

$60

Maximum 6 visits per policy year

Psychiatrist

Clinical Psychologist/Group Therapy

 

$180, maximum 6 visits per policy year

$130, maximum 6 sessions per policy year

Substance Abuse Counselling:

  • Individual Visit
  • Group Session

Combined Maximum Substance Abuse Counselling

Smoking Cessation Programme - QuitSmart Programme

 

 

$75
$15

6 visits/sessions per policy year


$130 per policy year

Sclerotherapy

 

Bermuda Fee Schedule

$1,000 per policy year

Lymphedema Treatment

 

 

$110

28 visits per policy year

Chronic Kidney Disease Management
(Programme must be pre-approved by Argus)

 

 

$3,900 per policy year

Vision Benefits   Argus Pays

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%

 

Dental Benefits   Argus Pays
Basic Dental Services (DE01)    
Preventive and Diagnostic

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride

 

Policy Year

Lifetime

100% of Fee Schedule

$1,400

Unlimited

Surgical and Minor Restorative

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Endodontics

 

Policy Year

Lifetime

100% of Fee Schedule

Unlimited

Unlimited

Periodontics

 

Policy Year

Lifetime

50% of Fee Schedule

$2,000

Unlimited

Major Restorative Services (DE02)

 

Policy Year

Lifetime

50% or 80% of Fee Schedule

$4,000

Unlimited

Orthodontic Services (DE03)

Only Insured Persons up to age 19 are covered

 

Policy Year

Lifetime

50% of Fee Schedule

N/A

$3,000

Prescription Benefits   Argus Pays

Prescription Drugs, Birth Control, Medicines and Sera available only by prescription

 

80% for brand name drugs
100% for generic drugs

$5,000 maximum per policy year

Overseas Coverage Benefits   Argus Pays

Major Medical Benefits – MM

Eligible Expenses are payable at a percentage of the lesser of Usual and Customary Charges or Discounted Rates.

All Insured Persons

Policy Year

Lifetime 

$500,000

$1,500,000

Dependent Children over age 19 and under age 26 who are not fulltime students

Policy Year

Lifetime 

$500,000

$500,000

Emergency Treatment

Insured calls Argus Health within 48 hours of incident

Insured does not contact Argus Health within 48 hours of incident, payable for inpatient facility only

100% Coinsurance


10% Coinsurance

Treatment Not Available in Bermuda

Argus Pre-Approves and treatment is obtained in Preferred Provider Network

Argus does not Pre-Approve,  payable for inpatient facility only

100% Coinsurance


10% Coinsurance

Treatment Available in Bermuda

In Patient Facility only, All Other Services are not Eligible

10% Coinsurance

Neonatal Treatment

Charges related to neonatal, congenital birth defects and high-risk pregnancy

Argus Pre-Approves and treatment obtained within the Canadian Argus Network

100% Coinsurance

 

The following services must be pre-approved by Argus Health 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 Healthcare

 

Unlimited 

Transplant Services

 

  Unlimited 

Airfare and accommodation are only eligible for Psychiatric and Substance Abuse services, Emergency Treatment and Treatment which is not available in Bermuda and must be pre-approved by Argus Health in order to be eligible

Commercial Economy Airfare - per Insured Person or Insured Minor and Parent/Guardian jointly (excludes preferred/priority seating and baggage fees)

 

$14,500 combined maximum per policy year

Hotel or Rental Accommodation

In the ‘Preferred Provider’ Network

 

Without Hotel or Rental Accommodation

Insured Person or Insured Minor and Parent/Guardian jointly: $180 per day

 

50% of Above

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

Ground Ambulance and Air Ambulance   Unlimited

Psychiatric Hospital or Substance Abuse Treatment Facility

 

Maximum

$850 X 45 days

$38,250 per policy year

 Psychiatric Professional Services   $1,200 per policy year
Cardiac Rehabilitation/Exercise Programme   $2,000 per policy year
Repatriation of remains   $10,000 for return of remains
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.