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

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

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 obtained from 'In Argus Network'

Argus does not pre-approve, payable for inpatient facility only

100% Coinsurance

 

10% Coinsurance

Treatment Available in Bermuda

Payable for inpatient facility only, all other services are not eligible

10% Coinsurance

Neonatal Treatment

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

Argus Health pre-approves and treatment obtained within 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

The following services apply only for Psychiartric 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 per 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

 

 

All other facilities and providers

 

 

Without Hotel or Rental Accommodation

Insured Person or Insured Minor and Parent/Guardian jointly: $250 per day

 

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 Individual Health Plan and are subject to limitations and policy maximums. Full terms and conditions are provided in the Master Policy.