Frequently Asked Questions

It’s quick and easy to submit a health or dental claim online with Argus Vantage. 

• Log in at www.argus.bm/argus-vantage
• Click on ‘Health Dashboard’
• Click ‘Submit a Health Claim’
• Complete the claim form
• Upload digital copies of your itemised invoice and proof of payment
• Click
• For dental claims, upload a completed and signed Dental Claim Form

It’s best to submit your claim as soon as possible after the date of service. However, to qualify for payment, you must submit your claim within 12 months.

You must keep invoices for claims over $2,000 for one year, as Argus reserves the right to request them at any time for audit or administration purposes.

Our team will typically review and pay eligible claims within approximately 10 business days.

If you disagree with the result of a claim, you can submit a request to argusclaims@argus.bm for review.

An out-of-pocket expense is the portion of a healthcare cost that you are responsible for paying because it is not fully covered by your insurance. For example, if your insurance covers $200 for a specific service but your provider charges $250, your out-of-pocket expense would be $50. Similarly, if your insurance covers 80% for brand name prescriptions and your prescription costs $100, your insurance would cover $80, and your out-of-pocket expense would be $20. 

In Bermuda, healthcare providers set their own fees, which may be higher than the limits covered by your health insurance policy. To reduce your out-of-pocket expenses, consider comparing different providers’ fees before receiving medical services.

For prescriptions, Argus covers 100% of the cost of generic drugs and 80% of the cost of brand-name drugs. To save on medication costs, ask your pharmacist for generic versions of drugs whenever they’re available.

All medical pre-existing conditions are covered. Dental pre-existing condition limitations apply to the provision of a crown, post, inlay, onlay, denture, bridgework, or implant. Please contact our Customer Service Centre for more information before you receive treatment.

The following care, treatment, supplies, or charges are not covered by your health policy:

• cosmetic surgery that is deemed to be medically unnecessary and is performed primarily to improve or change an insured person’s physical appearance, except as specifically provided
• charges pertaining to work-related injuries or illnesses that are required to be covered under the Workers’ Compensation Act 1965
• charges resulting from liability, which is established under the provisions of the Motor Car Insurance (Third Party Risks) Act, 1943, or another similar act or legislation 
• charges incurred when no charge would have been made if no insurance coverage had been in force
• services performed by a person who ordinarily resides in the insured person’s home, or who is a close relative, or by a physician or nurse who is an employee of a hospital and is paid by the hospital
• charges for investigational/experimental procedures, or for procedures which are not medically necessary
• charges as a result of complications of any excluded procedure
• charges for testing or training for educational, vocational, or learning disabilities
• charges resulting from the voluntary taking or being under the influence of any controlled substance, drug, hallucinogen, or narcotic not administered or taken on the advice of a physician
• charges resulting from injuries sustained while committing, or attempting to commit, an indictable criminal offence or felony, or when operating a vehicle while the blood alcohol level exceeds 80 milligrams of alcohol per 100 milliliters of blood, or as otherwise defined by the relevant legislation
• charges resulting from war, declared or undeclared, insurrection, or active participation in a riot or rebellion
• charges for replacement of supplies or appliances which are lost, mislaid, stolen, or broken
• charges for services performed by a provider of services not licensed, certified, authorized, or practising within the scope of their licence or qualifications, or whose qualifications do not satisfy the requirements of the policy to provide such treatment, or who has not been approved by us
• diagnostic tests performed for the use of a third party, including but not limited to:
  • visa requirements
  • employment requirements
  • school entrance
  • sports activities
  • life insurance examinations
• services provided mainly as a rest cure, maintenance, or custodial care
• infertility, artificial insemination, in vitro fertilisation, or the services of a surrogate mother
• treatment of sexual dysfunction
• treatment in connection with the reversal of surgical sterilisation
• the amount exceeding the usual and customary charges
• the part of any eligible expense that exceeds the amount allowable under the Health Insurance Act or the Bermuda Hospitals Board Act (Medical and Dental Charges) legislation or the applicable Bermuda fee schedule
• charges for which benefits are payable by any programme or agency funded by any government, including the Mutual Reinsurance Fund, or for which the insured person is entitled by law to obtain benefits without charge
• charges for missed appointments, advice by telephone other than approved telemedicine services, completion of claim forms, supplying of records, referral letters or reports, or transportation costs incurred by a physician or other provider
• professional services billed by a nurse while the insured person is confined in a hospital or other institution
• amounts in excess of the amount shown in the schedule of benefits
• a temporomandibular joint (TMJ) disorder, except as specifically provided under the dental benefit
• charges for medical care, treatment, and supplies incurred outside of Bermuda, except as specifically provided
• dental care and services; eyeglasses, frames and lenses; surgical treatment for vision correction; prescription drugs; specialty prescription drugs; durable medical equipment; miscellaneous medical and surgical supplies and devices; and accidental dental services and cardiac rehabilitation services provided outside of a hospital, except as specifically provided
•  ionising radiation or radioactive contamination from any nuclear fuel or waste
• charges from a hospital or other facility if the insured person has discharged himself against medical advice or failed to complete the prescribed treatment plan
• treatment, care, or services that would expose Argus to any international or United Nations’ trade or economic sanctions, laws, prohibitions, restrictions, or regulations
• charges that do not comply with the Argus claims editing process or standards of medical practice
• charges incurred following the failure of an insured person to obtain a second opinion when requested by us
• care, services, and supplies provided to alter the body’s genes, genetic makeup, or the expression of the body’s genes, except as specifically provided
• removal or replacement of dental implants
• charges for any injury or sickness arising from improper use of the Argus Wellness Programme
• charges resulting from service-related complications:
  • performed by a provider who is not licensed, registered, or certified, or is not practising within the scope of their licence or qualifications, or has not been approved by us, or
  • if the services have not been pre-certified by us, if applicable.

Notify Argus of any changes immediately. To ensure coverage is kept up to date, complete the Change of Information form and submit it to insurance@argus.bm This is required for:

• coverage changes
• changes relating to your dependents
• name changes

If your coverage ends under this group policy, you have the option to apply for an individual health insurance policy within 31 days of your termination date. If you are 65 or older, evidence of insurability may apply. We reserve the right to decline issuing an individual policy at our discretion. Note that any individual policy we offer may provide more restricted coverage compared to the group policy. The premium for an individual policy will be based on the rates in effect for your gender and age at that time.

Our Travel Concierge service offers seamless coordination of airfare and accommodation for members travelling overseas for medical care. It provides a single point of contact, ensuring a smooth and hassle-free experience when planning medical travel. Airfare booked through the Travel Concierge service is billed directly to Argus/BF&M, so members do not need to pay out of pocket for this expense. Members may also benefit from our preferential rates with certain hotels and other travel partners.

Your coverage may be reduced if you choose not to book airfare through the Travel Concierge service — this is dependent on your plan type.
 

No, booking your hotel through our Travel Concierge is optional. There is no financial penalty for arranging your own accommodation, as hotel costs are covered under your daily allowance.  However, for your convenience, Travel Concierge is available to assist with hotel bookings if needed.

If you request a hotel booking through our Travel Concierge service:

• The hotel will be reserved using your credit card
• You will pay for the stay when you check out, using the daily allowance provided to you by Argus

All health insurance premiums in Bermuda include a Standard Premium Rate (SPR), set by law. The SPR is made up of:

• The Standard Health Benefit (SHB) premium, which is retained by insurers to pay eligible SHB claims
• The Mutual Reinsurance Fund (MRF) fee, which is collected on behalf of Government’s Health Insurance Department

The Standard Health Benefit (SHB) is the base package of mandated health benefits in Bermuda. Every employee, non-working spouse, and child under the age of 18 is entitled to the care under the SHB by law. The benefits eligible as SHB are determined by the government.  
 
For a full list of Standard Health Benefits, approved providers, and reimbursement rate levels, please visit https://healthcouncil.bm/

The Mutual Reinsurance Fund (MRF) is a fee that is legislated annually by the government, and payable by every employee and non-working spouse with active health insurance coverage. The government’s Health Insurance Department administers the funds, which are collected by insurers on the government’s behalf.

Supplemental benefits are added on to the Standard Health Benefit (set by the government) in order to provide comprehensive health coverage. Supplemental benefits cover expenses for local and overseas services, rehabilitative care, nursing care, medical equipment, and supplies that are not defined as Standard Health Benefits. Refer to your Schedule of Benefits for more details on supplemental benefits.

General questions or health claims enquiries
Call 298-0888 to speak with one of our knowledgeable Customer Service representatives.

Before making arrangements for overseas medical treatment
Contact our Worldwide Call Centre for pre-approval: 

     From Bermuda, call 298-0429
     Or email overseascare@argus.bm
     From Canada and the US, call 1-800-720-7315 (toll free) or 1-905-532-2954 (collect)

Our team is available to assist with emergency medical care, emergency medical evacuation, discharge planning, care transition support, and insurance verification. The Argus Travel Concierge will also make your travel and accommodation arrangements as needed.
 

Argus will cover insured members with Home & Office (HO) benefits for phone and online video telemedicine calls with local healthcare providers. These benefits are equivalent to in-person visits and are subject to annual benefit maximums and number of visits. Ongoing coverage will be evaluated in accordance with government regulations and guidance. Please note that our coverage extends to services provided by regulated healthcare professionals and other approved providers, including, but not limited to:

• Physicians
• Dentists
• Nurses
• Registered Dietitians
• Physiotherapists
• Psychologists
• Psychiatrists
• Approved counsellors/therapists with clinical oversight by a licensed psychologist or psychiatrist

If you’re an insured member with Major Medical (MM) benefits, Argus will cover the initial consultation and follow-up telemedicine visits with overseas medical providers based on your current overseas care benefits. To schedule your appointment and receive pre-certification assistance, contact One Team Health (OTH) and a Case Manager will direct you to a provider that meets your needs and will help to minimise your out-of-pocket expenses.

For members who have recently received a challenging diagnosis (e.g., cancers, blood disorders, spinal surgery, etc.), Argus offers a virtual medical second opinion. Contact One Team Health at 1-800-720-7315 or email overseascare@argus.bm to get started.

Your spouse and your children may be considered your dependents in your health insurance policy.

A dependent spouse must be a legally married or legally recognised domestic partner.

A dependent child must be an unmarried, natural child, a stepchild, a child of a dependent spouse, or a legally adopted child who is:

• under the age of 19; or
• under the age of 26 if the child is in full-time attendance in a recognised school, college, or university; or
• age 19 and over, and impaired by reason of mental illness, physical illness or disability or intellectually disabled, incapable of physical or financial self-support, and unable to meet the essential requirements for physical health, safety, or self-care

In general, your dependents will have the same health insurance benefits as you. However, please note:

• At a minimum, your non-working/unemployed spouse will be insured for Health Insurance Act benefits
• Your working spouse may be insured for everything except Health Insurance Act benefits which must be provided by your spouse’s employer/li>
• Your self-employed spouse may be insured for full coverage/li>
• Dependent children may be insured for full benefits, although they may be entitled to Bermuda Government subsidies for the Health Insurance Act benefits/li>

If you enrol in the plan 31 days before becoming eligible, your coverage will begin as follows:

• For you, coverage begins on the date that you commence active work or, if you are not actively at work on that date, on the date you return to work
• For your non-working or unemployed spouse, coverage begins on the same date your coverage begins
• For any other dependent, their coverage begins on the date your coverage begins or the date you first enrol an eligible dependent, whichever is later
• For any subsequent eligible dependent, coverage begins on the date of eligibility, provided the dependent is not in hospital and is actively pursuing normal activities
• For a newborn child, coverage begins at birth, provided enrolment is made within 31 days of their birth

If you or your dependent enrol in the plan more than 31 days of first becoming eligible:

• We may require proof of good health, and coverage will become effective on the date we approve such evidence
• If dental coverage is provided, you and your dependent will be limited to a $1,000 maximum in the first 12 months of coverage

Your Health Insurance Act benefits end on the day your employment ends. If we are notified, and subject to premium payment, the Health Insurance Act benefits will be extended for up to four weeks following the date that your employment terminates, provided you do not become employed or eligible for insurance as a non-working spouse. All other benefits end on the date your employment terminates.

Your dependent’s coverage will end on the earliest of the following:

• the date your coverage ends
• the date the policy is amended to terminate dependent insurance
• the date the dependent is no longer an eligible dependent

In the schedule of benefits, “policy year” refers to June 1 through May 31.

We will continue coverage for eligible expenses incurred as a result of the total disability, without premium payment, for up to three months. This extension will only apply if the group policy remains active.