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
• 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.

For more information on services provided by Argus, visit www.argus.bm.

Major medical benefits are only included with our Essential and Classic Health Plans.

To help you make the most of your coverage, here’s what you need to know:

• Selecting local options: If a treatment is available in Bermuda, your plan does not cover the cost if you choose to have it done overseas instead.
• When overseas care is covered: Your major medical benefit covers emergency care and medically necessary treatment that is not available in Bermuda.
• What counts as an emergency: This includes urgent, non-elective care required due to an accident or sudden illness, where treatment is necessary to prevent serious or permanent harm to your health.
• What to do in an emergency: You must contact Argus within 48 hours of first receiving care. If we are not notified within this timeframe, your coverage will be reduced to 10% of the billed charges.
• For non-emergency treatment: If the care you need isn’t available in Bermuda, it must be pre-certified by Argus and accessed through the Argus Preferred Provider Network to receive maximum reimbursement based on your policy.

For full details, please refer to your Schedule of Benefits or contact us directly — we’re here to help you navigate your options.

Argus will provide coverage for you or for an insured child and one parent or guardian traveling together for medical treatment. Please note that coverage does not extend to other travel companions.

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.

If you received treatment for an injury or illness in the 12 months before your Argus health coverage began, overseas medical treatment for that same condition won’t be covered until you’ve had your Argus policy for at least 12 months.

This waiting period may not apply if you had overseas coverage under a Group Health Plan with Argus and switched to an Individual Plan within 31 days of leaving your group policy.

For those on the Classic Plan, certain dental treatments related to pre-existing conditions — like crowns, posts, inlays, onlays, dentures, bridges, or implants — may not be covered.

Contact our Customer Service team before receiving treatment to understand your coverage and avoid unexpected costs.

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 you or your dependents were previously covered under an Argus group health policy, you can apply for an Individual Health Plan within 31 days after your group coverage ends. If you're 65 or older, we may require evidence of insurability. Please note that submitting an application does not guarantee approval — all applications are subject to our review and acceptance.

If more than 31 days have passed since your group coverage ended, you can still apply, but evidence of insurability will be required.

Please be aware that the coverage under an Individual Health Plan may be more limited than what was available through your group plan. Your premium will be based on current rates and your age and gender at the time of application.

If you’d like to increase your level of coverage, this will also require approval based on evidence of insurability.
 

While both plans offer important protection, Individual Health Plans and Group Health Plans differ in their benefits and maximum coverage.

For example:

• If your Individual Plan includes prescription drugs, the maximum reimbursement is $7,500 per policy year, while group plans may offer unlimited coverage.
• Durable Medical Equipment such as CPAP machines, hearing aids, and orthotics are typically included in group plans but are not covered under Individual Plans.

If you have questions about transitioning your coverage or what’s included in an Individual Health Plan, we’re happy to help.

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

You may apply for coverage for each of your dependents. In most cases, they’ll receive the same health insurance benefits and coverage as you.

If you or any of your dependents are covered by this health plan and another insurance plan, we’ll work with the other insurer to coordinate benefits. This means we’ll make sure the total amount paid between both plans doesn’t exceed 100% of your actual eligible expenses.

Our goal is to help you get the coverage you’re entitled to, without duplication or confusion.

Your coverage starts on the date your application is approved by Argus. If you're applying for the first time, your coverage is subject to approval based on your health information.

We’ll notify you once your application has been reviewed and let you know when your coverage begins.

If you or your dependent enrol in the plan more than 31 days after 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 coverage will end on the date you choose to cancel your policy. To do so, we require 31 days’ written notice. Your policy may also be cancelled if premiums are not paid.

Dependent coverage will end on whichever comes first:

• The day your own coverage ends
• The date your policy is updated to remove dependent coverage
• When the individual no longer meets the definition of an eligible dependent
• When the premium payment period for dependent coverage has ended

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

Your health benefits and premiums are renewed each year on June 1. Premiums may increase annually based on several factors, including the government-set Standard Premium Rate, your age, your gender, medical inflation, how often benefits are used, and the details of your specific plan.

Yes. If you’re applying for individual coverage (not converting from an Argus Group Health Plan), you must be under the age of 70 to be eligible for Major Medical benefits under the Essential and Classic Health Plans.