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2024 Frequently Asked Questions
1. What are the 2024 benefit enhancements to Argus health plans?
Every year we review benefits[1] to ensure that they meet the unique healthcare needs of our members. This year’s new benefits are as follows:
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No Co-Pay at Argus Medical Practices:
Argus Members enjoy no co-pay at Island Health Services and Family Practice Group for GP and specialist services. This includes annual physicals. We are committed to removing financial barriers to promote preventive and chronic care and will ensure annual exams are scheduled in a timely manner.
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Increased Benefits:
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Immunisations and Injections: increased to $50 from $30, $1000 maximum for children under the age of 19
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GP Office Visits: increased to $130 from $125 (or 100% at Argus Medical Practices)
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Specialist Office Visits: increased to $150 from $125 (or 100% at Argus Medical Practices)
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Well Baby Exam: increased to $150 from $107
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Other Benefit Changes:
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Major Medical lifetime maximum is $5,000,000 (from unlimited)
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Overseas Psychiatric & Substance Abuse Treatment: maximum 90 days per policy year
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Hearing aids: 1 every 5 policy years
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Orthotics: 1 every 2 policy years
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CPAP: 1 every 5 policy years, up to a maximum of $5,000
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Pre-certification NPT Guidelines for Providers
- The primary care physician or pediatrician refers their Argus member to the testing provider/psychologist. The referral must include the provisional diagnosis and symptoms.
- The psychologist’s visit/interview must be complete at the time of the pre-certification request. If NPT is indicated after the psychologist’s visit, complete the NPT Request Form and submit it to insurance@argus.bm, attention ‘Provider Relations’.
- The psychologists as the testing provider must submit the NPT Request along with the primary physician’s referral and any supporting documentation.
Upon review, Argus will reply in 3 to 5 business days. The response will be given in writing to the Psychologist to conduct testing.
[1]Depending on your patient’s healthcare plan
2. Who should I contact if an Argus member requires medical assistance overseas?
Our overseas care management company, One Team Health (OTH), provides seamless overseas healthcare management while helping to reduce and control costs. To ensure that our members receive the maximum reimbursement under their insurance plans, please contact OTH for pre-approval. Please refer to the Argus website for the most up to date facility listings. OTH administrators are also available to assist you in locating specialists within our network for overseas care. To contact an OTH representative email overseascare@argus.bm or call 1-905-532-2954.
3. What is Thrive. Case Management and how can it help me and my patients?
Thrive Case Management is a free, voluntary service available to all Argus-insured patients. The service is for those with complex health conditions and need extra help understanding their condition and benefits. We also connect patients to local care providers, community services, and other resources, as needed.
A Thrive Case Manager, a registered nurse, will privately and confidentially work with your patient and their support persons to help them take a more active role in managing their health. We believe this enhances the managing physician’s clinical engagement with the patient.
Patients who benefit most from one-on-one assistance include those who:
- Are being discharged from an inpatient stay or have received care overseas
- Have at least one of the care needs below:
- Have one or more chronic health conditions including, but not limited to, heart disease, diabetes, hypertension, inflammatory bowel disease, degenerative musculoskeletal disorders, renal disease, etc.
- Have undergone an organ/tissue transplant
- Have complex medication regimes (high cost or specialty drugs)
- Have durable medical equipment needs
- Have a high-risk pregnancy
If you have patients who would benefit from our Thrive Case Management Programme, please contact us at 298-0888 or email us at thrive.nurse@argus.bm. To begin the referral process, complete this form and email it to thrive.nurse@argus.bm.
4. How do I submit claims?
Claims can be submitted electronically and securely via the Provider Portal, either via our Online Claims submission feature or scanned into PDF format and uploaded. This ensures the fastest turnaround time and best traceability for claims adjudication and payment.
To assist us in paying claims quickly and accurately, please ensure that claim forms are (i) completed in full, (ii) contain current policy and certificate numbers, and (iii) include the total billed amount.
Claims can also be submitted through Electronic Data Interchange (EDI) if your Practice Management software has the capability. Integration steps are required to enable this option. Please contact our Provider Relations Manager, Karima Smith, RN at ktsmith@argus.bm for next steps and to discuss timelines if this option is of interest.
5. What are the benefits of using the Argus Provider Portal?
The Provider Portal offers easy, secure, access to tools and functionality that help you support our members and administer your Argus account:
- Access benefit information 24/7
- Submit claims online and receive payment within five to seven working days. May experience longer processing times with hardcopy claims submissions
- View member accumulators/balances per benefit
- View and print Explanation of Payments (EOP)
6. Can I receive my Argus payments via electronic funds transfer (‘EFT’)?
Yes. All reimbursements are paid via EFT. Click here for EFT sign up. Once set up, funds will be transferred into your account typically on a Tuesday or Wednesday and a PDF version of the associated Explanation of Payment (EOP) will be emailed to the specified email address.
Note: Health claim reimbursements will no longer be paid via hardcopy cheques. If you have questions, please contact the Argus Customer Service Centre at 298-0888 or insurance@argus.bm.