The two plans offer dental benefits, doctor’s visits, in-patient and out-patient care at the hospital and overseas care.
Enrollment in the different plans is based on the age and benefit needs of the applicant.
The Table below, provides an overview of the benefits of the plans and a comparison between HIP and FutureCare:
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HIP
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FutureCare Plans
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Local In-Patient (King Edward Memorial Hospital (KEMH) / Mid-Atlantic Wellness Institute (MAWI))
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- Hospitalizations
- As per Bermuda Hospitals Board (BHB) (Hospital Fees) Regulations
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All costs associated with overnight stay. E.g. room and board, nursing
- KEMH - Covered at 100%
- MAWI – Covered at 100% up to 40 days in-patient stay
- New born delivery – covered at 100%
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All costs associated with overnight stay. E.g. room and board, nursing
- KEMH - Covered at 100%
- MAWI – Covered at 100% up to 40 days in-patient stay
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- Profession Physicians Fees
- HIP fees based on Bermuda Hospitals Board (Medical and Dental Charges) Order 2018
- Health Insurance (FutureCare Plan) (Additional Benefits) Order 2009 & Health Insurance (Health Insurance Plan) (Additional Benefits) Order1988
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During hospitalization (Maximums per admission)
- Internal Medicine - $1,684
- Hospital Visit Specialist - $1,029
- Hospital Visit GP - $812
- Obstetricians - $3,528
- Caesarean Delivery - $6,990
- SVD (Vaginal) Care/Delivery - $6,303
- Caesarean delivery fee for on-call delivery - $2788
- SVD fee for on-call delivery - $2,467
- Suction D&C (TOP) - $838
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During hospitalization (Maximums per admission)
- 75% reimbursement per admission
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Local Out-Patient Services (KEMH and Standard Health Benefit (SHB) Approved Providers*)
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- Emergency Room Visits
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Covered at 100%
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Covered at 100%
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- Diagnostic Imaging
- At SHB BHeC approved facility and fee schedule
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Covered at 100%
- Diagnostic imaging includes MRI, CT Scan, Ultrasound, X-Rays
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Covered at 100%
- Diagnostic imaging includes MRI, CT Scan, Ultrasound, X-Rays
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- Supplemental Diagnostic Imaging and Cardiac Diagnostics
- Health Insurance (FutureCare Plan) (Additional Benefits) Order 2009
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Not Covered
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Covered at 80% at KEMH and BHeC approved providers.
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- Laboratory Services
- At SHB BHeC approved facility and at the approved SHB fee schedule
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- Labs performed at KEMH – covered at 100%
- Supplemental – approved facilities, covered labs and fees
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- Labs performed at KEMH – covered at 100%
- Supplemental - approved facilities, covered labs and fees
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- SHB Wellness Benefit
- Via BHB D.R.E.A.M. Centre and Bermuda Diabetes Association
- At SHB approved fee schedule
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Covered at 100%
- E.g. Fall Prevention, Diabetes Counselling, Hypertension, Smoking Cessation, Asthma/COPD Education and Nutrition Consulting.
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Covered at 100%
- E.g. Fall Prevention, Diabetes Counselling, Hypertension, Smoking Cessation, Asthma/COPD Education and Nutrition Consulting.
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- BHB Employed Specialists
- As per Bermuda Hospitals Board (BHB) (Hospital Fees) Regulations
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Covered at 100%
- Benefit excludes Urology (see Specialist Visits in Supplemental Benefits)
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Covered at 100%
- Benefit excludes Urology (see Specialist Visits in Supplemental Benefits)
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- Artificial Limbs and Appliances
- Policyholder must have 12 months continuous active policy to be eligible for this benefit
- At SHB BHeC approved facility
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$100,000 lifetime max
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$100,000 lifetime max
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- Home Medical Services Benefit
- Physician assessment and referral required
- SHB BHeC approved providers and fee schedule.
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Services at a high-level:
- Registered Nurse Visits
- Wound care
- IV Therapy and associated drugs
- Palliative Care
- Nutritionist Counselling
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Services at a high-level:
- Registered Nurse Visits
- Wound care
- IV Therapy and associated drugs
- Palliative Care
- Nutritionist Counselling
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- Kidney Transplant
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$200,000 benefit for kidney transplant
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$200,000 benefit for kidney transplant
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- Dialysis
- At SHB BHeC approved facilities (effective 1 June 2019)
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- Haemodialysis, covered to monthly max of $11,284 ($868 per session)
- Peritoneal dialysis covered to a monthly max of $9,368 ($308 per diem)
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- Haemodialysis, covered to monthly max of $11,284 ($868 per session)
- Peritoneal dialysis covered to a monthly max of $9,368 ($308 per diem)
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- Anti-rejection Drugs
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Covered at 100%
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Covered at 100%
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HID Supplemental Benefits
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- GP Office Visits
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$42 per visit - max 4 visits per year
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$46 per visit
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- Specialist Physician Visits
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- $170 for two initial consults max/year
- $75 for three follow up visits max/year
- Includes oncology physician services at Bermuda Cancer and Health
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- $170 for two initial consults max/year
- $75 for three follow up visits max/year
- Includes oncology physician services at Bermuda Cancer and Health
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- Wellness Benefit
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6 visits per year covered at $35 / visit
E.g. Asthma, nutrition, diabetes counseling, fall prevention and counseling for smoking cessation
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6 visits per year covered at $35 / visit
E.g. Asthma, nutrition, diabetes counseling, fall prevention and counseling for smoking cessation
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- Prescription Drugs
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$1,000 per policy year maximum
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$3,000 per policy year maximum
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- Personal Home Care services:
- Requires Prior Approval for both HIP and FC
- New policies or re-enrolments on or after 29 July 2019, PHC Benefit applicants will be required to undergo means testing.
- Fully implemented by August 2020
- Policyholder must have continuous active policy for 12 months prior and meet clinical criteria to being eligible for this benefit
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$60,000 max per year which includes the following services and rates:
- Personal Caregiver - $15 per hour to monthly maximum of $2,610 (prorated)
- Skilled Caregiver - $25 per hour to monthly maximum of $1,525 (prorated)
- Adult Day Care - $200 per week to monthly maximum of $867 (prorated)
- Registered Nurse Visit - $75.00 per visit to a max 12 visits per policy year
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$60,000 max per year which includes the following services and rates:
- Personal Caregiver - $15 per hour to monthly maximum of $2,610 (prorated)
- Skilled Caregiver - $25 per hour to monthly maximum of $1,525 (prorated)
- Adult Day Care - $200 per week to monthly maximum of $867 (prorated)
- Registered Nurse Visit - $75.00 per visit to a max 12 visits per policy year
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- Radiation Treatments for Cancer Care
- Overseas coverage subject to approved provider network
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- Local - Covered at 100%
- Overseas
- Tier I: Approved Hospital – covered at 60%
- Tier II: Approved Out of Network Hospital – covered at 40%
- Tier III: Not Approved Out of Network Hospital – Not Covered
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- Local – Covered at 100%
- Overseas
- Tier I: Approved Hospital – covered at 75%
- Tier II: Approved Out of Network Hospital – covered at 55%
- Tier III: Not Approved Out of Network Hospital – Not Covered
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- Vision Benefit
- Applicable either in Bermuda or Overseas
- Referral not required for overseas Vision benefit
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- Eye examination and prescribed eyewear – not covered.
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- Eye examination - $50 per policy year
- Prescribed Eyewear - $200 max per policy year
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- Group Psychotherapy Sessions
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Not Covered
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$46 per visit
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- Clinical Psychologist Visit
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See Specialist Physician Visits |
$78 per visit
- 12 visits per policy year
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- Psychiatrist Visit
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See Specialist Physician Visits |
$131 for initial
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- Physiotherapy or Occupational Therapy Visit
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Not Covered
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$35 per visit
- max 12 visits per policy year
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- Speech Therapy Session Referral required from GP
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Not Covered
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$42 per visit
- max of 12 one-hour sessions per policy year
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- Chiropodist Visit
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Not Covered
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$41 per visit
- max 6 visits per policy year
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- Allergy Services
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See Specialist Physician Visit Benefit for Allergist Physician visits |
$500 lifetime maximum
- Includes test and treatment
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- Registered Nurse Home Visits
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See Personal Home Care and Home Medical Services benefits above |
12 visits per year - ordered by a physician
See Personal Home Care and Home Medical Services benefits above
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- Physician Home visits
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$82 per visit
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$82 per visit
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- Surgery
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Not Covered in a Doctor’s Office except Ophthalmic surgery at Bermuda International Eye Institute and Bermuda Eye Centre
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Not Covered in a Doctor’s Office except Ophthalmic surgery at Bermuda International Eye Institute and Bermuda Eye Centre
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31. Overseas Treatment
- Referrals will be required with the exception if travelling aboard and a medical emergency arises
- Treatment must be medically necessary and not available in Bermuda.
- Care coordinated through GMMI
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- Tier 1: Approved Hospital – covered at 60%
- Tier 2: Approved Out of Network Hospital – covered at 40%
- Tier 3: Not Approved Out of Network Hospital – Not Covered
See Overseas Coverage Brochure for additional details
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- Tier 1: Approved Hospital – covered at 75%
- Tier 2: Approved Out of Network Hospital – covered at 55%
- Tier 3: Not Approved Out of Network Hospital – Not Covered
See Overseas Coverage Brochure for additional details
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Dental Benefits: Paid in Accordance with the Bermuda Dental Fee Schedule
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Basic Dental Services:
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- Preventative and Diagnostic
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- 75% of Fee Schedule
- Policy Year: Unlimited
- Lifetime: Unlimited
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- 100% of Fee Schedule
- Policy Year: Unlimited
- Lifetime: Unlimited
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- Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride
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- 75% of Fee Schedule
- Policy Year: Unlimited
- Lifetime: Unlimited
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- 100% of Fee Schedule
- Policy Year: $1,200.00
- Lifetime: Unlimited
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- Surgical and Minor Restorative
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- 75% of Fee Schedule
- Policy Year: Unlimited
- Lifetime: Unlimited
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- 100% of Fee Schedule
- Policy Year: Unlimited
- Lifetime: Unlimited
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- Endodontics
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Not Applicable
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Root Canal Services
- 100% of Fee Schedule
- Policy Year: Unlimited
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- Periodontic
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Not Applicable
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Treatment of Gum Disease
- 50% of Fee Schedule
- Policy Year: $2,000.00
- Lifetime: Unlimited
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- Major Restorative
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Not Applicable
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Crowns, Inlays, Onlays, Dentures or Bridgework, Braces, Dental Implants and Related Procedures
- 80% of Fee Schedule
- Policy Year: $3,000.00
- Lifetime: Unlimited
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