HIP and FutureCare Benefits

The Health Insurance Plan (HIP) and FutureCare are plans provided by the Health Insurance Department (HID).

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.

Who qualifies for which plans and the exact benefits can be found in the HIP and FutureCare Plan Guide

The Table below, provides an overview of the benefits of the plans and a comparison between HIP and FutureCare:

 

HIP

FutureCare Plans

Local In-Patient (King Edward Memorial Hospital (KEMH) / Mid-Atlantic Wellness Institute (MAWI))

  1. Hospitalizations
  • As per Bermuda Hospitals Board (BHB) (Hospital Fees) Regulations

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%

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
  1. 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

During hospitalization (Maximums per admission)

  • Surgery - $2,167
  • Anesthetist - $1,200
  • Internal Medicine - $1,684
  • Hospital Visit Specialist - $1,029
  • Hospital Visit GP - $812
  • Obstetricians - $3,528
  • Caesarean Delivery - $6,990.12
  • SVD (Vaginal) Care/Delivery - $6,302.83
  • Caesarean delivery fee for on-call delivery - $2788.24
  • SVD fee for on-call delivery - $2,467.29
  • Suction D&C (TOP) - $838.27

During hospitalization (Maximums per admission)

  • 75% reimbursement per admission

Local Out-Patient Services (KEMH and Standard Health Benefit (SHB) Approved Providers*)

  1. Emergency Room Visits

Covered at 100%

Covered at 100%

  1. Diagnostic Imaging
  • At SHB BHeC approved facility and fee schedule

Covered at 100%

  • Diagnostic imaging includes MRI, CT Scan, Ultrasound, X-Rays

Covered at 100%

  • Diagnostic imaging includes MRI, CT Scan, Ultrasound, X-Rays
  1. Supplemental Diagnostic Imaging and Cardiac Diagnostics
  • Health Insurance (FutureCare Plan) (Additional Benefits) Order 2009

Not Covered

Covered at 80% at KEMH and BHeC approved providers.

 

  1. Laboratory Services
  • At SHB BHeC approved facility and at the approved SHB fee schedule
  • Labs performed at KEMH – covered at 100%
  • Supplemental – approved facilities, covered labs and fees
  • Labs performed at KEMH – covered at 100%
  • Supplemental - approved facilities, covered labs and fees
  1. SHB Wellness Benefit
  • Via BHB D.R.E.A.M. Centre and Bermuda Diabetes Association
  • At SHB approved fee schedule

Covered at 100%

  • E.g. Fall Prevention, Diabetes Counselling, Hypertension, Smoking Cessation, Asthma/COPD Education and Nutrition Consulting.

Covered at 100%

  • E.g. Fall Prevention, Diabetes Counselling, Hypertension, Smoking Cessation, Asthma/COPD Education and Nutrition Consulting.
  1. BHB Employed Specialists
  • As per Bermuda Hospitals Board (BHB) (Hospital Fees) Regulations

Covered at 100%

  • Benefit excludes Urology (see Specialist Visits in Supplemental Benefits)

Covered at 100%

  • Benefit excludes Urology (see Specialist Visits in Supplemental Benefits)
  1. Artificial Limbs and Appliances
  • Policyholder must have 12 months continuous active policy to be eligible for this benefit
  • At SHB BHeC approved facility

$100,000 lifetime max

$100,000 lifetime max

  1. Home Medical Services Benefit
  • Physician assessment and referral required
  • SHB BHeC approved providers and fee schedule.

Services at a high-level:

  • Registered Nurse Visits
    • Wound care
    • IV Therapy and associated drugs
  • Palliative Care
  • Nutritionist Counselling

Services at a high-level:

  • Registered Nurse Visits
    • Wound care
    • IV Therapy and associated drugs
  • Palliative Care
  • Nutritionist Counselling
  1. Kidney Transplant

$200,000 benefit for kidney transplant

$200,000 benefit for kidney transplant

  1. Dialysis
  • At SHB BHeC approved facilities
  • Haemodialysis covered up to a monthly maximum of $12,532
  • Peritoneal dialysis covered up to $10,409 per month or if less than a month, $342 per diem
  • Haemodialysis covered up to a monthly maximum of $12,532
  • Peritoneal dialysis covered up to $10,409 per month or if less than a month, $342 per diem
  1. Anti-rejection Drugs

Covered at 100%

Covered at 100%

HID Supplemental Benefits

  1. GP Office Visits

$42 per visit - max 4 visits per year

$46 per visit

  1. Specialist Physician Visits
  • $170 for two initial consults max/year
  • $75 for three follow up visits max/year
    • Includes oncology physician services at Bermuda Cancer and Health
  • $170 for two initial consults max/year
  • $75 for three follow up visits max/year
    • Includes oncology physician services at Bermuda Cancer and Health
  1. Wellness Benefit

6 visits per year covered at $35 / visit

 

E.g. Asthma, nutrition, diabetes, lifestyle counseling, fall prevention and counseling for smoking cessation

6 visits per year covered at $35 / visit

 

E.g. Asthma, nutrition, diabetes, lifestyle counseling, fall prevention and counseling for smoking cessation

  1. Prescription Drugs

Not Applicable

$2,000 per policy year maximum

  • 100% paid
 
  1. Personal Home Care services:
  • Requires Prior Approval for both HIP and FC
  • Policyholder must have continuous active policy for 12 months prior to being eligible for this benefit

$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

$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
  1. Radiation Treatments for Cancer Care

 

  • Local - Covered at 100%
  • Overseas
    • HID preferred network – covered at 60%
    • Non-HID preferred network – covered at 50%
  • Local – Covered at 100%
  • Overseas
    • HID preferred network – covered at 75%
    • Non-HID preferred network – covered at 65%
  1. Vision Benefit
  • Applicable either in Bermuda or Overseas
  • Eye examination and prescribed eyewear – not covered.

 

  • Eye examination - $50 per policy year
  • Prescribed Eyewear - $200 max per policy year
  1. Group Psychotherapy Sessions

Not Covered

$46 per visit

  • max 24 visits/year
  1. Clinical Psychologist Visit

Not Covered

$78 per visit

  • 12 visits per policy year
  1. Psychiatrist Visit

Not Covered

$131 for initial

  • $81 for follow-up visits
  1. Physiotherapy or Occupational Therapy Visit

Not Covered

$35 per visit

  • max 12 visits per policy year
  1. Speech Therapy Session Referral required from GP

Not Covered

$42 per visit

  • max of 12 one-hour sessions per policy year
  1. Chiropodist Visit

Not Covered

$41 per visit

  • max 6 visits per policy year
  1. Allergy Services

Not Covered

$500 lifetime maximum

  • Includes test and treatment
  1. Registered Nurse Home Visits

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

 

  1. Physician Home visits

$82 per visit

$82 per visit

  1. Surgery

Not Covered in a Doctor’s Office except Ophthalmic surgery at Bermuda International Eye Institute and Bermuda Eye Centre

Not Covered in a Doctor’s Office except Ophthalmic surgery at Bermuda International Eye Institute and Bermuda Eye Centre

 

 

 

  1.  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
  • See Overseas Section for additional details
  • 60% coverage at HID preferred facility
  • 50% coverage at a non-HID preferred facility
    • If travelling abroad, only emergency treatment covered
  • 75% coverage at HID preferred facility
  • 65% coverage at a non-HID preferred facility
    • If travelling abroad, only emergency treatment covered

Dental Benefits: Paid in Accordance with the Bermuda Dental Fee Schedule

Basic Dental Services:

 
  1. Preventative and Diagnostic
  • 75% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  1. Exams, Consultations, Polishing, Scaling or Root Planing, Fluoride
  • 75% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  • 100% of Fee Schedule
  • Policy Year: $1,200.00
  • Lifetime: Unlimited
  1. Surgical and Minor Restorative
  • 75% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  1. Endodontics

Not Applicable

Root Canal Services

  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  1. Periodontic

Not Applicable

Treatment of Gum Disease

  • 50% of Fee Schedule
  • Policy Year: $1,500.00
  • Lifetime: Unlimited
  1. Major Restorative

Not Applicable

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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