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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

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

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

 

 

Profession Physicians Fees

HIP fees based on Bermuda Hospitals Board (Medical and Dental Charges) Order 2015

Health Insurance (FutureCare Plan) (Additional Benefits) Order 2009 & Health Insurance (Health Insurance Plan) (Additional Benefits) Order1988

 

During hospitalization (Maximums per admission)

  • Surgery - $2,114

During hospitalization (Maximums per admission)

  • 75% reimbursement per admission

 

  • Anesthetist - $1,171

 

 

  • Internal Medicine - $1,643

 

 

  • Hospital Visit Specialist - $1,004

 

 

  • Hospital Visit GP - $792
  • Obstetricians - $3,442
  • Caesarean Delivery - $3,442
  • SVD (Vaginal) Care/Delivery - $3,442
  • Caesarean delivery fee for on-call delivery - $3,442
  • SVD fee for on-call delivery - $3,442
  • Suction D&C (TOP) - $3,442

 

 

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

Emergency Room Visits

Covered at 100%

Covered at 100%

 

Diagnostic Imaging

At SHB BHeC approved facility and fee schedule

Covered at 100%

Covered at 100%

 

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

 

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.

 

 

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

 

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.

 

BHB Employed Specialists

As per Bermuda Hospitals Board (BHB) (Hospital Fees) Regulations

Covered at 100%

  • Benefit excludes Urology

Covered at 100%

  • Benefit excludes Urology

 

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

 

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

Services at a high-level:

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

 

Kidney Transplant

$150,000 benefit for kidney transplant

$150,000 benefit for kidney transplant

 

Dialysis

At SHB BHeC approved facilities

Covered at 100%

Covered at 100%

 

Anti-rejection Drugs

Covered at 100%

Covered at 100%

 

HID Supplemental Benefits

GP Office Visits

$42 per visit - max 4 visits per year

$46 per visit

 

Specialist Physician Visits

  • $170 for two initial consults max/year
  • $170 for two initial consults max/year

 

  • $75 for three follow up visits max/year
    • Includes oncology physician services at Bermuda Cancer and Health
  • $75 for three follow up visits max/year
    • Includes oncology physician services at Bermuda Cancer and Health

 

Wellness Benefit

80% coverage per visit/session to a max of $35 per visit, up to 6 visits per year

80% coverage per visit/session to a max of $35 per visit, up to 6 visits per year

 

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

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

 

 

 

 

 

Prescription Drugs

Not Applicable

$2,000 per policy year maximum

 

  • 100% paid for generic drugs

 

  • 80% paid for brand name drugs

 

Personal Home Care services:

$60,000 max per year which includes the following services and rates:

$60,000 max per year which includes the following services and rates:

 

Requires Prior Approval

  • Personal Caregiver - $15 per hour (max 40 hours per week)
  • Personal Caregiver - $15 per hour (max 40 hours per week)

 

Policyholder must have continuous active policy for 12 months prior to being eligible for this benefit

  • Skilled Caregiver - $25 per hour (max 14 hours per week)
  • Skilled Caregiver - $25 per hour (max 14 hours per week)

 

  • Adult Day Care - $50 per day to a max of $200 for 7 days
  • Adult Day Care - $50 per day to a max of $200 for 7 days

 

  • Registered Nurse Visit - $75.00 per visit to a max 12 visits per policy year
  • Registered Nurse Visit - $75.00 per visit to a max 12 visits per policy year

 

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%

 

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

 

Group Psychotherapy Sessions

Not Covered

$46 per visit

  • max 24 visits/year

 

Clinical Psychologist Visit

Not Covered

$78 per visit

  • 12 visits per policy year

 

Psychiatrist Visit

Not Covered

$131 for initial

  • $81 for follow-up visits

 

Physiotherapy or Occupational Therapy Visit

Not Covered

$35 per visit

  • max 12 visits per policy year

 

Speech Therapy Session Referral required from GP

Not Covered

$42 per visit

  • max of 12 one-hour sessions per policy year

 

Chiropodist Visit

Not Covered

$41 per visit

  • max 6 visits per policy year

 

Allergy Services

Not Covered

$500 lifetime maximum

  • Includes test and treatment

 

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

 

Physician Home visits

$82 per visit

$82 per visit

 

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
  • 75% coverage at HID preferred facility

 

  • 50% coverage at a non-HID preferred facility
    • If travelling abroad, only emergency treatment covered
  • 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:

Pre-Estimate required from your Dentist prior to undergoing extensive dental procedures

Preventative and Diagnostic

  • 75% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited

 

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

 

Surgical and Minor Restorative

  • 75% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited
  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited

 

Endodontics

Not Applicable

Root Canal Services

  • 100% of Fee Schedule
  • Policy Year: Unlimited
  • Lifetime: Unlimited

 

Periodontic

Not Applicable

Treatment of Gum Disease

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

 

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

 

 

 

 

 

 

 

Persons 65 and older should apply to HID for the Certificate of Entitlement (COE). Find out more information on the Certificate of Entitlement page.

If you are a healthcare provider and are seeking reimbursement from HID for claims, find out how to register and submit claims on the HID Provider page.

  

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