HIP and FutureCare Benefits

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
• 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

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 (effective 1 June 2019)

• Haemodialysis, covered to monthly max of $11,284 ($868 per session)
• Peritoneal dialysis covered to a monthly max of $9,368 ($308 per diem)

• Haemodialysis, covered to monthly max of $11,284 ($868 per session)
• Peritoneal dialysis covered to a monthly max of $9,368 ($308 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 counseling, fall prevention and counseling for smoking cessation

6 visits per year covered at $35 / visit

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

1. Prescription Drugs

$1,000 per policy year maximum

• 100% paid

$3,000 per policy year maximum

• 100% paid

1. 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

$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

• Overseas coverage subject to approved provider network

• 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

• 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

1. Vision Benefit

• Applicable either in Bermuda or Overseas
  • Referral not required for overseas Vision benefit

• 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

$78 per visit

• 12 visits per policy year

1. Psychiatrist Visit

$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

$500 lifetime maximum

• Includes test and treatment

1. Registered Nurse Home Visits

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

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

• 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

• 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

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: $2,000.00
• 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