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 & FC Premium and Plan Brochure

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))
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 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*)
Emergency Room Visits	Covered at 100%	Covered at 100%
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

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 (see Specialist Visits in Supplemental Benefits)	Covered at 100% Benefit excludes Urology (see Specialist Visits in Supplemental Benefits)
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 Nutritionist Counselling	Services at a high-level: Registered Nurse Visits Wound care IV Therapy and associated drugs Palliative Care Nutritionist Counselling
Kidney Transplant	$200,000 benefit for kidney transplant	$200,000 benefit for kidney transplant
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)
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 $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
Specialist Physician Visits
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
Wellness Benefit
Prescription Drugs	$1,000 per policy year maximum 100% paid	$3,000 per policy year maximum 100% paid
Prescription Drugs	$1,000 per policy year maximum 100% paid	$3,000 per policy year maximum 100% paid
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




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
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
	Eye examination and prescribed eyewear – not covered.
Group Psychotherapy Sessions	Not Covered	$46 per visit max 24 visits/year
Clinical Psychologist Visit	See Specialist Physician Visits	$78 per visit 12 visits per policy year
Psychiatrist Visit	See Specialist Physician Visits	$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	See Specialist Physician Visit Benefit for Allergist Physician visits	$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
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:
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: $2,000.00 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

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