Regulated Health Insurance Benefits
The regulated package of health insurance benefits is comprised of two components: Standard Health Benefit (SHB) which includes select hospital and community based services and products, and Mutual Reinsurance Fund (MRF) benefits which includes health programmes and select high-cost services and procedures such as dialysis and kidney transplantation. The separation of SHB and MRF benefits is based on the differences in funding of the two components and does not impact access for individuals with an active health insurance policy. The two groups of benefits are often collectively referred to as SHB. The Standard Premium Rate (SPR) is the price determined annually to cover the cost of SHB and MRF services.
Supplemental Benefits (Unregulated)
Supplemental benefits are those that fall outside of SHB and MRF. These benefits are not mandated and thus each insurer decides what premium to charge for those benefits and what reimbursement rates to pay out for those benefits, and each provider determines the total charges for offering those benefits.
Questions regarding the total cost of care and any associated insurance reimbursement for these services should be directed to the applicable health service provider or insurer.
MRF Programmes
Programmes under the MRF are intended to provide defined support or services for a defined period of time.
Maternity Benefit Programme
The Maternity Benefit Programme provides access to pre-natal through immediate post-partum care for uninsured and underinsured individuals who meet one of the following criteria:
- unable to afford the monthly premium for the Health Insurance Department’s HIP and does not qualify for insurance premium assistance through the Department of Financial Assistance; or
- insured under a policy that does not include maternity care and are unable to enroll in a health insurance plan that does include maternity care
BENEFIT ENROLLMENT
Individuals must be registered with the Clinic to be considered for the Programme. The following should also be noted:
- Clients originally seen in private practice must be referred to and registered with the Clinic to benefit from this Programme.
- Coordination of care is managed by the Clinic in collaboration with the private practice obstetricians; thus Programme participant’s primary provider is the Clinic
- Individuals who deliver without being seen at the Clinic are not eligible for funding under this Programme.
BENEFIT INCLUSIONS
For eligible individuals, coverage under this benefit is only applicable when clinically necessary, pre-natal and/or immediate post-partum services are provided to clients by in-network health businesses/ and professionals, namely:
- Diagnostic imaging or laboratory studies provided at King Edward Memorial Hospital or Lamb Foggo Urgent Care Centre;
- Specialist care provided at King Edward Memorial Hospital or Lamb Foggo Urgent Care Centre;
- Non-clinic based obstetric care provided by an obstetrician registered as such by the Bermuda Medical Council;
- Specialist care provided in the community where the specialist care is not available at the hospital and where pre-approval has been granted by the administrators; and
- Maternity-related prescription medications.
RELEVANT LINKS
Innovation Programme
Our commitment is to encourage advancements that significantly improve the well-being of the community.
AIM: The primary goal is to identify a community health or social issue and to improve health outcomes for individuals living with or at risk of such challenges.
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Aging in place
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Improving Chronic Disease Management
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Early Years (0-5 years / First 1000 days)
Kidney Transplant Coordination Programme
The Health Council in collaboration with local nephrologists and overseas transplant centres provides transplant coordination for residents and education to transplant candidates, recipients, donors and their families.
Did you know that 50% of Bermuda’s residents battle chronic health conditions? Click to learn more.
Employer Compliance
Information about employer compliance with the Health Insurance Act 1970, can be found here (link)
Bermuda Drug Formulary
The Bermuda Drug Formulary (view here) is a comprehensive, evidence-based list of essential medicines designed to address the most common diseases in Bermuda. It promotes accessibility, affordability, and quality in healthcare by guiding the selection and use of medicines to support better health outcomes for the community.
To remain up-to-date on the ongoing consultation around price regulation for the Drug Formulary, visit our engagement page.
Relevant Legislation
Resources & Templates
FAQs
Bermuda’s national formulary is the list of common essential medications along with associated products and devices used in medical treatments, which are intended to be medically appropriate, cost-effective, and sold at a regulated price. [1]
Reference:
The national formulary highlights the medicines and medical products that are most effective for the treatment of the most prevalent medical conditions in Bermuda in order to:
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Promote rational medicines use; and
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Assist decision-makers who are working to ensure that essential medicines are available and affordable.
Essential medicines are those that satisfy the priority healthcare needs of the population. They are selected with due regard to public health relevance, evidence of efficacy and safety, and comparative cost-effectiveness.
Essential medicines are intended to be available within the context of functioning health systems at all times, in adequate amounts, in appropriate dosage forms, with assured quality and adequate information, and at a price, the individual and the community can afford. [2]
Reference:
[2] IIHI_Essential_Medicines_Report_2015-Web1.pdf (farmaindustria.es)
The Pharmacy & Therapeutics committee is responsible for selecting items for inclusion on the formulary that are supported by the health needs of Bermuda’s population, appropriate standards of practice, peer-reviewed medical literature, and other factors.
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Ms. F. Ann Daniels – Bermuda Health Council board member
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Mrs. Elizabeth Harrington – Bermuda Health Council secretariat member
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Dr. Ashley Smith – Nominated by the Pharmacy Council
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Dr. Annabel Fountain – Nominated by a registered statutory health board (BMC)
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Mr. Francis Burnett – International member representing the pharmaceutical market
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Dr. Ayo Oyinloye – Ad hoc appointment
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Dr. Terry Lynn Emery – Ad hoc appointment
No. This formulary in no way limits or changes the ability to prescribe, import, or sell any medications.
Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. [3]
Reference:
[3] Promoting rational use of medicines: core components (who.int)