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;
- 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.
- 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.
Innovation Programme
The Innovation Programme (“Programme”) provides support for innovative solutions to address Bermuda’s high rates of non-communicable chronic diseases and associated disabilities.
The programme is funded by a transfer from the Mutual Reinsurance Fund (“MRF”) to support public health interventions that consider local context, are derived within the local environment and can complement the health system in addressing this major health system issue of chronic disease. We welcome programmes, initiatives, and innovations that address the risks associated with non-communicable chronic diseases. The Health Council will provide Programme oversight, and all reporting of the use of awarded funds and outcomes resulting from the funded initiatives will be made public.
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)
National Drug Formulary
The Bermuda National Drug Formulary 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.
National Drug Formulary (coming soon)