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Frequently Asked Questions
2024 Health Renewal
1. Why is the cost of healthcare increasing?
Healthcare costs are rising worldwide, and our island is facing unique challenges, that include an aging population, chronic diseases, high-cost prescription drugs, and increased demand for services. Watch our short video for a more comprehensive view of the healthcare landscape and how we are actively addressing these issues.
2. How will my premium be calculated this year?
This year’s premium calculations remain the same as in previous years. Your total premium will be inclusive of the Standard Premium Rate (SPR) and your Supplementary Premium.
Standard Premium Rate (SPR)
The SPR, which includes the Mutual Reinsurance Fund Premium (set and charged by Government and paid directly to Government on your behalf), remains at $400.31 per month per insured adult. This is unchanged from last year.
Supplementary Premium
The premiums for supplemental medical, dental, and vision care benefits are administered by Argus. Premium adjustments to your policy may vary by company and/or account, and are based on factors such as:
- General medical inflation – the overall increase in healthcare costs due to factors like medical technology advancements, higher service demand, and increasing labour and supply costs. Worldwide healthcare costs have seen a reported increase of approximately 10%, as noted in the AON Medical Trends Rate Report
- Utilisation trends – the patterns or changes in how often healthcare services are being used by the insured population. This year, utilisation was at an all-time high.
- The overall claims experience – the collective claims history across all Argus policies, including frequency, amounts, and the demographics of your employees and their dependents. These demographics encompass age, gender, lifestyle, and employee turnover rates.
- Plan-specific claims history – the detailed claims history of your company’s plan over the past three years, including the number, type, and cost of claims.
- Benefit plan details – specific coverage details, including the types of benefits, coverage limits, and the scope of coverage, which can influence premium adjustments according to the assessed risk level, claim potential, and coverage breadth.
3. What are the 2024 benefit enhancements to my health plan?
Every year we review benefits[1] to ensure that they meet the unique healthcare needs of our members. This year’s new benefits are as follows:
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No Co-Pay at Argus Medical Practices:
Argus Members enjoy no co-pay at Island Health Services and Family Practice Group for GP and specialist services. This includes annual physicals. We are committed to removing financial barriers to promote preventive and chronic care and will ensure annual exams are scheduled in a timely manner. -
Increased Benefits:
- Immunisations and Injections: increased to $50 from $30, $1000 maximum for children under the age of 19
- GP Office Visits: increased to $130 from $125 (or 100% at Argus Medical Practices)
- Specialist Office Visits: increased to $150 from $125 (or 100% at Argus Medical Practices)
- Well Baby Exam: increased to $150 from $107
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Other Benefit Changes:
- Major Medical lifetime maximum is $5,000,000 (from unlimited)
- Overseas Psychiatric & Substance Abuse Treatment: maximum 90 days per policy year
- Hearing aids: 1 every 5 policy years
- Orthotics: 1 every 2 policy years
- CPAP: 1 every 5 policy years, up to a maximum of $5,000
[1] Depending on your healthcare plan
4. Who should I contact if I require medical treatment overseas?
Argus, in partnership with One Team Health, Inc. (‘OTH’), provides seamless overseas healthcare management, while helping to reduce and control costs. The OTH staff of doctors, nurses, and case managers work together to provide access to appropriate and high-quality care, allowing you to focus on your health, not logistics. Please call 298-0429 to speak to an OTH representative.
5. What tools are available to help me better manage my healthcare?
Our Thrive. Case Management Programme is voluntary, confidential, and free of charge to members with complex health conditions. A Nurse Case Manager provides one-on-one support and guidance to help you navigate your health plan benefit and local healthcare resources to help you get the care you need. Thrive. Case Management can benefit members who:
- are being discharged from an inpatient stay or have received care overseas.
- have at least one of the care needs below:
- one or more chronic health conditions including, but not limited to, heart disease, diabetes, hypertension, inflammatory bowel disease, degenerative musculoskeletal disorders, renal disease, etc.
- undergone an organ/tissue transplant
- complex medication regimes (high cost or specialty drugs)
- durable medical equipment needs
- a high-risk pregnancy
Contact us at thrive@argus.bm to learn more and enroll.
Our Wellness Rewards Programme, powered by Tictrac, can be customised to help you build healthy habits. Tictrac measures your activity against a weekly target of 150 active minutes. Meet this goal and we'll reward you $5 each week – that's up to $260 a year! All rewards will be paid on a quarterly basis through our electronic funds transfer service.
To learn more, contact Shakira Warner, VP, Population Health Management, at thrive@argus.bm.
6. What are the benefits of using our online portal Argus Vantage?
With Argus Vantage, you can obtain a total view of your Argus Health account using a single username and password. Using your desktop, tablet or smartphone, Vantage provides easy access to the tools and resources needed to help you better manage your plan.
- Access benefits information 24/7
- Submit claims online
- View and print ID cards from home
- Access digital wellness tools and challenges with Get Up & Thrive.
7. How do I sign up to receive my Argus reimbursement payments via electronic funds transfer (EFT)?
EFT is a secure and efficient wat to receive your reimbursement payments. The process is quick and easy. Click here to sign up.
Note that all members are now required to sign up for EFT to receive their health claims reimbursements. If you have questions, please contact the Argus Customer Service Centre, by phone,at 298-0888 or email at insurance@argus.bm.