Health Insurance

Health Insurance Act 1970
Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012
Exemptions and Permissions
Resources

Health Insurance Act 1970

According the Bermuda Health Council Act 2004, the Bermuda Health Council is responsible for licensing health insurers. The Health Insurance Act 1970 dictates how health insurance is to be governed in Bermuda.
Here are some key pieces of information found in the Act that employees and employers may find valuable.

  • Every employer must make health insurance available to all employees and their non-employed spouses through a licensed insurer.
  • Self employed persons are also required to have health insurance.
  • Health insurance coverage must include a minimum of the full standard hospital benefit.
  • If a spouse becomes employed, the employer is no longer required to provide insurance for that spouse.
  • It is the responsibility of the employee to inform his/her employer when a spouse becomes employed.
  • An employer is required to pay the insurer the entire cost of the health insurance premium for each employee and their non-employed spouse, but may deduct from an employee’s salary (or wages) up to half the cost of the standard premium.
  • Promptly after an employee is hired, the employer must provide the employee with the name of the health insurer who is offering the health insurance contract and the insurance number of the health insurance contract.

Employers’ Compliance with the Health Insurance Act 1970

The Bermuda Health Council monitors employers’ compliance with the requirement to provide employees and non-working spouses with health insurance under the Health Insurance Act 1970. The Act requires that insurers report to BHeC any failure on the part of an employer to comply with requirements under the Act. BHeC and the Department of Social Insurance (DOSI) investigate reported employers to confirm delinquent cases. Failure to comply can result in a fine between $500-$1000 or 6 months imprisonment.

Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012

The Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012, which are effective August 1, ensure providers are paid promptly by insurers and prohibit charging insured patients for the insured portion of a health bill at the time of service (upfront payments).
These Regulations also mandate the Bermuda Health Council to monitor and enforce compliance by the healthcare providers and insurers.
Some additional information about the Regulations and what they entail for various stakeholders includes:

Providers must:

  • submit claims to insurers for the insured portion of a patient’s visit (Section 3); this means providers cannot charge insured patients the insured portion at the time of service

Insurers must:

  • inform healthcare providers of a patient’s level of coverage at the time of service (Section 6)

Bermuda Health Council must:

  • impose penalties on non-compliant health service providers and insurers (Sections 12 & 13)
  • grant exemptions to health service providers and insurers, where appropriate (Section 15)

Exemptions and Permissions

Health service providers and insurers who have received permission or an exemption from the Regulations and therefore can charge the insured portion at the time of the visit will be posted here:

Exemptions and Permissions  

Resources

Application Forms
Claims Regulations: Patients Need to Know
Guide to Health Insurance Claims Regulations
Upfront Payment Legislation 2012 Frequently Asked Questions
Upfront Payment Legislation 2012 InBrief
Why Health Insurance? (brochure)