Claims Regulations

The Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012 prohibit charging insured patients for the insured portion of a health bill at the time of service (upfront payments), and set out the requirements and procedures for providers to make claims and receive reimbursement.

The Bermuda Health Council monitors and enforces compliance by health service providers and insurers with the Regulations.

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 (exceptions apply under our Exemptions and Permissions)
  • provide specific data elements in a claim (Schedule 1)
  • Submit claims (electronic or paper) to insurers within 30 days of procedure completion (Section 4)

Insurers must:

  • inform healthcare providers of a patient’s level of coverage at the time of service (Section 6)
  • notify healthcare providers of receipt of electronic claims within one day (Section 7)
  • notify providers if any information is missing within 7 days (Section 8)
  • pay clean electronic claims within 30 days of receipt (Section 9)

Bermuda Health Council must:

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

Exemptions and Permissions

The Health Insurance (Health Service Providers and Insurers) (Claims) Regulations 2012, prohibit healthcare providers from charging insured patients for the insured portion of a health bill at the time of service (upfront payments) and ensure providers are reimbursed promptly by insurers.

However, the Regulations also charge the Bermuda Health Council (BHeC) with the responsibility to grant a health service provider an exemption or permission to request payment of the insured portion of a bill at the time of the visit.

Under the Regulations, BHeC is also able to approve an insurer to vary their payment of claims requirement of 30 days.

Those health service providers and insurers who have received permission or an exemption from the Regulations are posted here: