Government Employees (Health Insurance) (Benefits) Amendment

Link to law: http://www.bermudalaws.bm/Laws/Annual%20Laws/1996/Statutory%20Instruments/Government%20Employees%20%28Health%20Insurance%29%20%28Benefits%29%20Amendment.pdf
Published: 1996

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Government Employees (Health Insurance) (Benefits) Amendment Order 1996
GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

1989 Revision 1

AG7/25B:LW-sd 04/08/05

BR 17/1996

GOVERNMENT EMPLOYEES (HEALTH INSURANCE) ACT 1986

1986 : 5

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

The Minister of Finance, in exercise of the power conferred upon
him by section 12 of the Government Employee (Health Insurance) Act
1986, makes the following Order:

Citation and commencement
1 This Order, which amends the Government Employees (Health
Insurance) (Benefits) Order 1986 (hereinafter referred to as "the Order"),
may be cited as the Government Employees (Health Insurance) (Benefits)
Amendment Order 1996 and shall come into operation on 1 April 1996.

Amends paragraph 1 of the Schedule to the Order
2 Paragraph 1 of the Schedule to the Order is amended—

(a) in sub-paragraph A—

(i) by deleting "and" from sub-paragraph (xii);

(ii) by replacing the full stop at the end of sub-
paragraph (xiii) with a semi-colon and adding
the following—

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

2 1989 Revision

"(xiv) diabetic education and counselling but
limited to one education and one
counselling programme; and

(xv) hospice care in an establishment which
the Committee has approved.";

(b) by deleting sub-paragraph E and substituting the
following—

"E ARTIFICIAL LIMBS, ORTHOPAEDIC BRACES
AND ARTIFICIAL APPLIANCES
The supply, maintenance, repair and renewal of artificial
limbs or any artificial appliance as defined in the
Hospital Insurance (Artificial Limbs and Appliances)
Regulations 1971 [title 18 item 9(o)] will be paid, so
however that the amount payable shall be calculated
from the relevant date and shall not exceed $10,000.

In this paragraph, the "relevant date" means in relation
to an accident or injury giving rise to the need for an
artificial limb or artificial appliance, the date on which
the accident or injury occurs, and in relation to an
illness, the date on which the surgical treatment for the
removal of the natural limb or implantation of the
artificial appliance occurs.".

Amends paragraph 2 of the Schedule to the Order
3 Paragraph 2 of the Schedule to the Order is amended—

(a) by deleting sub-paragraph 1 and substituting the
following—

"1 HOSPITAL EXPENSES
For treatment in the emergency ward as an out-patient
which would normally be provided in a doctor's office, if
it can be shown that the insured person's doctor was not
available or the condition which is considered to be an
emergency arose at a time when the doctor's office is
normally closed: expenses which the Committee shall
approve as being reasonable and customary.";

(b) in sub-paragraph 4 by deleting from sub-paragraph (iv)
"all expenses incurred; and" and substituting "expenses
incurred which the Committee shall approve as being
reasonable and customary; and";

(c) by deleting sub-paragraph 5 and substituting—

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

1989 Revision 3

"5 DENTAL TREATMENT
In case of injury to a sound natural tooth: expenses
incurred for immediate treatment in the dentist's clinic
which the Committee shall approve as being reasonable
and customary.

In case of further treatment prescribed by a dentist,
including the provision of dentures: expenses incurred to
a maximum determined by the Committee.

In case of the excision of impacted teeth, a tumour or a
cyst: expenses incurred which the Committee shall
approve in advance as being reasonable and
customary.";

(d) in sub-paragraph 7 by inserting next after "in respect of"
the words "medical attendance for";

(e) by deleting sub-paragraph 8 and substituting the
following—

"8 BENEFITS FOR TREATMENT OVERSEAS
The Committee may approve institutions for the
purposes of medical treatment, consultation or technical
investigation overseas and may adjust the admissible
benefits payable under this sub-paragraph where such
treatment, consultation or investigation is obtained at an
institution which it has not approved for such purposes.

For health insurance cover for treatment, consultation or
technical investigation overseas, three categories of
benefit shall apply, that is to say—

(a) Essential treatment, consultation or technical
investigation

Treatment, consultation or technical investigation
is essential if there is no alternative in Bermuda,
and a medical or surgical specialist practising in
Bermuda has certified the treatment as essential
and urgent and immediately necessary for the
health or survival of the insured person or essential
in the long-term. The admissible benefits payable
for this category are as follows—

(i) medical, surgical and hospital expenses
incurred which the Committee has
approved in advance as being
reasonable and customary;

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

4 1989 Revision

(ii) travel expenses limited to a maximum
determined by the Committee;

(iii) expenses for essential ambulance plane
services limited to 80% of the cost
thereof.

Funds will be made immediately available for
essential treatment, consultation or technical
investigation in any necessary case.

(b) Optional treatment, consultation or technical
investigation

Treatment, consultation or technical investigation
is optional if it is not immediately necessary for the
condition of the insured person and alternative
treatment therefor may or may not be available in
Bermuda but it would be reasonable on medical
advice for the insured person to elect treatment,
consultation or technical investigation overseas.
The admissible benefits payable for this category
are as follows—

(i) the insured person will be responsible
for all charges incurred overseas and
may claim reimbursement for such
charges at the rate for similar services
provided in Bermuda so however that—

where the cost of the charges incurred
overseas is less than the cost of similar
services provided in Bermuda, the
insured person may claim the cost of
the expenses actually incurred;

where the cost of the charges incurred
overseas is greater than the cost of
similar services provided in Bermuda,
the insured person may claim
reimbursement at the rate for similar
services provided in Bermuda plus 50%
of the difference between the charges
incurred overseas and the charges for
similar services in Bermuda;

where the services were not available in
Bermuda the insured person may claim
for medical expenses which the

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

1989 Revision 5

Committee has approved as being
reasonable and customary; and

where the services were provided as the
result of an emergency, the insured
person may claim for medical expenses
which the Committee approves as being
reasonable and customary;

(ii) no claim may be made for travel or other
expenses.

(c) Standard treatment, consultation or technical
investigation

Treatment, consultation or technical investigation
with or without medical advice is standard if it is
available in Bermuda and does not merit
consideration under category (a) or (b) above. The
admissible benefits payable for this category are as
follows—

(i) the insured person may claim
reimbursement for charges incurred
overseas at the rates for similar services
provided in Bermuda;

(ii) no claim may be made for travel or other
expenses.";

(f) by deleting sub-paragraph 9 and substituting the
following—

"9 PRESCRIPTION DRUGS
Subject to an annual deduction of $25 in respect of each
insured person, the cost of drugs prescribed by a doctor
for the treatment of an illness or pathological condition
and of accessory equipment prescribed by a doctor
which is necessary to determine the amount of the drugs
required to be administered or to administer the drugs
will be paid to a maximum of 80% thereof.

Claims for reimbursement must be submitted to the
Committee on or before 30 April in the relevant year.";

(g) by inserting next after sub-paragraph 10 the following
new paragraphs—

"(11) SPEECH THERAPY
The cost of speech therapy which the Committee has
approved in advance as being reasonable and customary

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

6 1989 Revision

will be paid up to a maximum of 3 months for each
prescription, if the therapy is prescribed by a doctor.

(12) ASTHMA AND DIABETES COUNSELLING
The cost of counselling expenses which the Committee
has approved in advance as being reasonable and
customary will be paid up to a maximum of 80% of the
cost thereof, if the counselling is prescribed by a doctor.

(13) EYE TREATMENT
The insured person may claim $25 on an annual basis
for an eye examination or $150 on an annual basis for
an eye examination which results in the fitting of lenses
and frames.

For the purposes of this paragraph lenses and frames
include the following—

(i) frames;

(ii) bifocal and trifocal lenses, including tints and
prescription glasses;

(iii) non-disposable contact lenses when initially
required due to a change in prescription where
improved visual sharpness is not possible
through the use of regular eye glasses to a
maximum of 3 pairs of non-disposable contact
lenses;

(iv) disposable contact lenses up to the maximum
annual benefit.

For the purposes of this paragraph lenses and frames do
not include the following—

(i) duplicate and spare eye glasses;

(ii) duplicate and spare non-disposable contact
lenses;

(iii) sunglasses, prescribed or otherwise;

(iv) safety glasses;

(v) services for visual training or remedial
exercises.".

GOVERNMENT EMPLOYEES (HEALTH INSURANCE)
(BENEFITS) AMENDMENT ORDER 1996

1989 Revision 7

Made this day of 1996

Minister of Finance