Health Insurance, Medical Test Access & Fees

March 25, 2015

The Bermuda Health Council and Bernews have teamed-up to answer your questions about the island’s health care system. Visit bhec.bm to submit your queries and look for our response on Bernews every month.

Employer Insurance, Medical Tests, Fees MIH 150325

Question 1: I just started a new job and my employer told me that I would have to complete my probation period before I can get health insurance. Is that true?

Answer: The short answer is no. If you are a full-time employee, your employer, by law, must provide you with health insurance from the first day you begin work for them. This requirement is found in Section 20 of the Health Insurance Act 1970 which states that an employer must have, and maintain, an active health insurance policy for themselves, their employees and their employees’ non-employed spouses.

According to Section 5 of the Employment Act 2000, your first day is the first day you start work for an employer and includes any probationary period. Therefore, your probation period should not be exempt from requiring health insurance.

That said, however, there are a few types of employees that are excluded from these requirements. The Health Insurance [Exemption] Regulations 1971 outline these exemptions.

These include:

  • Full-time students who are employed on a Saturday, public holiday or period of vacation
  • Casual or Part-time workers who are employed for less than 45 hours per month
  • Temporary employees hired for 2 months or less
  • And other categories not immediately relevant to your case.

So if you are not within this category, then your employer must be providing you with insurance from your first day working for them.

Question 2: If I’m referred for a lab or imaging test by my doctor, can I be denied the test by the testing facility?

Answer: When you are referred for a lab or imaging test, the referring health professional has to state why you need the test. The testing lab or facility may have very little knowledge of you and your concerns, so the referring health professional’s requisition letter or form will be the only way to provide this information. Without it, the lab or testing facility will not be able to be paid by insurers for the procedure, and so may not be able to perform the test, causing a delay for you.

To avoid any inconvenience, your health professional must include as much information as possible on this referral form and most importantly the reason for the test. The reason may be written-out long hand by your health professional, but they must also include an ICD code; this is an International Classification of Diseases [ICD] code in numbers and letters that describes the condition for which laboratory or imaging test is needed.

No one wishes to delay or deny a lab or imaging test, so the best way to avoid this inconvenience is to check your referral form before you leave your health professional’s office to make sure the ICD code and other details are completed.

Question 3: I have insurance, but the last time I went to my doctor I was charged almost $150 for the visit! I assume insurance covers some of this, but is there no limit to what a doctor can charge?

Answer: Fees charged by private health professionals are not regulated in Bermuda’s health system, nor is what insurers must pay for most non-hospital treatment. Currently Bermuda’s health system allows each party to determine what to charge and what to cover. In this case, it appears your physician’s fees were more than the reimbursement from insurance and therefore you were charged a co-pay.

One option, if you are concerned about the co-pay, is to shop around to see what other health professionals would charge as these can vary from practice to practice. We have an online Healthcare Directory which can be very useful for finding a health professional. It is available here. Some health services do have regulated fees; the schedules are available on our website here.

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Comments (3)

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  1. As a senior I appreciate this somewhat merger of Bernews and Bermuda Heath Council.
    “The Bermuda Health Council and Bernews have teamed-up to answer your questions about the island’s health care system. Visit bhec.bm to submit your queries and look for our response on Bernews every month.”
    This is an excellent idea! The general public can now make inquiries via Bernews.

  2. Missing Canada says:

    Thanks Bernews, this is helpful!

    I remember the first time I was charged a co-payment, I had to pay $100 just for a prescription renewal. I had never payed a doctor before in my life! Small price to pay to live in paradise, but a shock none the less.

  3. Huh says:

    THey should call it what it really is, A SICKNESS CARE SYSTEM.