BHeC Call For Standard Health Benefit Proposals

July 7, 2015

The Bermuda Health Council advised that proposals for benefit changes in Bermuda’s minimum health insurance package will be invited from 7th July 2015, to take effect in 2016.

BHeC said, “As part of the evaluation of healthcare services funded by the Standard Premium Rate, the Bermuda Health Council considers annual changes to the Standard Health Benefit [SHB] and the Mutual Reinsurance Fund [MRF] to recommend to the Minister of Health Seniors and Environment. Changes are now being considered for the fiscal year starting April 2016.

“Based on feedback from private and public sector stakeholders, population health trends and utilization patterns, the SHB Review Committee under the Bermuda Health Council, noted the need to prioritize secondary prevention and treatment of specific chronic non-communicable conditions, and end of life care, in order to improve patient outcomes, contain insurance premiums and reduce healthcare costs.

“Within this scope, the Bermuda Health Council would like to invite eligible healthcare providers to submit proposals to address these priorities in 2016.

Proposals will only be considered that fall within the following categories:

  • A] Interdisciplinary, comprehensive Diabetic Foot Care for patients at risk for amputation
  • B] Evidence-based assessment and case management for chronic kidney disease to prevent or delay the need for dialysis
  • C] Evidence-based assessment and case management for cardiovascular disease to prevent or delay heart attacks or stroke
  • D] Post-acute rehabilitative care following a neurological event or injury
  • E] Palliative care and end-of-life care management in home or hospice settings
  • F] Non-invasive vascular screening services that would minimize the use of CT radiation and contrast-enhanced MRI imaging
  • G] Evidence-based implantation of cardiac defibrillators in Bermuda to reduce need for overseas referrals

“Proposals will only be considered for medically necessary services that will direct care to clinically appropriate, cost effective settings, and incent health system cost containment leading to premium stabilization.

“Final determination of reimbursement levels for proposed services will be established in collaboration with the Bermuda Health Council, using an international standard of relative values of services in addition to a Bermuda cost of business factor.

“Proposals with services bundled for maximum cost efficiency will be favoured over individualized fee-for-service cost methodologies. Approved proposals may become effective from 1st April 2016.

“Application forms and details of the application and review process will be posted on the Health Council’s web site. In particular, applicants should review the SHB Proposals Guide for eligibility and assessment criteria. The Guide and Application materials will be available from 7th July 2015 at

“Completed applications must be submitted electronically no later than 11:59pm 23rd August 2015 to Applicants must submit completed forms inclusive of population need data, individual medical procedures proposed and estimates of service provider costs. All proposals will be evaluated using a standardized methodology, ranking submissions based on risk size and effectiveness of interventions [See SHB Proposals Guide].

“Successful applications will be approved in principle for actuarial pricing. Final determination on benefit changes will be made once the impact on premiums is analysed. Note: Proposals approved in principle may not receive final approval to become standard health benefits.

“All applicants will be notified whether their proposal was accepted in principle or not by 23rd September 2015. Approvals in principle will be confirmed as approved or declined by March 2016.

“Prospective applicants are encouraged to attend an information session to address any questions regarding the process. The information session will be held on 20th July 2015 at 5:15 pm at the Bermuda Health Council, Sterling House, 16 Wesley Street, Hamilton.”

Questions may be addressed to Dr Ricky Brathwaite at by 5pm 23rd July 2015. Responses to all questions will be published [anonymised] on our website on 27th July 2015.

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