Bermuda – Health Insurance

Is health insurance mandatory in Bermuda?

Bermuda law requires certain categories of insurance to be maintained by individuals and businesses, including statutory health insurance coverage for employees and their non-employed spouses. This makes Bermuda notably different from many countries where public healthcare is funded through general taxation and available free at the point of use — there is no equivalent of a national health service on the island.

Pursuant to the Health Insurance Act 1970, employers in Bermuda are legally required to provide at least the Standard Health Benefit — the minimum level of health insurance coverage — for their full-time employees and their non-working spouses who are legal residents and reside in Bermuda.

Under the Act, employers are liable to pay the full SHB premium. However, they are entitled to recover up to 50 per cent of the premium from the employee, provided the deduction is documented in the employment contract or with written consent, and that it complies with the Employment Act 2000.

Bermuda law does not require employers to provide health insurance to part-time employees, defined under the Health Insurance (Exemption) Regulations as those working fewer than 15 hours per week, not more than two months in any calendar year, or students under 26.

Self-employed persons are also required to maintain SHB-level coverage under the Act. If a self-employed individual hires staff, they become subject to the same employer obligations under the Act and must provide SHB-compliant coverage to their full-time employees.

There is no legal mandate requiring unemployed or retired persons to maintain health insurance. However, given how costly healthcare in Bermuda can be without cover, most residents — regardless of employment status — are strongly advised to hold some form of valid policy.

How does the state health insurance system work in Bermuda?

The Health Insurance Plan (HIP) and FutureCare are the two plans provided by the Health Insurance Department (HID). Both plans offer dental benefits, doctor’s visits, in-patient and out-patient care at the hospital, and overseas care, with enrolment in the different plans based on the age and benefit needs of the applicant. HIP is generally available to residents under 65, while FutureCare is the government plan designed for older residents.

Every plan includes the Standard Premium Rate, made up of two components — the Standard Health Benefit, which provides access to a base package of mandated health benefits, and the Mutual Reinsurance Fund (MRF), which is a contribution to select high-cost benefits as well as health system administration.

The types of services, reimbursement rates for the SHB and MRF benefits, and the Standard Premium Rate are set by the Minister of Health following an annual review to ensure healthcare market sustainability, inclusion of feedback from stakeholders, affordability of services, and diversity of benefits.

The SPR — a mandatory, government-run feature of all health insurance coverage across the island — was last set at $400.31 per customer per month as of November 2021. The Bermuda government has acknowledged that across the world medical inflation continues to rise, affecting the cost of clinical care, medical equipment, pharmaceuticals, and hospital operations, and that Bermuda is not immune to these pressures. An increase to the SPR was announced for April 2026 — check the Health Insurance Department website for the current rate.

In practice, most employers contract with private insurers offering enhanced benefits above the SHB minimum, and often select the level of coverage most appropriate for their employees and their dependants. This means the quality and breadth of employer-provided cover can vary significantly from one workplace to another.

All government pensioners, employees, and their dependants are covered under the Government Employee Health Insurance (GEHI) plan. This is a separate scheme from HIP and FutureCare and applies specifically to those working in the public sector.

What does Bermuda’s state health insurance cover?

The SHB is the base package of mandated health benefits in Bermuda, and every employee, non-working spouse, and child under the age of 18 is entitled to care under the SHB by law. It is similar in concept to a minimum benefits floor, though unlike a universal public system, it does not cover all health needs without cost to the individual.

SHB premiums only cover eligible SHB services offered locally in the community by approved providers, and are not portable to other jurisdictions. This is a critical point for expats: if you receive treatment abroad, the SHB will generally not reimburse those costs.

Services that are covered in full without a cap under the government plans include hospitalisations, emergency room visits, lab services, and staying in hospital to give birth. However, these premiums do not cover all healthcare costs in Bermuda — for some services the benefits are capped, meaning you remain liable for any costs incurred above the stated amount.

The SHB covers local medical services, primarily services provided by the Bermuda Hospitals Board, which operates King Edward VII Memorial Hospital and the Mid-Atlantic Wellness Institute. Community-based SHB benefits defined in regulations include, but are not limited to, dialysis services from approved providers.

Supplemental benefits determined by each provider — over and above the SHB — can include services such as vision and dental care, as well as overseas medical treatment. Whether these are included in your plan depends on whether your employer has arranged enhanced coverage or whether you hold an upgraded HIP or private policy.

Overseas treatment is a benefit provided by HIP and FutureCare under their respective Supplemental Benefit Orders. To qualify, the treatment must be medically necessary and not available in Bermuda, and the policyholder must have a referral from a specialist or physician. Overseas treatment is limited to a 45-day in-patient stay during a twelve-month period for the same diagnosis.

The Certificate of Entitlement (COE) is for Bermudian residents who qualify for the government’s aged subsidy, and the Personal Home Care Benefit assists FutureCare and HIP policyholders who qualify with the costs of personal care services in their home.

How do you apply to join the state health insurance system?

If you are receiving health insurance through your employer, they are legally required to register you for that scheme and should do so on your behalf. If you need to enrol independently — for example, because you are self-employed, between jobs, or your employer’s plan does not include dependants — the process is managed directly through the Health Insurance Department (HID).

1. Determine which plan you need. Enrolment in the different plans is based on the age and benefit needs of the applicant. HIP is for adults under 65 and children, while FutureCare is designed for residents aged 65 and over. For a parent enrolling a dependent child aged 18 or younger, or aged 19–21 and a full-time student in Bermuda, the Youth Enrolment Form (FORM-CA18) applies.
2. Complete the relevant enrolment form. New enrolments for HIP and FutureCare are accepted and require the completion of a paper enrolment form at the Health Insurance Department at Sofia House, 48 Church Street. You will need to bring your ID and proof of immigration status.
3. Submit your application and supporting documents. Completed applications and all supporting documentation can be faxed to 295-9213 or hand delivered to the HID office at Sofia House, 48 Church Street. Contact the department in advance at 295-9210 to confirm the current list of required documents for your situation.
4. Pay your first month’s premium. You must return the form along with your first month’s premium to the Health Insurance Department. Premium payments can be made via debit/credit card, cash, or cheque — HID cannot accept online transfers for new enrolments.
5. Receive your confirmation of coverage. A confirmation of coverage letter will be issued for all new enrolments and should be presented to health service providers as necessary. Keep this document accessible, as you may be asked to show it when attending appointments or accessing services.
6. Apply for the Certificate of Entitlement if applicable. Eligible persons may apply for premium subsidies under the Health Insurance (FutureCare Plan) (Eligibility) Regulations 2009 by obtaining a Certificate of Entitlement. This is available to persons over 65 who have been resident in Bermuda for a continuous period of not less than 10 years during the 20 years immediately preceding their 65th birthday.

For full details on enrolment, benefit schedules, and approved providers, visit the Government of Bermuda’s HIP and FutureCare benefits page or call the Health Insurance Department directly on +1 441 295-9210.

What are the advantages of international private medical insurance for expats?

Having private medical cover in Bermuda is not mandatory, but it can make a real difference — given how expensive healthcare in Bermuda can be, and the capped benefits involved in the main Health Insurance Plan, a private policy can help avoid unexpected costs. For expats in particular, the limitations of local plans around overseas coverage and benefit caps make a comprehensive international policy worth serious consideration.

Bermuda has among the most expensive healthcare systems in the world, which means that even relatively routine treatment can result in significant out-of-pocket costs if your standard plan has reached its benefit cap. Unlike systems with fee-free primary care — such as those found in parts of Europe or Canada — Bermuda’s model is largely insurance-driven, with costs at every level of care.

Bermuda’s healthcare system is largely private, and most residents and expats, including retirees, are responsible for covering the costs of their own healthcare. For those moving to Bermuda for work, employers are legally required to provide health insurance plans to their employees, but the extent of that coverage can vary from one employer to another — meaning that taking out a private health insurance plan can help fill in any gaps.

Having private medical insurance in place in Bermuda means you can benefit from shorter waiting times, as access to more healthcare facilities means you can get appointments and specialist treatments faster. This is particularly relevant given that Bermuda is a small island with limited on-island facilities.

Bermuda has one main hospital — King Edward VII Memorial Hospital, situated close to the capital, Hamilton — with around 300 beds covering accident and emergency and a wide range of inpatient and outpatient care. There is also the Mid-Atlantic Wellness Institute for mental health. For any condition requiring specialist treatment beyond what these facilities can provide, medical evacuation to the United States or elsewhere may be necessary — a potentially enormous cost without appropriate cover.

Expat health insurance plans offer international coverage and additional benefits that cater specifically to the needs of expats. A good international private medical insurance (IPMI) policy will typically include: worldwide emergency treatment; direct billing arrangements with hospitals so you don’t have to pay upfront; mental health support; repatriation cover; and access to specialist care overseas without needing a referral through the local system first.

Some insurers pay the healthcare provider directly, while others require you to pay upfront and submit a claim for reimbursement. When choosing a policy, consider the extent of the coverage, including whether it covers pre-existing conditions, emergency care, and routine check-ups. These factors matter more in Bermuda than in countries where baseline state cover is broader.

Bermuda law allows individuals to maintain multiple insurance policies, including combinations of HIP and private insurance. However, coordination of benefits under the Insurance Act 1978 ensures that duplicate payments are not made for the same claim, and in practice, maintaining dual coverage may not always be cost-effective due to overlapping benefits — so it is worth assessing whether the additional financial outlay justifies the enhanced protection.

Private insurers operating in Bermuda include Argus, BF&M, and Colonial, which offer a variety of health insurance plans to cater to different needs. International providers such as AXA Global Healthcare, Cigna, and Allianz Care also offer policies designed for long-term residents abroad. Always compare policies carefully and confirm that any plan you choose meets Bermuda’s SHB minimum requirement if you are relying on it as your sole cover.

Frequently asked questions

Does my employer have to provide health insurance in Bermuda?

Yes. Pursuant to the Health Insurance Act 1970, employers in Bermuda are legally required to provide at least the Standard Health Benefit for their full-time employees and their non-working spouses who are legal residents and reside in Bermuda. This applies to both local and foreign employees.

What is the difference between HIP and FutureCare?

Both HIP and FutureCare are plans provided by the Health Insurance Department and offer dental benefits, doctor’s visits, in-patient and out-patient hospital care, and overseas care. Enrolment in the different plans is based on the age and benefit needs of the applicant. HIP is generally for residents under 65, while FutureCare caters to those aged 65 and over.

Can I use my Bermuda health insurance if I travel or receive treatment abroad?

SHB premiums only cover eligible SHB services offered locally in the community by approved providers and are not portable to other jurisdictions. HIP and FutureCare do offer overseas treatment benefits, but the treatment must be medically necessary, not available in Bermuda, and the policyholder must have a referral from a specialist or physician. Emergency care abroad is covered for policyholders travelling overseas.

Is there a subsidised plan for older residents?

The Certificate of Entitlement (COE) is for Bermudian residents who qualify for the government’s aged subsidy. To qualify, a person over the age of 65 must have been a resident of Bermuda for a continuous period of not less than 10 years during the 20 years immediately preceding their 65th birthday.

Do expats have to use the government health insurance plan?

The SHB coverage is typically arranged through either the Government-administered Health Insurance Plan or through a private insurer. Expats whose employers provide private insurance that meets the SHB minimum are covered. Those without employer cover can enrol directly in HIP or take out a qualifying private policy — the obligation is to hold SHB-level cover, not specifically to use the government plan.

How much does the government HIP plan cost?

Indicative premiums reported by AXA Global Healthcare suggest the standard Health Insurance Plan premiums cost approximately $459 per month for adults, $220 per month for children, and $1,239 per month for those over 65. These figures may have changed — always check the current rate on the Government of Bermuda’s HIP and FutureCare page.

What happens if I have both HIP and private insurance?

Bermuda law allows individuals to maintain multiple insurance policies, including combinations of HIP and private insurance. However, the coordination of benefits under the Insurance Act 1978 ensures that duplicate payments are not made for the same claim. It is worth speaking to both insurers to understand how claims will be managed before committing to dual cover.

Where do I enrol for HIP or FutureCare in Bermuda?

New enrolments for HIP and FutureCare are accepted and require the completion of a paper enrolment form at the Health Insurance Department at Sofia House, 48 Church Street. You can contact the department by phone on +1 441 295-9210 or visit the official Health Insurance Department page for further guidance.