Bermuda has had a basic insurance plan called the Standard Health Benefit, or SHB, since 1970. This includes mostly hospital services, but provides limited coverage for prescriptions or office visits. This basic plan is not available for sale on its own, so it is now seen by the Bermudan health authorities to be of limited use, and the government is currently undertaking a radical overhaul of the public health insurance system. In addition, your employer may have signed you up with either the Health Insurance Plan (HIP) or the more costly FutureCare.

The new coverage, currently in transition, is intended to include enhanced benefits such as greater access to primary care and some prescription drugs. A number of residents are at present unable to access public healthcare, due to high co-payments. They therefore wait until their health situation becomes an emergency. The government reports that the current inefficient system thus contributes to a situation in which people do not receive sufficiently early medical care to prevent serious illness or costly emergency procedures.

Bermuda’s healthcare is of a good standard, but extremely expensive. Moreover, although the island’s system can handle most eventualities, if you are suffering from a more serious condition you may still need to be treated in the US, usually in one of the East Coast’s hospitals, so many expats choose to have a medical evacuation clause in their private insurance policies.

The new Bermuda Health Plan is designed so that Bermuda’s residents will also be able to access preventative care and early treatment. The government says that in the future, healthcare premiums will be maintained at an affordable level, and co-pays will be limited to approximately $25.

If you are currently covered by Health Insurance Plan HIP or FutureCare, you will retain your current benefits. When the Bermuda Health Plan is in place you will receive the enhanced level of coverage, including an increased number of doctors’ visits, chronic care management and some prescription drugs.

The new Health Plan will be compulsory, so if you currently have private cover as well, you will be able retain your current level of coverage but you will need two health plans: the Bermuda Health Plan and separate supplemental benefits. The government says that is similar to the case with pensions, where you have the Social Insurance pension and a mandatory private pension. Individuals and employers will continue to be able to select supplemental insurance plans which best suit their requirements, so you will still be able to tailor your private coverage to your own particular needs.

The unified or single payer system proposed for Bermuda will be a public-private partnership. Implementation began in 2019 and is estimated to take between 3-5 years to be fully installed. The government aims to begin the transition to a better basic health plan and a single payer system in the third quarter of 2020.

The new scheme will be compulsory, so it will cover you as an expat if you are resident in the island. Currently, your employer must register you with one of the insurance providers: you cannot opt out, nor can you change provider.

Although Bermuda is a British Overseas Territory, there are currently no reciprocal healthcare arrangements in place between the UK and Bermuda.

When the new scheme is implemented it will be compulsory, so you will automatically be signed up. At present, your employer chooses your mandatory coverage for you.

At present employers may deduct no more than half of the monthly premium from an employee’s salary.

It is your responsibility to notify your employer of any changes to your non-employed spouse’s employment status.

If your employer is non-compliant with the law and you incur medical bills during a period of non-coverage, your employer will be responsible for paying your medical bills. Employers are encouraged to shop around and purchase a policy that is affordable so that payments can be made on time, thereby avoiding any disruptions in coverage. It is your employer’s responsibility to notify you about any changes to your health insurance policy.

Employers are free to select their own health insurance plan, under government regulation. They must also make contributions into the insurance system: this may be a 50:50 split.

All employer-chosen health plans must be offered by majority-Bermudian owned and operated, not non-Bermudian, companies licensed by the Bermuda government to provide such services.

The new scheme aims to cover both primary and secondary care, increasing the number of visits you can make to your GP and covering an increased range of prescription charges. Its stated aims are:

• universal access to basic health coverage
• urgent physical and mental health care, hospitalisation, primary care, preventive care and health maintenance
• contributions based on ability to pay
• use of overseas care to get the best value for money for the population
• mechanisms put in place to pay healthcare providers and ensure optimal quality to patients and maximum efficiency to the healthcare system
• integrated IT system including demographics, medical history and billing
• strategies to meet the healthcare needs of people with chronic illnesses, and physical, cognitive and mental disabilities
• monitoring and regulation of the quality of healthcare provision
• regulation of healthcare technology
• promotion of healthy lifestyles and maintenance of health conditions to limit NCDs such as heart disease, cancer and diabetes

SHB currently covers hospital care and some essential community-based services like x-rays, mammograms and home infusions.

Both HIP and FutureCare offer dental benefits, doctors’ visits, in-patient and out-patient care at the hospital, and overseas care.

When the Bermuda Health Plan comes in, you will experience some immediate changes if you are currently covered by FutureCare or HIP. For example, you will see reduced copays for primary care. HIP policy holders will have access to more primary care visits, significantly lower copays and $400 prescription drug cover.

The government says that over time, it is envisioned that a comprehensive set of benefits under the Bermuda Health Plan will eventually replace the current HIP and FutureCare, but will ensure that no one, including seniors, is made worse off by the reforms.

It is advisable, however, to ensure that you are covered after the age of 65 by taking out private health insurance.

As an international student it is advisable to take out private cover during your time in Bermuda. Contact your educational institution to see if they have in-house cover or can recommend an insurance provider.

Your family will be covered by national insurance when the single payer system comes in. Until then, you will need to rely on your existing coverage if you are already resident in Bermuda, whether public or private. Your non-working spouse, children and seniors should be covered by your current insurance.

Hamilton Health Centre, St. George’s Health Centre, and Somerset Health Centre are government-run dental practices but currently offer limited provision due to a large existing patient base. New clients may be placed on a waiting list.

The waiting period for dental procedures at Government of Bermuda health centres is currently six to eight months. The government says that priority will be given to eligible patients who, upon triage, require urgent or emergency care. Others will be referred to private practices.

Given these limitations, you may choose to go directly to the private sector, which is of a high standard in Bermuda.

At present, the contribution rates are unclear as the scheme is in transition. SHB premiums are currently $355.31 a month.

Authorities note that the distribution between the MRF (Mutual Reinsurance Fund) premium and the Health Insurance Act (HI) premium has significantly changed in 2019 as the system starts to shift. The monthly MRF premium will be $331.97 and the HI premium will be $23.34.

For FutureCare, the monthly premium is currently $504.21 per person.

For HIP, the adult monthly premium is currently $433.31 and the youth monthly premium is $190.00.

Both current and future health insurance is mandatory but many expats also choose to take out private cover, perhaps for elective procedures or to cover specific issues for tailored coverage. You may also want to take out a policy with a medical evacuation clause.

Private insurance will cover all primary and hospital care, plus specialist appointments, elective dental and optical care, and cosmetic surgery.

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for (obviously, a more expensive insurance package will give you more a extensive range of treatment and facilities). As so many variables have an effect on the cost of international private medical insurance it becomes very difficult to give accurate estimates without knowing the full details of the coverage required.

However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The main international companies and some local providers cover Bermuda, including:

• Argus Insurance
• BF&M Life Insurance Company Ltd
• Cigna
• Colonial Medical Insurance Company Ltd
• Expat Financial
• Freisenbruch-Meyer Insurance Ltd
• Somers Isles Insurance Company Ltd

Given Bermuda’s British connections, you should have few difficulties with communication if you speak English.