Understanding your health
insurance premium

How is my premium calculated?

There are two main components making up your comprehensive health insurance premium, the Standard Premium Rate (SPR) and the Supplemental Coverage, which are described in the diagram below.

YOUR COMPREHENSIVE HEALTH PREMIUM
	STANDARD PREMIUM RATE (SPR)			SUPPLEMENTAL
		Standard Health Benefit (SHB)	Mutual Reinsurance Fund (MRF)		Supplemental Coverage
		Fee set by Government	Fee set by Government		Fee set by Insurer
		^$23.34	^$376.97
		Collected and retained by Insurer to pay eligible SHB claims	Insurer collects and passes on 100% to the Government		Amount varies based on the client and the coverage plan



		WHAT'S COVERED	WHAT'S COVERED		WHAT'S COVERED
		Diagnostic imaging and select services outside the hospital by approved providers.	Majority of services performed by Bermuda Hospitals Board (BHB), HIP services, high dollar claims for services such as dialysis; helps fund BHB and Bermuda Health Council operational costs.		All health services performed outside of SHB: prescription drugs, overseas major medical, vision care, dental care, mental health care, home and office services and preventative care wellness.

What would cause my premium to increase?

There are two main factors that can cause your premium to increase:

1. The first is any change to the Standard Premium Rate (SPR) which is mandated by the Government.

This is set by the Government and is outside of BF&M’s or any health insurer’s control. When the Government adjusts the fee for the SPR, every insured person—not just BF&M customers—incurs that adjustment.

2. The second is any change to your Supplemental Coverage, which is adjusted by your insurer based on the factors listed below.

For Group Health customers:

Claims experience of BF&M’s entire book of business
Utilisation levels of health insurance benefits
Demographic changes
A Group’s specific claims experience in relation to premiums paid

For Individual Health customers:

Claims experience of BF&M’s entire book of business
Changes in age band based on your current age

What’s included in my Supplemental Coverage by BF&M?

Prescription drugs
Overseas major medical
Vision care
Dental care
Home and office services
Therapeutic services
Mental wellness
Preventative care
Wellness services

What is preventative care?

There are two sides of healthcare—prevention and treatment. We encourage and want you to stay well, and we support this mission by providing our customers with access to the appropriate screenings, therapeutic services and other resources needed to manage their health and prevent disease.

Learn more about preventative healthcare

What are wellness services?

Included in our coverage, BF&M continues to offer extensive wellness benefits through our LiveWell programme. These benefits include Kurbo lifestyle health coaching programme, Eat Right for Life nutrition education series and chronic disease management programmes through our community partners. In addition, our individualised Wellness Platform (Virgin Pulse) is accessible to all members.

Learn more about our LiveWell programme

Your 2024 Schedule of Benefits

The coverage provided to you through BF&M’s Supplemental Coverage is outlined in your Schedule of Benefits for the year and is dependent on the plan selected by yourself and/or your employer.

For Individual Health (Smart Care) - Click here to view your 2024 Schedule of Benefits

For Individual Health (Core Health) - Click here to view your 2024 Schedule of Benefits

For Group Health (Global Series) - Click here to view your 2024 Schedule of Benefits

We are constantly seeking to improve our benefits. During 2020, BF&M expanded our WorldCare Second Opinion service to include a new mental health product, which enables virtual access to professionals who can diagnose, recommend treatment, and answer your questions, all from the comfort of your home and at no additional cost to you.

What is an out-of-pocket expense?

In Bermuda, an out-of-pocket expense refers to the difference between the insurance payment and your healthcare provider’s fee for services.

How can I reduce my healthcare costs?

We suggest you compare healthcare providers to help minimise your costs. In Bermuda, different providers can charge differently, and are not mandated to publicise their costs; therefore, your out-of-pocket will vary between providers. In addition, for overseas hospital benefits, if you do not obtain authorisation prior to receiving care, or obtain care out-of-network, BF&M only pays a percentage of the claims charged. The balance of service owed is your out-of-pocket amount.

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Understanding your healthinsurance premium