Healthcare Reimbursement in Bermuda: Who Reimburses What Depending on Your Situation

CLEISS lists Bermuda neither among the States linked to France by a social security agreement nor among the territories covered by the European regulations: for a temporary stay, it places it in the “other countries or situations not covered”. The CLEISS page on the United Kingdom does not mention this territory either. There is therefore no European card, no aggregation of periods and no cross-cover. Four players may be involved depending on status: the employer's local insurer or the Health Insurance Department's public plan, the maintained French scheme (secondment), the CFE and international health insurance.

The notions of reimbursement basis and out-of-pocket cost help compare offers. The conversions on this page are based on the ECB reference rate, the Bermuda dollar being at par with the US dollar. How care is organised is presented in the guide to the Bermuda healthcare system.

The local contract employee is insured by their employer from the first day, together with their non-working spouse, with an approved local insurer, under the Standard Health Benefit. The employer bears at least 50% of the premium and may deduct the rest from the salary. The Bermuda Health Council specifies that this basic cover must come from an approved local insurer and that providers do not accept foreign insurance for it. Children are not included in the employer's obligation: they come under the youth rate of the public plan or the contract chosen. See the glossary entry on the local contract.

The seconded employee remains affiliated to the French scheme during the assignment, for three years renewable once according to CLEISS. Their contributions are paid in France as if they worked there, but they may also have to pay those of the host country. They are covered up to what they would have received in France: they send their fund the paid invoices with form S 3125c, and top-up health cover is advised if care is expensive. Their dependants follow the same procedure; those who stay in France remain attached to the fund. Sick leave is declared to the fund within 48 hours. See seconded or expatriate and the glossary entry on the seconded employee.

The self-employed person has no employer to insure them. The public HIP plan is open to all residents aged 18 and over, for $459.24 (about €409) according to the Health Insurance Department, and the expatriate can also join the CFE voluntarily for sickness and maternity. International insurance completes the arrangement for medical evacuation and care abroad. See digital nomad insurance.

The student has no European card. The HIP youth rate ($220, about €196) is for ages 0 to 18, or up to 21 for a full-time student at a local institution; beyond that, the adult premium applies. Before age 30, the CFE offers a youth offer (with a contribution that depends on age and the plan chosen). See student insurance abroad.

The spouse and children of a local employee: the non-working spouse is included in the employer's obligation, not the children or dependent parents. For a seconded employee, the reimbursement procedure is the same as for the holder. The CFE and international insurers both offer family contracts. See expat family insurance.

The retiree does not come under form S1, valid in Europe. CLEISS states that they check with the local institutions to what extent the local scheme covers their care, and that they may join the CFE voluntarily or take out private insurance. In Bermuda, FutureCare (ages 65 and over) costs $530.14 (about €472) for people eligible for the age subsidy, which is reserved for holders of Bermudian status, and $1,528.48 (about €1,362) for the others; HIP is $1,239.60 (about €1,104) for someone aged 65 and over who is not eligible. The CFE retiree offer has a contribution that depends on age and the plan chosen, with no health questionnaire, for holders of a pension from the French basic scheme. See the guide health insurance for retirees abroad and the page retirement in Bermuda.

During a temporary stay in France, French cover applies to holders of a French pension who can show at least 15 years of insurance in France and who have no professional activity; the accompanying spouse is not covered, and a hospital stay of more than one month requires prior recognition by the CPAM. CFE members send their claims to the CPAM of Seine-et-Marne.

The CFE is a voluntary social protection body. In France, it reimburses according to the principles of the Assurance Maladie (the French national health insurance); abroad, reimbursement depends on the country of care and the type of care, with a rate or flat amount applied to actual expenses. As an example, the CFE cites reimbursement of a general practitioner consultation “up to €18.55” abroad for its retiree offer. The Bermuda-specific scale can be read in the CFE's table of benefits: the difference from the price charged remains the member's responsibility. The guide CFE reimbursements details this mechanism.

• Offers: main offer, youth offer (under 30) and retiree offer, each with a contribution that depends on age and the plan chosen; the final price depends on the country, age and family composition. The first two also cover stays of less than three months in France.
• Waiting period: cover starts immediately if membership takes place before departure or within three months of settling abroad; beyond that, the waiting period is three months for those under 44 and six months for those over 45.
• Maternity: conception must occur after membership or after attachment as a dependant.

On returning to France, service-public states that a CFE member can keep their expatriate benefits for three months under conditions. Without the CFE, a person who does not start work immediately must show three consecutive months of residence in France before applying for universal health cover (form S1106); a person who takes up a job is covered from the first hour worked. See reducing the waiting period and the page return to France.

International health insurance from the first euro reimburses actual costs within the limits of its contract, after any deductible, waiting periods and exclusions. It answers the weak point of public plans abroad: HIP and FutureCare limit hospitalisation abroad to 45 days over twelve months for the same diagnosis and pay neither for the air ambulance, nor the hotel, nor transport. Contracts are compared on the annual ceiling, the coverage zone, evacuation and the handling of medical history.

The tourist has no entitlement to cover on the spot. CLEISS recommends taking out travel insurance suited to the real cost of care in the country, or checking existing cover such as that of a bank card. Reimbursement on return to France of unforeseen care is a possibility and not an entitlement, and medical repatriation is not covered by health insurance. The Department of Immigration stated a tourist stay of at most 180 days. See long-stay travel insurance.

The benchmarks below draw on the Health Insurance Department's brochure and the Standard Health Benefit guide; they describe the public plans, not private contracts.

• Consultation: HIP reimburses $42 per general practitioner visit, up to four visits a year, and FutureCare $46 per visit; a specialist consultation is reimbursed $170 for the first two consultations a year and $75 for three follow-up consultations. Specialist doctors employed by the BHB are covered 100% (urology excluded).
• Hospitalisation: all costs of an overnight stay at the KEMH are covered 100%; the Mid-Atlantic Wellness Institute is covered 100% up to 40 days. Doctors' fees during hospitalisation are capped per admission for HIP (for example $2,167 for surgery) and reimbursed at 75% for FutureCare.
• Medicines: the SHB covers certain infusion and chemotherapy drugs, as well as anti-rejection drugs after a transplant; cover of everyday medicines depends on the policy.
• Dental: HIP covers preventive care, check-ups and minor surgical care at 75% of the dental fee schedule; FutureCare covers them at 100% and also reimburses crowns, dentures and implants at 80% of the schedule, up to $3,000 a year.
• Optical: not covered by HIP; FutureCare reimburses the eye exam up to $50 and glasses up to $200 a year.
• Maternity: hospital delivery is covered 100% by HIP. The SHB includes two ultrasounds (second and third trimesters), certain hospital tests and hospital delivery costs, from the first day of employment; private practice fees are not part of it. HIP obstetric fees are capped per admission ($6,303 for a vaginal delivery, $6,990 for a caesarean).

The reimbursement guide and the page expat health insurance give benchmarks; Expavy helps match these options against your situation.