The Bermuda Healthcare System: Compulsory Insurance, Public Hospital and Emergency Care

The Bermuda Health Council, formed in 2006 under the 2004 Act, oversees the coordination of the system: it registers health professionals, approves insurers and providers, regulates fees and publishes the standard premium rates. The Ministry of Health sets the content and price of the Standard Health Benefit each year, after review. The Health Insurance Department runs the public plans, while government employees come under the civil servants' insurance scheme (GEHI). The Bermuda Hospitals Board (BHB), a body created by a 1970 Act whose members are appointed by the Minister of Health, operates the hospitals.

The Bermuda Health Council's national health accounts give the funding structure: the Ministry of Health contributes 21.9%, health insurance 61.5%, households 14.9% and donations 0.9%. On the spending side, the BHB, classed in the public sector, accounted for 41.7% of the total, local doctors 7.8%, dentists 4.3%, prescription drugs 6.1% and care abroad 12.6%. The Council also publishes data series whose tables are online; they are not given here for lack of direct reading.

The 1970 Health Insurance Act requires the employer to insure any employee who works more than 15 hours a week for more than two months a year, as well as their non-working spouse, but neither children nor dependent parents. Cover starts on the first day of employment, through a policy in the employer's name with an approved local insurer. 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. Exempt are summer students during the holidays, people working less than 15 hours a week or less than two months a year, those already covered by their main employer and employed retirees covered by a former employer.

The official labour guide states that the employer bears at least 50% of the premium and may deduct the rest from the salary. A dismissed employee receives four weeks of cover from the first day of dismissal. An employer who deducts premiums without paying them over must refund them and is liable for medical expenses incurred during a period without cover. The Council keeps a list of non-compliant employers.

The Standard Health Benefit (SHB) is the minimum package common to all policies. It covers ten categories of benefits: appliances and prostheses, home medical care, dialysis, hospitalisation and certain hospital outpatient care, certain infusion and chemotherapy drugs, kidney transplant and anti-rejection drugs, certain imaging outside hospital and palliative care at home. There is no co-payment or extra billing for SHB services. The corresponding premium, the Standard Premium Rate, is set each year; its current amount was not read on the pages consulted. The government covers 100% of the SHB hospital services for all children under 19 and certain populations.

The Health Insurance Plan (HIP) is for ages 18 and over, with a youth rate for ages 0 to 18, or up to 21 for a full-time student at a local institution. FutureCare is for ages 65 and over. The plans are available to all residents, individually or as a group. The age subsidy is based on the Certificate of Entitlement: you must be at least 65, hold Bermudian status, live in Bermuda and have lived there for ten continuous years in the twenty years before applying. Residents who are not eligible pay the full premium, shown in the table below.

According to the Health Insurance Department's brochure, HIP and FutureCare cover 100% of hospitalisation at the KEMH (the Mid-Atlantic Wellness Institute up to 40 days), emergency care, imaging (MRI, CT scan, ultrasound, X-ray) and tests carried out at the KEMH. An additional benefit reimburses $42 per general practitioner visit, up to four visits a year for HIP, and basic dental care is covered at 75% of the fee schedule in HIP and 100% in FutureCare. FutureCare adds in particular optical cover (eye exam at $50 and glasses up to $200 a year). Cosmetic procedures, second opinions and experimental treatments are excluded.

Doctors and other professionals are registered by the Bermuda Health Council, whose online platform handles initial applications, renewals and non-practitioner statuses. The BHB includes the King Edward VII Memorial Hospital (KEMH), the Mid-Atlantic Wellness Institute (mental health) and the Lamb Foggo urgent care centre. The BHB's annual report states that the KEMH is funded by public and private insurance payments, by government grants and, to a lesser extent, by direct payments from uninsured people.

A statement from the Ministry of Health and the BHB recalls that the KEMH is the only emergency department in the territory and that no other local facility can take over. Waiting times can be long for admitted patients (several hours before the decision to admit, then a long wait for a bed), whereas patients not admitted generally stay less than four hours. A significant share of patients could be treated in primary or community care, and patients medically ready for discharge still occupy acute care beds.

The emergency number is 911 (ambulance, fire, police, sea rescue). During Hurricanes Imelda and Melissa in autumn 2025, the Lamb Foggo centre opened as an emergency care centre.

The Bermuda Health Council publishes the Bermuda Drug Formulary, a reference list of medicines, as well as mandatory medical and dental fee schedules for services covered by a policy. The Council's reinsurance programmes include the kidney transplant programme and the maternity programme, the latter covering prenatal care and the immediate postpartum period for uninsured or underinsured people who cannot pay the HIP premium.

For treatments unavailable locally, HIP and FutureCare rely on a network of hospitals abroad: HIP reimburses 60% in an approved hospital and 40% in an approved out-of-network hospital, FutureCare 75% and 55%; the stay is limited to 45 days of hospitalisation over twelve months for the same diagnosis. Air tickets, air ambulance, hotel and transport are not covered. Medical evacuation therefore remains to be arranged through repatriation assistance.

The France Diplomatie (the French foreign ministry) “travel advice” page was not found for Bermuda at the date of consultation: medical advice before departure, from a doctor or an international vaccination centre, remains the recommended way to bring vaccines up to date. In a statement, the Bermuda Ministry of Health recommends that travellers check their immunity against measles and be vaccinated with the combined measles-mumps-rubella vaccine before departure; people born before 1957 are considered immune, and a blood test can check immunity. A person with a fever and a rash after travelling should report their travel to their healthcare professional.

The main seasonal risk is climatic: the hurricane season runs from 1 June to 30 November, and the government recommends keeping a two-week supply of medication, food and water for at least three days and a portable radio, with the emergency station 100.1 FM broadcasting instructions.

No social security agreement links France and Bermuda, and the Carte Vitale gives no entitlement to cover on the spot. An employee on a local contract is insured by their employer; the seconded employee stays on the French scheme for three years renewable once (CLEISS, the French centre for European and international social security liaison); other profiles choose between the HIP, the Caisse des Français de l'Étranger (CFE, the voluntary French social security scheme for expatriates) and international insurance. The page healthcare reimbursement in Bermuda details each situation, and Expavy helps compare the options.