Hospital Insurance (Standard Hospital Benefit) Regulations 1971

Standard hospital benefit

1 Subject to these Regulations, standard hospital benefit shall consist of the in-patient services specified in regulation 2 and the out-patient services specified in regulation 3.

In-patient services

2 Standard hospital benefit shall include the following in-patient services —

(i) accommodation and meals at the standard or public ward rate;

(ii) full nursing services;

(iii) laboratory, radiological and other diagnostic procedures, including biopsies (except that surgeon's fees are not in cluded), together with the necessary reports, for the purpose of maintaining health, preventing disease and assisting in the diagnosis and treatment of any injury, illness or disability;

(iv) drugs, biological and related preparations which are pre scribed by an attending physician in accordance with the hospital formulary and administered in the hospital;

(v) use of operating room, anaesthetic facilities and other facilities required in operating procedure, including nec essary equipment and supplies;

(vi) standard surgical supplies;

(vii) use of radiotherapy facilities;

(viii) use of physiotherapy facilities;

(ix) services rendered by persons who receive remuneration for that service from the hospital;

(x) use of haemodialy sis facilities and up to $30,000 towards the cost of a kidney transplant and thereafter the full cost of all maintenance drugs;

(xi) treatment for alcoholism (other than alcoholism causing acute mental illness);

(xii) use of ultrasound facilities;

(xiii) diabetic education and counselling but limited only to one education and counselling programme;

(xiv) hospice care in an establishment under the charge and management of the Board or in an establishment approved by the Commission;

(xv) speech therapy (in-patient); and

(xvi) the use of orthopaedic appliances.

[Regulation 2 amended by BR 14/1991 effective 1 April 1991; by BR 14/1993 effective 1 April 1993, by BR 17/1995 effective 1 April 1995; and by BR 24/1998 effective 27 March 1998]

Out-patient services

3 Standard hospital benefit shall include the following outpatient services —

(i) pathological studies, X-ray and other diagnostic proce dures not obtainable or generally provided in a doctor's office, as prescribed by a physician, including biopsies (except that surgeon's fees are not included), together with the necessary reports, for the purpose of assisting in the diagnosis and treatment of an out-patient;

(ii) the use of radiotherapy, occupational therapy and physiotherapy facilities in the hospital when prescribed
by a physician:

(iii) the hospital component of out-patient services necessary for the initial treatment of accidental injuries suffered within forty-eight hours preceding the time of treatment or of acute illness, and the hospital component neces sary to support operative or diagnostic procedures per formed by a registered medical practitioner or under his direction, including the use of an operating room and anaesthetic facilities, surgical supplies, nursing and the supply of drugs and biological and related preparation s which are prescribed by a physician on the medical staff of the hospital in accordance with the hospital formulary and administered in the hospital;

(iv) local ambulance service in essential cases;

(v) X-ray of the breast performed at the Bermuda T.B. Can cer and Health Association or at the general hospital on the prescription of a physician;

(vi) hospital services rendered to an out-patient by hospital staff outside the hospital for specific purposes as approved by the Hospital Insurance Commission;

(vii) speech therapy rendered to an out-patient provided that the patient had previously been an in-patient and that the treatment does not exceed three month duration;

(viii) the use of haemodialysis facilities; and

(ix) the use of orthopaedic appliances.

[Regulation 3 amended by BR 10/1994 effective 1 April 1994, by BR 17/1995 effective 1 April 1995; and by BR 48/1998 effective 1 July 1998]

Limitation of benefit

4 Subject to the Hospital Insurance (Portability) Regulations 1971 [title 18 item 19(e)], benefit in respect of in-patient treatment prescribed in regulation 2 shall apply without limit as to the duration of the period of confinement in hospital.

Exclusions

5 Standard benefit shall not include the following—

(i) treatment of mental disorder, nervous disorders (other than those with a defined pathological cause), chronic alcoholism or drug addiction except treatment pre scribed in the Hospital Insurance (Mental Illness, Alco hol and Drug Abuse) Regulations 1973 [title 18 item 9(t)];

(ii) rest cures, sanitaria and custodial care including in-pa tient treatment in the geriatric and rehabilitation ward of the general hospital;

(iii) cosmetic or plastic surgery unless necessary to correct traumatic injury;

(iv) general health examination, dental work or treatment, dental X-rays, extractions, fillings and general dental care except dental surgery for the excision of impacted teeth or of a tumour or cyst or treatment of sound natu ral teeth damaged as a result of an injury;

(v) treatment involving examination of the eye or ear for the purpose of fitting eye glasses or hearing aid except where such a treatment is necessitated by damage to the natu ral eye or ear as a result of an injury;

(vi) the provision of medications for the patient to take out of the hospital;

(vii) diagnostic services performed to satisfy the requirements of third parties;

(viii) visits solely for the administration of drugs, vaccines, sera or biological products;

(ix) transportation or travel other than local ambulance ser vices;

(x) treatment or advice given in the out-patients' or emer gency departments which would normally be provided in a doctor's office (such treatment, however, will be provided if it can be shown that the patient's doctor was not available or the condition which is considered to be an emergency arose at a time when the doctor's office is normally closed. For the purposes of this paragraph "emergency" means the sudden occurrence of a physical illness requiring professional assessment and care);

(xi) treatment given or hospital facilities used which have not been prescribed by a registered medical practitioner, unless such treatment or use is certified as urgent and necessary by a medical officer employed by the Board.

Treatment provided in the general hospital

6 In relation to treatment provided in the general hospital, stan dard hospital benefit shall include services and supplies which are pro vided by the Board or its officers and servants, but shall not include fees for professional services provided in a private capacity or provided by any physician, surgeon, dental practitioner or other practitioner of a profes sion associated with medicine who is not an officer or servant of the Board.

Treatment included in standard hospital benefit

7 Standard hospital benefit shall include—

(a) treatment prescribed in the Hospital Insurance (Mental Illness, Alcohol and Drug Abuse) Regulations 1973 [title 18 item 9(t)];

(b) maternity treatment in accordance with the Hospital In surance (Maternity Benefit) Regulations 1971 [title 18 item 9(n)]; and

(c) the supply, maintenance repair and renewal of artificial limbs or artificial appliances in accordance with the Hospital Insurance (Artificial Limbs and Appliances) Regulations 1971 [title 18 item 9(o)].

Treatment in an approved hospital outside Bermuda

8 Standard hospital benefit shall extend to cover treatment in an approved hospital outside Bermuda as defined in the Hospital Insurance (Portability) Regulations 1971 [title 18 item 9(e)].

Bermuda Consolidated Legislation

Hospital Insurance (Standard Hospital Benefit) Regulations 1971