Bermuda Consolidated Legislation

 

BERMUDA STATUTORY INSTRUMENT

BR 41/1987

HOSPITAL INSURANCE (HEALTH INSURANCE PLAN) REGU LATIONS 1987

[made under the authority of section 37(1) of the Hospital Insurance
Act 1970 [title 18 item 9] and brought into operation on 1 September 1987]

ARRANGEMENT OF REGULATIONS

1 Citation

2 Individual voluntary con tract

3 Group compulsory con tract

4 [omitted]

5 Commencement [omitted]

Citation

1 These regulations may be cited as the Hospital Insurance (Health Insurance Plan) Regulations 1987.

Individual voluntary contract

2 The health insurance plan issued by the Commission shall, in respect of each plan issued to any person in pursuance of the voluntary scheme under Part IV of the Hospital Insurance Act 1970 [title 18 item 9] be in the form set out in Schedule 1.

Group compulsory contract

3 The health insurance plan issued by the Commission shall in re spect of each group plan issued to any employer in pursuance of the compulsory scheme under Part III of the Hospital Insurance Act 1970 [title 18 item 9] be in the form set out in Schedule 2.

Revocation

4 [omitted]

Commencement

5 [omitted]

SCHEDULE 1

THE HOSPITAL INSURANCE COMMISSION

The health insurance plan issued under section 11 of the Hos pital Insurance Act 1970 [title 18 item 9].

INDIVIDUAL CONTRACT OF VOLUNTARY INSURANCE

Particulars of insured

1 Name of Insured
Address
Policy Number
Effective Date
First Premium
Renewal Premium
Due date of first Renewal Premium
Premium payable monthly/quarterly/biannually/annually.

Benefit

2 Benefit provided under the health insurance plan is the standard hospital benefit prescribed in the Hospital Insurance (Standard Hospital Benefit) Regulations 1971 and in addition thereto the benefit specified in an order made under section 11 of the Hospital Insurance Act 1970.

Portability of benefit

3 Benefit shall be payable under the health insurance plan in re spect of treatment outside Bermuda in accordance with the provisions of the Hospital Insurance (Portability) Regulations 1971.

Payment of premium

4 Premiums shall for all purposes become due on the first day of the month for which they are payable. Premiums shall be payable at the offices of the Hospital Insurance Commission or in such other
manner as the Commission may direct.

Revision of the health insurance plan

5 The benefits and premiums payable under the health insurance plan may from time to time be revised in accordance with any revision of the Hospital Insurance Act 1970 or any regulations or or der made there under.

Termination

6 The health insurance plan shall terminate—

(a) in the event of non-payment of any premium due under the plan, on the expiration of one month from the date on which such premium becomes due;

(b) on the expiration of a period of six months from the date on which the insured ceases to be ordinarily resident in Bermuda.

Reinstatement

7 Health insurance plans which have terminated may be rein stated without medical evidence of insurability only during an enrolment period.

Claims

8 In relation to treatment received by a person insured under the health insurance plan in the general hospital or in the office of a regis tered medical practitioner, claims for benefit under the plan shall be made on behalf of the insured by the Bermuda Hospitals Board or the medical practitioner, as the case may be, and payment shall be made by the Commission directly to the Board or the medical practitioner or by re-imbursement to the patient if payment for the treatment is proven to have been made.

Disputes

9 Any dispute or question arising in connection with the health in surance plan shall be resolved in accordance with the provisions of sec tion 12 of the Hospital Insurance Act 1970.

Construction of health insurance plan

10 In the event of any dispute or question arising in connection therewith, the health insurance plan shall be construed subject to and in accordance with the relevant provisions of the Hospital Insurance Act 1970 and any regulations made thereunder.

Issued on behalf of the Hospital Insurance Commission by [blank]

Date [blank]

Insurance Officer

SCHEDULE 2

THE HOSPITAL INSURANCE COMMISSION

Health insurance plan issued under section 11 of the Hospital Insurance Act 1970.

GROUP CONTRACT OF COMPULSORY INSURANCE

Particulars of employer

1 Name of Employer
Nature of Business
Business Address
Policy Number
Effective Date

Premium

2 The premium prescribed in the Hospital Insurance (Standard Premium) Regulations 1971 or specified in an order made under section 11 of the Hospital Insurance Act 1970 shall be payable in respect of each employee who is employed by the employer on the first day of any month and similarly in respect of the non-employed spouse of each such em ployee.

Benefit

3 The benefit provided under the health insurance plan in respect of each person insured thereunder is the standard hospital benefit pre scribed in the Hospital Insurance (Standard Hospital Benefit) Regula tions 1971 and in addition thereto the benefit specified in an order made under section 11 of the Hospital Insurance Act 1970.

Portability of benefit

4 Benefit shall be payable under the health insurance plan in re spect of treatment outside Bermuda in accordance with the provisions of the Hospital Insurance (Portability) Regulations 1971.

Payment of premiums

5 Premiums shall for all purposes become due on the first day of the month for which they are payable. Premiums shall be payable at the offices of the Hospital Insurance Commission or in such other manner as the Commission may direct.

Within two weeks of the end of each month the employer shall submit to the Commission a certified list of employees and their non-em ployed spouses together with the appropriate premium. Failure to sub mit this information and the appropriate premium renders the employer liable to prosecution under section 23 of the Hospital Insurance Act 1970.

Cover

6 Where a premium is paid by the employer in respect of any em ployee that employee shall be covered under the health insurance plan for the month for which the premium is paid.

Where an employee takes up employment during the course of a month and he is not compulsorily insured for that month by his previous employer, he shall be covered under the health insurance plan from the first day of employment and no premium shall be payable for such cover.

Cover ceases on the first day of the month next following the date of termination of employment except that if the employee does not become compulsorily insured with any other employer cover under the contract shall continue, without any premium being payable therefor, for a period of four weeks from the date of termination of employment.

The provisions of this paragraph apply, with the necessary changes in respect of the non-employed spouse of an employee.

Revision of health insurance plan

7 The benefits and premiums payable under the health insurance plan may from time to time be revised in accordance with any revision of the Hospital Insurance Act 1970 or any regulations or or der made there under.

Termination

8 The health insurance plan may be terminated at the request of the employer, on payment of all premiums due thereunder and on giving one month's notice of termination to the Commission, where—

(a) a new contract of hospital insurance has been effected with a licensed insurer;

(b) an approved scheme has been established; or

(c) the employer's business has been taken over by or amal gamated with that of another employer.

Records

9 The employer shall establish and maintain a record with respect to each employee insured under the health insurance plan showing the employee's name, sex and date of birth, the date on which the insurance of that employee becomes effective and the date of termination of em ployment. Similar data shall be maintained in relation to non-employed spouses of employees.

Clerical errors in maintaining records shall not invalidate insur ance cover otherwise valid or continue in operation insurance cover oth erwise validly terminated.

The employer shall furnish the Commission with any information reasonably required in relation to any matter pertaining to the contract.

Any documents furnished to the employee by the employer in connection with the health insurance plan and the wages and other records of the employer relevant to the health insurance plan shall be open for inspection by the Commission at all reasonable times.

Certificate of insurance

10 The Commission shall issue to the employer for delivery to any employee insured under the health insurance plan an individual certifi cate certifying that such employee has been insured under the health in surance plan and indicating the effective date of cover.

A certificate shall similarly be issued in respect of the non-em ployed spouse of an employee.

Claims

11 In relation to treatment received by a person insured under the health insurance plan in the general hospital or in the office of a regis tered medical practitioner, claims for benefit under the plan shall be made on behalf of the insured by the Bermuda Hospitals Board or the medical practitioner, as the case may be, and payment shall be made by the Commission directly to the Board or the medical practitioner or by re-imbursement to the patient if payment for the treatment is proven to have been made.

Disputes

12 Any dispute or question arising in connection with the health in surance plan shall be resolved in accordance with the provisions of sec tion 12 of the Hospital Insurance Act 1970.

Construction of health insurance plan

13 In the event of any dispute or question arising in connection therewith, the contract shall be construed subject to and in accordance with the relevant provisions of the Hospital Insurance Act 1970 and any regulations made thereunder.

Issued on behalf of the Hospital Insurance Commission by [blank]

Date [blank]

Insurance Officer

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